Ohio House Medicaid Committee - 6-3-2026

Chair Gross.

Vice Chair Barhorst.

Ranking Member Baker.

Representative Craig.

Representative Dieter.

Representative Ferguson.

Representative Hall.

Representative Lampton.

Representative Lett.

Representative Mullins.

Representative Uldslager.

Representative Rohmer.

Representative Samani.

Checked in.

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And Representative Williams.

Thank you, Chair. I move to amend House Bill 795 with Amendment-136-3280-2.

Thank you, Chair. A summary of some of the changes. This sub-bill creates mandatory civil fines for the offense of Medicaid fraud in the amounts of $1,000 for fifth degree felonies, $5,000 for fourth degree felonies, $25,000 for third degree felonies, $75,000 for third degree felonies that carry presumption of prison term, $150,000 for first degree felonies or second degree felonies. It also specifies that non-emergency medical transportation does not include transportation conducted by an emergency medical service organization licensed by the State Board of Emergency Medical Fire and Transportation Services, increases the referral trigger within the Department of Medicaid, must refer HCBS providers to the auditor of state from two to six providers at the same address, prohibits a provider from receiving payment from ODM for any personal care services under HCBS waivers that they provide to a member of their own family, creates a prior authorization structure for personal care services administered by ODM and the Department of Aging, though not for DODD, requires the lowest amount of PCS be approved to safely treat a person who is determined to need these services provided for defined periods of time based on the determined needs of the patient and standardized procedures that would be developed by ODM establishes audits and quarterly reappraisers to ensure program integrity creates additional components that must be satisfied for a person reporting suspected fraud to the auditor of state to receive up to 10 of the recovered amounts as an incentive The person reports a fraud through the auditor of state's fraud reporting system. The report of fraud materially contributes to an audit for fraud, an investigation of fraud, the discovery of fraud, or a filing of civil or criminal actions for fraud. The report of fraud results in a fraud recovery. The person who reports fraud is not found liable for or convicted of and does not plead guilty to or otherwise is found to have participated in the fraud. And the person satisfies any additional eligibility requirements established by the Attorney General. Specifies that Medicaid fraud constitutes what's known as a predicate offense for conviction under the corrupt activity statute. Removes independent forensic audit compliance framework language. establishes Medicaid managed care organizations payment integrity mechanisms, including upon the identification of credible indicators of fraud, waste, or abuse, permitting Medicaid MCO to implement a reasonable and timely payment integrity action, including payment suspension and prepayment review and denial, generally prohibiting a Medicaid MCO from initiating prepayment review for a Medicaid provider without first obtaining approval of the department, unless they determine that the provider is high risk and ODM is informed, Authorize a Medicaid MCO to suspend payments to suspected high-risk providers during an open investigation and stand-down period by providing notice of the suspension of ODM. Upon the identification of credible evidence of fraud or materially inconsistent billing, requires each Medicaid MCO to make a report to ODM, which shall be referred to the Attorney General's Office. Clarifies that the definition of risk contractor includes any entity participating in the Medicaid program. incorporates language in the bill regarding enhanced fraud identification and prevention measures for hospice providers under the Department of Health, clarifies that the bill's authorization of inspector general officers to act as peace officers only applies for the purpose of investigating Medicaid fraud, grants the Attorney General subpoena power in matters of Medicaid fraud, and removes provisions from the bill concerning publicly funded child care programs.

Objection.

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Child with multiple disabilities, including deafblindness. I have been her sole provider since she graduated from high school in June of 2024. We've been looking for providers since then, and we have not found them. I've been on duty consistently since that time. I prepared a great testimony, but when I was leaving the House at 2 o'clock today, I saw that you amended this bill completely. So my testimony doesn't really apply anymore, so I'm just going to come up here and, you know, first of all, ask the chair, are you a medical doctor? Because our kids get services based on orders from medical doctors. So you've made statements in your opening, and they are not true. And I didn't know that we were here to hear what your opinion is on this. I thought we were going to talk about laws. So, you know, I think there's maybe some misunderstanding about what personal care services means. and for people that cannot use their hands or feet, they do need help with personal care, and if they don't receive it, they can get pressure sores that will kill them. And, you know, in terms of EVV, I have read a report from the State Auditor of Ohio, dated November of 2024, that says as of that date, Ohio has spent $146 million on EVV implementation, and it is not working, and you can ask anybody in this room, and they will have a story for you. When the bill did talk about parents having to sign in for EVV to be caregivers, I just wanted to ask this committee if, say my daughter wakes up screaming at 2 o'clock in the morning because she can't manage her secretions and she needs me to use a suction machine to do that, would I need to stop and sign in with my face ID before I do that and risk her getting aspiration and possibly dying of sepsis? This is the committee. kind of stuff that we're dealing with on a daily basis. And we've been trained to do pulmonary therapies from doctors. We are not respiratory therapists. I give my daughter seven medications on a daily basis from a, I make my own charts. So I'm not just a babysitter with a can of Campbell's soup. I mean, come on, people. Thank you so much.

Thank you. Actually, I am a medical doctor, so I am going to ask you, in reference to the care that you provide your daughter, one of the things that's being considered is not paying family members. Would that, if you were held to the same standards as home health care people, and...

I understand that. I'm certified. If we were to say that family members who are providing personal care will be required under Medicaid to follow those, would you be okay with that? I understand you're following that now, but would you be okay with that, number one? And number two, would you prefer if you couldn't provide the care and get paid, would you want someone else to then come into the home? Because that would be the alternative to help your daughter. So I'm just, I'm not, I think what you're doing is commendable, and I'm very impressed with the care that you provide. But I think we understand that it is cost effective for family members to be paid. We also understand that people give up jobs to care for their kids. And we can't expect people who give up jobs to not have an income source, because the alternative is then going to be that we as a statehouse have to provide that care. I'm sorry, the question was, would you be okay with being held to those standards to be able to get paid?

And ma'am, if you would just address the chair, it's through the chair to the representative for the future for everyone.

You are not the one we're looking for.

Yes, we have companies that provide personal care services with no certification. You are not the part we're looking for. We have people providing personal care, not for the DD community, but we do provide those. And so that's what we're trying to rein in.

Thank you, Chair. Thank you for coming to testify today. Thank you for the services that you provide. I think it's important to note that just like other provisions of the bill that excluded out the Department of Developmental Disabilities, We are in conversations about excluding our particular conditions, DD autism, things of that nature. What we're looking to address is the direct fraud that's been reported in the state of Ohio, that's been investigated by the state of Ohio, that's been convicted in the state of Ohio, and making sure that we provide for taxpayer protection and program integrity. That's the intention, and it is fast moving. The sub-bill was introduced. We are continuing to discuss further amendments that will happen before our next committee hearing next week, and we encourage everyone to be engaged in the process. So I do appreciate your concerns. I did read your written testimony and your concerns about EVV. But would you agree that EVV previously was mandatory in the state of Ohio, and only recently has it been converted to being optional?

Thank you, Chair. The amendment is listed on our website. We've been here since 2.30. I understand. It's available for you to read and provide any feedback to the members of the committee. We know what the intentions are, and it's not made up. I mean, the Medicaid expenditures in the state of Ohio have exploded to now 50% of our GRF funds. So it's out of control. And when we're catching people committing fraud for personal services, where family members are providing personal care services, including companionship care, of simply being paid to go and spend time with a family member, that's a concern of taxpayers, that we're allowing our waivers to be used in that fashion. So that's the type of conduct that we're looking to try to wrap our hands around and make sure that that is not taking away resources from individuals who actually need care. Making sure that the money goes to the right individuals that need the services that are provided and that people are not committing fraud here in the state of Ohio That the intention And I look forward to continuing to work with everyone If you want to send emails of your concerns directly to my office I more than willing to read them after you have an opportunity to read the sub bill

Thank you, Mrs. Lynch. Representative Lett, one question. No follow-up. Just a reminder, no follow-ups. Mrs. Lynch, there are still questions for you.

Thank you, Chairwoman.

You are definitely not getting dismissed. Thank you for coming. I'm sorry that you had to, quite frankly.

have a nurse? And then they say, well, you know, what are you dealing with? Because, you know, and so you have to then put your kid in categories, G-tube, trach, nonverbal, deafblind, and nobody wants to work with deafblind people, by the way. you know do they walk what about their ADL so you have to answer all these questions about your loved one and then they can say usually what happens next is they have to then post that job on the internet because there aren't anymore like when we started this in 2005 there were nurses and you'd call an agency and they'd say oh yeah we'll send one out today Well, now they have to post it on Craigslist or whatever. And it's not actually Craigslist. And, you know, you wait. And then you might meet somebody, but then they come to your house and they either want to work with your kid or not. And usually the more help you need, especially medical help like trachs or suctioning, those kind of put you down the ladder of who wants to work with you and who doesn't. Because for providers, they are walking into a stranger's home, and they're entrusted with keeping that person alive alone with no supervisor, no coworkers, no breaks, no bathroom breaks. So it's a very hard proposition, and it's not that high of a reimbursement, And it is, you know, there's also a big lag between if somebody gets approved to work with your child and them get in the state payment system, sometimes as long as six weeks. So we're expecting people to work for six weeks for no money. So it's a very hard process. I've left out a lot of steps.

Can you talk about what a day looks like in providing care for your daughter?

Thank you.

Chairwoman Gross and members of the committee, I'm here today for a friend. He's the sort of person who dedicates his whole being to making the world a better and more interesting place. an educator and an incredible writer with a razor sharp wit and something insightful to say about basically any topic i don't know if you've ever had a friend that you hope will be I'm famous someday because you know the world just needs to hear their voice. But for me, he is that friend. I know you know where this is going, but for a second, please just pretend you don't. Take the first image that comes to your mind of that person and imagine you had a friend like that and think about the life that you would want for that friend. I'll tell you what the life I want for my friend. I want him to be able to go out for coffee, go to a friend's birthday party, take a shower. I wanted to be able to do literally anything other than lay in bed alone, covered in sores and surrounded by filth. I'm here today because my friend Justin has cerebral palsy, and these are the stakes for him. Over the past year, I've watched him try to put a care team together. He's explored every agency, plastered the city in flyers, and cold-called hundreds of individual providers. This has basically turned into a second job for him, and all he has to show for it is one new part-time provider. There is a dire shortage of providers. The only fix is getting new people into the field, and now our government has frozen that lifeline for the next six months while they figure out how to save money on it. Without home health providers, Justin can't get out of bed or get clean, much less eat a home-cooked meal, leave the house, or live a fulfilling life. So I have to ask, do you think that that's negotiable? That you can just say, sorry, we'll try to fix it soon and wash your hands of it. That the right to the pursuit of happiness doesn't apply if you're disabled. I wish I could pretend that this was all a surprise to you, but I know that Justin has been in exactly this spot, explaining exactly these things, and yet rather than going to trivia with our friends like we do every Wednesday, we're here now again doing it. I can't wrap my head around how you could keep hearing the same things that I have heard and still think that all of this is somehow acceptable or necessary. So as you listen to the many testimonies from disabled people today, I'm asking you to try to imagine that they're not a constituent and you're not at the state house. Imagine you're at coffee with your best friend, and he's telling you why he won't be able to leave the house anymore. Imagine you're visiting your sister, and she's explaining why she has to give up her home and move into a facility somewhere far away. I'm not an expert in Medicaid or Medicaid fraud or any of the legal technicalities related to it, but I don't need a PhD to know this. If some YouTuber says there's embezzlement at the power company, you don't shut off the grid for six months, and you don't make people live in the dark until you fix it. I've heard a lot of talk today saying that the goal is to take this money that's going into fraud and reinvest it and give it to the people who need it, I'm asking please put that in the bill if that's the intent. The bill doesn't reflect that. The bill says that we are cutting back and we are trying to eliminate fraud, and the bill does not say anything about DeWine's freeze on hiring of new providers.

Thank you, Chair, and thank you so much for your testimony. You are truly a remarkable friend. Just to level say, because the bill is now posted online, but one of the biggest concerns that I have within this bill is that it would bar a family member, regardless of how many oversight or regulations or stipulations, would bar any family member from providing care. and from my understanding that is a minimum of taking about 7,000 providers out of the current system. Could you speak to what if we actually went forward with this current version of the bill as your friend has spent so much time and has gotten a part-time provider what it would mean to have 7 less providers and all of those people looking for other caregivers what would What would that mean for your friend It would swallow up even more of this pool of people that have been completely unavailable And frankly, the issue here, a big part of the issue here, beyond just the cutting of the

Thank you. Thank you. Thank you so much for your testimony. And is Nicholas Denton available? All right. Jan Doherty. All right. Justin Martin. Mr. Justin Martin. I would love for you to come up and provide testimony. Does this sound good? Are we, how are we doing? Yeah, can you all hear? Okay, great.

Thank you for your testimony. I would just ask you to remember that I haven't voted. I'm the chair of this committee, but just because I accept the sub bill does not mean that I agree with everything in the bill. So I would ask that personal attacks be limited. So thank you. Are there any questions? Representative Timms.

Representative Stewart. Thank you, Chair, and thank you for your testimony. I want to pick up where you said one of your providers was defrauding you, but you said you understand why she felt the need to violate me. I mean, if in this state, as you're aware, one out of every $2 we have goes to Medicaid, shouldn this committee want to make sure that folks can defraud you moving forward The way that you go about doing that

Representative Baker, ranking member Baker. Thank you, Chair. Thank you for coming in and testifying today. If you're comfortable sharing, will you, feel free to say you don't want to answer this.

If you're comfortable sharing, will you share whether the person that defrauded you was a family member and whether you think a provision that family members can't provide these services would help prevent the fraud that you experienced?

Representative Sweeney. Thank you, Chair. Thank you so much for your testimony. So in the bill that was just accepted, the bill is increasing further protections in home health care for agencies, basically for everyone besides family members. And to me that says that we believe that this committee is capable of regulating this in a way that mitigates fraud but says that under no circumstances can a family member provide that care. Do you think it is possible for this committee to make sure that even family members aren't committing care? fraud, that if we can ensure that a stranger isn't committing fraud, that we could also ensure that a family member isn't committing fraud and allow that option to still be available.

Thank you so much, Mr. Martin, for your time today. We really appreciate you and your time.

I would appreciate if our government refrained from personal attacks. I would like to call on Maria Matzik, and then up next will be Georgie Elson.

One minute, thank you.

Thank you, Mrs. Matzik, for your testimony.

Through the chair, I'm sorry, representative, I only heard half of that.

Representative, thank you. Yes, I worked for a period of time as a home choice transition coordinator, and that means that I would go into facilities when someone requested transitioning out into the community. I did that for about three and a half years, and I will tell you that there was not one transition that was not heartbreaking. It was deplorable in the facilities. People did not get the care that they needed. We would go into the nursing homes. The floors would be sticky. the nursing home would smell like urine as soon as you came in. And there was one time that we went in, there was a sign on the door that said that the state was in the building, that they were reviewing the nursing home. That was the only time that I had ever been in that nursing home where individuals' call lights were answered, where people treated them with compassion and with respect. And then they actually acted like they were caring for people. They are horrific places to be in.

Thank you.

All right. Can you guys hear me okay? Okay. Thank you for the opportunity to testify today. Let me be clear. Fraud should be investigated and prosecuted, but I'm concerned that what we're seeing right now is not a balanced effort to protect taxpayer dollars. We are watching what appears like a coordinated political narrative that exaggerates and misrepresents data in order to justify cuts to Medicaid HCBS services and restrictions on family providers, all while giving far less attention to the larger systemic sources of waste, fraud, and abuse. Family caregivers are not the reason that Ohio has a care crisis. Instead, they are the reason the system has not yet completely collapsed. Ohio already faces a severe shortage. Many disabled people cannot fill all their approved hours, and I'm in that situation right now. I had lost some stable caregivers and so in the last year I've had nine different providers coming in in my house in and out and it is not an easy thing. So why is there a care crisis Well for a long time care aides were only making 12 to 13 an hour until advocacy efforts helped push some of those rates up But agencies aren required to pass all of those rates to their employees So these workers receive lower pay, no health insurance, retirement or paid leave. Despite recent bizarre narratives that this is some cushy, easy and well sought after career, almost all of my carers have had multiple jobs and did not want more of my hours even when they were available. I've had four different providers at a time and my brother only started providing me care recently because I couldn't find providers and he provides me care just every other weekend. So it's not like he's like oh like this is some great job let me just quit my nine to five as a quality manager, sacrifice all my health insurance and, you know, just collect because they're not doing this because it pays well or because they get good benefits. They're doing it because no one else is doing it. So when we threaten to pull the last leg under the table that's keeping everything afloat, it's going to be catastrophic for people. It will simply force more disabled people into nursing homes and institutions, which do cost payers more, cost taxpayers more. Personally, I'm someone who relies on 30-plus medications a day, IV injections, breathing treatments. You can't put someone like me in an institution where there's 20 other patients just as complex and expect to get decent care. Statistics say that in institutions, people only get three and a half hours of care, roughly. And, you know, in the community, I get 12 hours of direct care. So, also, I have daily anaphylaxis. So if I don't have a provider right there at that minute, I could die. So that's what we're talking about here when we're talking about cutting services and forcing people into institutions. I think it's really important to acknowledge the current oversight that providers and recipients already experience because there's a lot of misconceptions about that. So to qualify for a waiver, waiver recipients must meet strict medical and financial eligibility. Someone comes to the home to do an initial assessment of the individual. For me, this was completed by the Area Agency on Aging, and we are assessed on an annual basis. A doctor must also write a prescription order for services, and this is not a one-time thing either. This is also on an annual basis. These assessments and prescription orders dictate the services someone is eligible to receive. So my services look different than the next person's, even within the same waiver. Every individual is different and every individual service has to be assessed individually and qualified for. Your care manager is part of this process. They develop a service plan of only what you qualify for. If a service is not medically necessary, it will not be on the service plan and it will not be provided. The same is true for any equipment needs. For example, say you need a shower wheelchair. You bring this to your care manager and a physical therapist actually comes to your home to do an evaluation to make sure you need the chair. And if the process gets too delayed, they come back and repeat the evaluation. Individuals also regularly are visited by waiver oversight personnel, nurses from the agencies, the care manager that comes to the home, and depending on services, you know, people might have therapists regularly or things like that. But when people claim that there are all these individuals on waivers who do not actually need the services who would not need to be institutionalized without home care I have a hard time believing that that is even possible How Therefore I wondering are we trying to say that the waiver recipients the Area Agency on Aging personnel who reassesses the often multiple doctors through the years, the care managers, the nurses, the physical therapists, the family members, the multiple agencies, various care aides, and other service providers and personnel who visit the home are all getting together to coordinate some massive fraud and are all lying about the individual need, individual's needs. That's unlikely. And I just wanted to add, you know, independent providers, they are certified. They have extensive service and billing documentation, keep the medical histories. They have to keep this all for seven years. and providers must meet the first aid, have background checks, have CPR training. They must comply with annual reviews, provider renewals, and audits. Even independent providers fall under and are contracted by managed care, which is something I've heard, you know, misunderstandings about here. So these care managers do dictate those people's hours. You do have to message them if your schedule changes, even if you're independent. So there is oversight. I know I'm out of time.

Thank you. Thank you so much for your testimony. You mentioned that your brother is helping you. Is he done the training and everything as an official home health care? and what does he, you know, I think we talk a lot about the loss of wages and things that, what is he giving up to help you? I mean, clearly he's your brother and he wants to help you, but in exchange, you know, it's not easy and it takes a lot of effort and a lot of work and the cost of gas to come get you. What all does that entail that if we were to take away payment for family members, How would that impact your life as well as your brothers?

Thank you so much, Chairwoman. Thank you, Ms. Ellison, for coming in today. I wanted just to illuminate, you know, for the committee, what type of a waiver are you currently accessing? And if you could give us a little bit of the background of what it was like to access that waiver to begin with.

Rinku Member Baker. Thank you, Chair. And thank you for being here today and telling us your story. I think that we would all agree that I would think that you and I are on the same page about preventing fraud and people doing bad things so that the money can be going to people like you who really need the services. We've been working on this bill on requiring certain requirements and oversight for strangers to make sure that we can prevent fraud. since you've received care from caregivers and from your brother would you support the same requirements and oversight to family members like your brother or do you think there's something intrinsically different with family providing services that they are at an increased risk of fraud

for your time, Ms. Elson, today. Thank you.

Testing, testing, testing. hello hello thank you Chair Gross Vice Chair Burhorst Ranking Member Baker and members of the House Medicaid Committee I don't know if you all remember me but I was here about a week ago and graciously you let me say a few minutes after reporter Luke Rosiak spoke I'm bringing a few different things today than I said last time all of this first of all is very, very frightening to me, just very frightening. I represent the Ohio Olmstead Task Force, which is a statewide advocacy group. So I represent many people with disabilities and their family members, and we support community living along with the Olmstead Act, which is what we were named after, to live within the community of people's choosing. In some respects, I cannot believe this is happening. I mean, if you look at disability history, we have been marginalized and put away and locked up in institutions because we are different. But disability is one of those groups that you can enter at any time of your life. And if you live long enough, the chances kind of go up that you might acquire a disability sometime in your life. And so this can affect all of us, all of our family members, every single person sitting in this room. There's a chance that any one of us could become disabled for a long time. or a short time. All I've ever asked for is to be able to live with dignity and begin even the same chances and choices that everybody else has. I did not ask to be born with a disability, neither have all of these other people. And I make do with what I have. I think I've achieved quite a bit in my life, and I will continue to do so. But I just don understand how you can make broad strokes and just look at huge fortunes of this program Like one of the biggest things is that personal care services are the thing It's the service that all of us rely on. And you have to have hands on care to receive personal care services. So how you can just go ahead and decide to get rid of that service altogether is the thing that we all use across systems. Besides that fact, you have three different systems. You have the developmental disability waivers, you have the aging waivers, and you have the Medicaid waivers. Not all of us with developmental disabilities are on a Dodd waiver. So you can't carve out people from Dodd specifically, because many of us, again, with developmental disabilities, are on aging waivers and the Medicaid waivers. So you have to look at all three of these systems and you cannot make these broad strokes. There are several ways family members can get paid on all of these systems. You cannot cut out care from family members. So many of us through COVID only got through COVID because of family members. So you cannot make these broad strokes and just get rid of all families. You have to take the time to look at the system and affect different components of it to get rid of the fraud, waste, and abuse. This needs more time to be looked at in a more thoughtful way.

Representative Stewart. Thank you, Chair. Thank you for your testimony, and I appreciate in your written remarks, I mean, you've engaged with the text of the bill. So I just want to ask you about one item you flagged as being problematic in your view. You said you're concerned about draconian electronic surveillance because the bill mandates GPS tracking and electronic verification for every home care visit. every state employee has to clock in and out. Virtually every law enforcement officer in the state of Ohio is in a cruiser with GPS tracking or, you know, body cams to verify that the people were paying to do the work or actually doing the work where they said they were doing it at.

What is wrong with that in the context of the largest expenditure we have in the state of Ohio?

Representative Samani. Thank you so much for your testimony. Question, if we kept family caregivers, if we don't eliminate them, how would you suggest eliminating or helping to prevent waste, fraud, and abuse, you know, for those family members that are in this position of taking care of people?

Thank you for your answer. Thank you.

Yes. To the chair, to the representative, thank you. Again, I've been working in this system for over 12 years, many of us in the audience longer, and I still don't understand all the nuances of all the systems that we have in place. Obviously, I know the MyCare system a little bit better because I utilize that service. But they all are different. We use different language. We use different everything, different laws that govern that. And again, to make sweeping things because you looked at the data and you've heard a few people talk. It's just not enough to know the nuances. Yes, I want to get rid of fraud. Yes, I would love the system to work better and smoother so it's not so painstaking to get on these programs. Yes, I would love to see that, but you really have to study the system. You have to talk to the people that know the system and get everybody's thoughts on this, and giving the three-minute, five-minute testimonies are just simply not enough time. You have to bring the voices together, and I know you want to get this done, and I know you said you've been working on this, but it's not a thing that you can rush through because there will be human damage. There will be human damage.

Thank you. Thank you. Chairwoman Gross, Vice Chairman Boehler, Ranking Member Baker, and members of the House Committee, thank you for the opportunity to provide opposing testimony today. You have my written testimony in front of you, so what I'm going to talk about is what I've been hearing. and so I when I was 15 I was in a diving accident I had spinal cord injury when my family members asked my mom are you going to put her in an institution my mother said over my dead body she was an aid in an institution and the horrors that she saw in an institution she said absolutely not so I was able to come home with an Ohio Medicaid waiver I receive private duty nursing in the evenings to provide care because I need to catheterize every two to three hours at night. I cannot have an indwelling bully. I will get a UTI. I've almost already died of sepsis from a UTI. I can't risk that. And in 2003, I was Miss Wichita, Ohio, and I got the privilege of working with former state senator, Congressman Steve Stivers. I am a registered Republican, but I am fiscally liberal because of services that I need. And through working with him, we were able, he wrote the bill of Medicaid buy-in for workers with disabilities that was implemented in 2008. Because of that, I'm able to keep my long-term care benefits and thousands of Ohioans are able to keep their long-term care benefits but also work in the community, pay taxes. and my concern is that with the EVV tracking system, I'm concerned of being confined to my home. And I deserve privacy. Let me tell you a little bit about the history of EVV. It was implemented in 2018, but it wasn't really implemented. It was just really implemented to make sure that it's in phase one now, I believe, of where they're making sure that every single EVV visit matches. And when you say EVV was mandated already in the GPS tracking, it really wasn't, but the option, the part to option out of it was done because advocates like me came forth and didn't want their privacy shared with the whole world. I mean, I'm not going out and doing bad things, but I am a United States citizen. I have a right to privacy, and I don't think my right to privacy should suffer at me having to require Medicaid services. Thank you.

thank you chairwoman thank you so much for testifying today i wanted just to kind of tease out a little bit about the medicaid buy-in waiver can you tell us a little bit about the medicaid buy-in program and then simultaneously what would happen to you if you did not have access to Medicaid. Thank you.

Thank you so much, Ms. Day, very much. Next witness, Matt Onesti. And up after that is Mary Counter.

Thank you. Thank you, Mr. Onesti. Excuse me. Thank you.

well I don't know fortunately or unfortunately I'm not a member of the general assembly but I will make the assumption that it's going to be significantly longer than three weeks. What are we at now? Three, four weeks. This feels like something that probably should have taken a couple of months going through, talking to those that are impacted by this, talking to people who provide services, talking to proper departments, talking to people again with lived experiences who have a whole swath of stories that we are prepared to tell you and that we can share. I wanted to share the story that I shared today specifically because it's a real lived experience that would have put me in a terrible predicament if I would have happened to be going through college right now and I don't wanna be one of those people who just because I made it through on the other side, we're gonna lift the ladder up behind us and have cookies for anybody in college right now or anyone who needs these services right now. So I, to answer your question, at least a couple months, maybe a month but a couple of months would be amazing Thank you Ranking Member Baker Thank you Chair and thank you for being here today I agree with you that this is complicated and it a really complicated system and lots of

receive personal care services under a waiver? Like what services that is? Oh, it's everything. So what I listed earlier especially is these are, these waivers are paying for everything from my equipment that I am riding around in currently in my electric wheelchair, pays for home modifications in my house to put on, you know, one of the cooler ones we put on was a door that I could hit or a button for my door that could get me in and out of my house so I could be a little more independent. And then finally, the biggest piece of this is, again, the caregivers. This is the main part of what my waiver is paying out. I have an IO waiver. I require a lot of care. I named a lot of things earlier purposely because I need a lot of help with everything. I need help putting on shirts and shoes and showering myself. I can't cut up my own food. I would like to, and I would like to be as independent as possible, but having these services and having these supports are what gives me the ability to live whatever it means to live a normal life. And it's not even as normal as what I'm sure you all get to live through in your daily lives. It's things that you don't have to think about.

Thank you. Members, any other questions for the witness? Thank you so much. You may have noticed that we have gone through our deadline, which we will make sure that everyone has the opportunity to speak. I do ask that you try to maintain your timing, but I appreciate everybody's willingness to work with us. And my next witness is Mary Counter, and then Jen Algy will be next up after Mary Counter.

Okay. Yep. Okay.

Thank you very much. to Ms. Counter for your testimony. All right.

There's no doubt about it. It's going to cost a lot more. And it's also going to cost in the terms of pain and agony. And that's the really tough part. Of course, my granddaughter does not want to remain a home health aide. She's in the process of schooling to become an LPN and then an RN. So these health care providers are going to vanish. And also, having a home health, having somebody that helps you at home, that is a family member, is really important.

Hi, Chairperson Gross, Vice Chair, Bar Horse, Ranking Member Baker, and members of the House Medicaid Committee. I'll be as respectful as I can, but this bill is devastating to the community that I love. I am the Director of Policy and Civil Rights at the Arc of Ohio. I appreciate this opportunity to be here, but I don't want to be here. I want to be home with my two kids. My son Jack Finley is 15 and has autism and epilepsy and my daughter Evie has Down syndrome and she just turned 14 My son has seizures He sometimes has seizures all day long When he drops, I just, I would just implore you to put yourself in a situation where you see your child's face disfigured, where you cannot help them, where you have to call 911 every single time, where your daughter who is, has Down syndrome and doesn't understand what's going on is crying and screaming. It's awful. It's a terrible, hard thing that a lot of these parents and people here with disabilities go through. I am so grateful that they are here testifying. I hate going after Matt and Jennifer and Justin, but it is so important that you understand who we are and what this community deals with day in and day out in order to give our family members and people that we love and support so much a good life. Disability is a natural part of life, but there's a reason why Medicaid costs so much. I know we're so worried about it being 50 cents on the dollar, but I'm glad that Ohio spends that much money on Medicaid. It helps people, people that need help the most. Taking away family caregivers will break our home and community-based service system. My children do not have price tags. Sorry. While we have the goal of protecting the integrity of Ohio's Medicaid system, we're deeply concerned about this bill and the speed at which it's going through this committee. We're disturbed by what appears to be a coordinated effort with partisan campaigns to mislead and purposely confuse Ohioans regarding fraud, waste, and abuse. In Medicaid, I know autism moms. I know moms who have kids with Down syndrome. These are the most honest, hardworking people on the planet. They are not here to defraud any system. It is almost impossible to get a Medicaid waiver, a DD waiver in the system. I help people with this in my job. I tell moms to get on, get some therapy before they start the process because of how hard it is to talk about your child's seizures, to talk about what your child needs, their behaviors, their medical issues. It is so hard to get. So if there are wrongdoers in the system, I do hope they're caught and dealt with. but the narrative that it's families and that we need to stop everything and really stop families from caring for people with disabilities is wrong. It's the wrong direction. It's not what Ohio should be doing. I'm really disappointed. We're concerned about the impact on the direct care workforce. Ohio continues to face a severe shortage of professionals and home care workers. providers are struggling to recruit and retain staff, and families frequently report going without authorized services because workers are unavailable. People with disabilities deserve accountability and dignity. They also deserve to be part of any new policy that affects them, and the haste of this bill, based on distorted and parochial reporting, left people with disabilities and their families out of the process. Ohio is better than this. We don't need to be part of a campaign strategy or propaganda designed to blame our most vulnerable for alleged fraud. We ask that you read and listen to the testimony from real families and work with us. We're here, and like Matt said, we want to tell our stories. For these reasons the Arc of Ohio respectfully opposes House Bill 795 urges its committee to work with members of the disability community to design legislation based on facts and real life experience to protect people rights direct funds to services and support, and continue to use evidence-based measures to protect the integrity of the Medicaid

Would love to hear your thoughts on that, and thank you. Thank you. Through the chair, to the representative, we should be investing in care. I'm an attorney. I went to school. I took the bar. I worked downtown Cincinnati for a decade. I thought that was going to be my life. I had my kids, and I was like, we're going to daycare these kids. They're going to be raised in public schools. Like, these are the things that we're going to be doing, and I had my kids. I was pregnant with my daughter, Evie, when I was going through, going to Cincinnati Children's to get him diagnosed with autism. Evie was born full term and had Down syndrome. And that's when I was like, okay, I might be doing something a little different here. I went back to work. I tried to do my best. My husband works full time. But eventually, my son could not go to regular daycare. My daughter needed open heart surgery and seven more surgeries to open her airway. I had to leave my job. I tried to go part-time. I tried to hold on. I want to be a good tax-paying citizen, just like all of you. But I left my job for six years and stayed home with my kids. I served on boards. I volunteered for a lot of, you know, I had to keep my brain in the game. But women are doing this work. Family members are doing this no matter what. We're always going to be doing more. We're not getting paid. I don't even get, I don't get paid. I have a direct support professional that helps my son, myself. But at the end of the day, families are the only thing saving the system, someone else said before. If we kick this one leg off, there is nothing else. There's nothing else that can come in to save us. And we're going to be there for our kids. We're going to keep caring for loved ones. But I live with the reality every single day, and I usually try and fall asleep without thinking it at night. but I will not be here forever, and I'm trying to create a community and a village that will take care of my kids when I'm no longer here. And we need strong Medicaid. We need a strong home and community-based care system so they can live in the community and do the things that I know that they can do. As a freshman in high school and a seventh grader, I have big hopes for them, and I want them to be able to continue to live in their community and have friends and have jobs, but they're going to need help for the rest of their life. I know they will. So we have a great system here in Ohio. I think that we've done a really good job, and I'm happy with what we've done, and I just don't know why we would do this right now. I'm really shocked and dismayed.

Short answer is no. There are no people waiting in the wings. When I find my care providers, it's a long process, and I hope that they stay, and I try to make it a good environment for them. But like everyone else has said, there's no benefits to this job. It's a pretty low-paying job. There are not enough people. I work in a lot of rural communities in my job. There is no one in Highland County. There's no one up in Wilmington, Ohio. There's no one in Beth Clinton County. They can't find anybody. There's no one. I mean, they're using their school aides, usually, who are already really working hard during the week and probably need a break but are doing it because they love these kids. They're finding people from wherever they possibly can, but there's no, we already have a care crisis. We're already not keeping up with how much care our loved ones need. And so I can't even imagine it, to be honest with you. It's thousands. 7,000 seems low to me, to be honest. From my job and what I know, I know it's higher than that.

Through the chair to the representative, we have a great system in place. I thought we were doing a great job, to be honest with you. I was surprised. I mean, I work for the Arc of Ohio. We have a family choice program that's separate from what I do in advocacy. And the bureaucracy that we need to go through to make sure that that agency runs really well is a lot. I mean, and parents and the DSPs and everybody in that, in the agency provider, they all have to fill out all the paperwork, do all the EVV verification. so I don't think that we are looking at anything especially from the family and the DD side now I don't know what's going on at the MCOs I don't know what's going on with these out of state companies that came in I don't know but from what we see from families and from moms and dads doing the work that we've been doing for years now at the Arc of Ohio we just don't see it So I feel like we have what we need in place, and maybe we just need to look at what those MCOs are doing or some other parts of the system.

Through the chair to the representative. of, yeah, I've been coming up here for a few years now. Basically, when you're a parent of especially two kids, and there's only two kids, this is your purpose. So I've been coming up here for several years to talk about bills. Ohio has some really great work in the area of DD. So I've never seen anything like this in the time that I've been doing this. The other organizations that I work with haven't seen anything like this. I know it's an election year. I know there's a lot going on. I know we have a governor's race, but I don't think anything like to this magnitude should be done this fast. I think a lot of families, and I know a lot of families at the Arc of Ohio, once we've started to put it on social media, this is what's going on, and we've sent it out in our newsletter, make sure that you're, you know, reading through this, check this out just today. I mean, I think we had like 200 comments and thousands and thousands of views, so I know people are going to be like, what is going on? And we're going to be flooding this place with families and people with disabilities and friends of people with disabilities. So this is going to take a lot of time to wade through. You're going to have to listen to your constituents one way or another, however this process goes. But I would just hope that we would take the time to listen to people, especially people who've come today with lived experience. There's so many more people like these great people who testified today who want to tell their story, I would invite any of you, especially Rep Stewart, Rep Williams, to come to my house or come to one of our houses and check out what it really means to care for someone with a developmental disability. It is not, I promise you, it's not just sitting around playing chess or checking, you know, being a companion or playing basketball. I wish it was. We all wish it was that easy. It's not. So yeah, I would hope that we would take six months, you know. We don't, I don't see what the, we're going to get a governor in here who's going to have to do all these things. So we might as well just give it the time it needs and let the process play out.

Okay You just put it around me then Thank Thank you Okay Chair Gross Vice Chair Barhorst Ranking Member Baker and members of the Medicaid Committee I really can't say a lot more than what I've heard today, so I'm not going to sit here because you've got my written testimony. All I'm saying is I think that, and it's not that I don't support parts of House Bill 795, I do think there's probably fraud, But I think the people that are mainly being punished with a lot of this is people who have not done anything. And I just think that needs to be looked at. I've been in a wheelchair 40 years. I had two small kids. I raised them. I've worked. I've been a social service director in a nursing home. You know, I've seen, and I've been a caseworker with Job and Family Services. I know what goes on out there. You know, and I know I don't want to be institutionalized. and I need a waiver to help. I mean, I can't bathe and dress, and I don't have finger function. I can't turn a doorknob. I can't put a hairbread in. I mean, there's a lot to life that people that are able-bodied don't see because I was able-bodied for 25 years. So I'm just here to say that I think this needs looked at and considered. and I also work for chronic care management for a physician's office and I have a lot of patients. I say I but it's not I, it's the physician. There's a lot of patients that they don't even get out of bed. They can't get out of bed and they can't even feed themselves and they're on waivers and that's how they exist and they don't want to be institutionalized.

Representative Timms. I don't really have a long question. I really just wanted to offer a comment and say thank you for coming here today and for everyone for staying here. I know some folks had to leave, but thank you for sharing the lived experiences of those people who can't get out of bed. I have a close family member who is also in that condition, and so I just really feel like your advocacy today is speaking to that, so I just wanted to say thank you.

Sure.

That I can't say. I don't think it's necessarily with family caregivers. And I'm not saying that's not taken advantage of. But to be honest with you, people who are, the pay is so low. Well, I don't know. But to me, the pay is so low. I don't see that being something that there's a ton of fraud in. And there are probably family members that come and don't do anything. But if they're actually doing the jobs that need done, and the provider signing off saying that they need that kind of care, I mean, I just, it's hard work. I mean, I would not want to be an aide. and for what they make, jeez, shamosas. So I don't know. Never thought about that one.

Sorry you got a little bit of traffic jam Okay Thank you Okay. Does it go any higher? Okay. There we go. Okay. Not a microphone person. I got a drum. I'm so sorry. I really appreciate you. We'll see how this works. All right, there you go. Chairwoman Gross, Vice Chair Barhost, Ranking Member Baker, and the members of the House Medicaid Committee. Thank you for listening to our testimony today. My name is Emily Lark. I'm a full-time caregiver for my seven-year-old daughter, Annika. Like many family caregivers, I had to walk away from a career as a veteran English teacher to be the primary caretaker for Annika, my medically complex disabled child. You've heard a number of testimonies today explaining the clear difference between caretaking and parenting. So I want to talk a little bit about why I am a caregiver. I'm a caregiver so that my child is safe. we have not had any luck with any sort of direct support or nursing and so I stepped aside we're working on one teacher salary and of what I'm paid we're able to stay in the house that we have and have the transportation to barely make ends meet so that my daughter can go to school play adaptive baseball Perform in her adaptive figure skating troupe. Take her weekly art classes. Ride adaptive bikes and hike with us. Garden and play with her two dogs that love her. Go to friends' birthday parties and have dance parties and gate trainers with her friends. And disability rights marches. Visit art museums and natural history museums because dinosaurs and art are life. Go to the Cleveland Orchestra and live theater performances of Fraggle Rock and Bluey so that she can roller skate in her gait trainer and be the amazing seven-year-old girl she is because while her disability is and will always be a part of her, she has a life to live with her own interests, thoughts, and experiences. She deserves to be in community, and her community deserves to have the privilege of having her be a part of it. Her disabled and non-disabled friends are the next generation of nurses, doctors, teachers, inventors, entrepreneurs, and legislators. Imagine what an inclusive and better world they will create after having a friend who talks with her eyes, has wheels for legs, and can eat and play simultaneously. Disability is a normal part of the human experience. I hope you live long enough to experience disability, and I hope whoever takes care of you had a friend like Annika that made them realize how normal and necessary disabled people are to our community. Thank you.

Thank you so much Representative Sweeney Thank you Chair and thank you both for being here and your patience I believe you from Blank County and you driven over three hours to be here and you're going to drive three hours home, and you've waited hours to give your testimony.

So thank you. My direct question is, to me, there's some good things in here, But the biggest concern of this bill is the idea that in this sub-bill we are saying that the state is not going to allow you to get paid to care for your daughter. But instead, the sub-bill would say that we'd rather have a stranger in your home. Could you speak to who you think is going to give the best care to your daughter, whether that's you or somebody that, as we've spoken to, can be there for two weeks and not having continuous care? what that means for the quality of life for your daughter?

Thank you. Thank you. Representative Timms.

Um, it's, it's been very difficult to access care. Um, accessing the waiver was an arduous process, um, full of very difficult, if I'm going to be very honest, um, There were some dishonest moments during the interview. We had to get another interviewer as we applied for the waiver because I was refused to provide evidence of my daughter's medical disabilities. In addition, they changed our due dates for the interviews to when my daughter was in the hospital. So while I was providing care for my daughter in the hospital, while we were concerned with seizures, I had to also do an interview to see if she could qualify for the waiver. Life is very different. There's a lot less sleep, and I thought lesson planning took up a lot of nighttime. But this is different. This is waking up at 2 in the morning for a seizure. This is being ready to rush to the emergency room that is over an hour away at any time. Our providers, a lot of them are down here. My daughter was diagnosed with acute on chronic pancreatitis as a surprise. We were in nationwide for most of November and December this past year. we do not get paid as care providers during that time at all. And meanwhile, we are paying for... I'm very sorry. I promise we'll play soon. But during that time, we do not get paid, yet we are paying for meals out of pocket. We are paying the cost of parking our car. and it becomes very stressful and exhausting, but I would do it again if it meant giving her equity and access to the world around her. And I think a lot of parents are like me. Honestly, I am too tired to take advantage of anything. And so I really, really would like you to just consider, even with the EVV, the GPS tracking, so there's a difference between family caring and clocking in and clocking out of a shift job. I am driving three hours for appointments for specialists down here. I can't be at home to clock in and clock out if I am feeding my daughter blended G-tube feeds while my husband is driving and we are three hours away from home. Like, that's not the reality. It isn't a shift job. These are people's lives. Imagine if you had to divide your life into shifts. that's not fair to the disabled person and it's not fair to the family. Ani should be able to access her community at whatever time and not have to sit at home and have her home be invaded and her privacy invaded. We should be able to go to the orchestra at 8 p.m., you know, things like that. That might be a little late, but... Thank you.

Thank you, Chair. I just curious this device that Annika has So I have Pranky Romic in my district and I curious to know if that device came from them But if not tell us a little bit about it how it works and how she able to communicate with you all through that

Do you want to say something? I know I hate putting you on spot.

Is it okay if I show that?

we'll just real quick yeah prc satel that's pranky romix so that's in my district so i I should have used that name. Sorry. I was super excited to see that you all are able to use it.

Yeah.

Thanks.

Thank you, Chair. Thank you for coming in to testify. I will tell you that coming in here means a lot. I take my job very seriously. We've got to address the fraud issue in this state. But what you all have said will be taken very seriously. and I'll make sure that we get it correct.

My wife is also a middle school teacher I see your dog dad too she a dog lover It a fundraiser for city dogs We volunteer for city dogs out of Cleveland. Yeah, too much of my money goes to dogs, but that's okay. Relatable. But I will just tell you that when people come in and testify, we have some of the same people that come in all the time that are paid to be here and those that are not paid to be here make a hundred times the impact least on me and I'd rather be home with my kids right now But when I see parents like you, I'll just tell you that I want to do what I can to help you get the right solution while also taking care of the tax money that we cannot continue to let be wasted. So anyway, your three-hour drive was worth it, and I'm happy that you stepped out.

Thanks.

Thank you. Thank you.

Thank you, Chair. I was hoping I could dry up a second after Representative Ferguson. Thank you for being here. Thank you for painting the picture of what a day looks like. Thank you

gosh, he got me going. Thank you for providing an amazing life for Anika.

We try.

Yeah. Okay. So I feel like you have painted the dignity that's needed picture. And the pushback that I keep hearing is we need to save money and we need to save fraud. And I think that there is this made-up dichotomy that it's one or the other. And I think that, so my question to you is, as an Ohio taxpayer, when you're thinking not personally about your life, but about Annika's friends with disabilities' lives, would you rather the taxpayer money from your paycheck, from your husband's paycheck, goes to family members providing care for Annika's friends, or goes to long-term care facilities?

Thank you so much.

Thank you, Chair. Through the Chair, you know, I'm going to double tap on what Rep Ferguson talked about. I'm looking at your daughter. You know, I've got two little girls that are seven and five, and I would rather be at home with them, especially looking at your daughters, making me miss my girls even more. You know it hit me while you were testifying that everyone in this room right now all of you and those who have come and gone you all here You've come here because you're scared. And the actions of this body have scared you, and that's disgraceful to me. Because it didn't have to be like this. Certainly, fraud is a worthy endeavor, worthy of our time. but not like this. And I keep thinking, you said earlier, you have a three-hour drive back home. Some of you have shorter and longer drives. And can you just talk about, my question for you is, can you just talk about what this whole process was like for you today to come down here? Like, what was in your mind, what your concerns are about what's going to happen when you leave here today? Can you just talk about that?

Thank you so much. Representative Lett.

Thank you for the question, Representative Lutt. The Medicaid waiver means everything because my daughter is everything to me. And if we didn't have the waiver, we couldn't afford care. I bet dad's feeding dogs at home. She said feed dog, which is, it's their dinner time. That's really hard. We, families like mine, live with that, that dichotomy that duality every day of trying to live in the moment and not knowing how many how long those moments are going to last And when I achieved the waiver after 10 months of fighting, and I know people have been fighting way longer. I'm just really annoying. But I cried. I cried relief, just like when it took nine months to get her a stander so that she can stand and she can bake and she can garden and she can do things that kids do. And it also helps her gut motility. So that's also wonderful. But that took nine months. I cried. I don't think there would be anything without the waiver. Yes, it's incredibly difficult to access services sometimes. But it's all we have. Yes, Brewster said all.

I just need 30 seconds to speak to a witness here about the people in this room. When you do this for 30 years, when you go to committee after committee, it starts doing things to your brain. One of the things that it does is even when your own friends or your own mother tells you, you know, you're not a burden, I would do this for the rest of my life if I had to believe her. You mostly believe them but you don quite because you seen in meeting after meeting committee after committee your entire life quantified on a spreadsheet And it takes somebody else who you don't even know articulating what I'm sharing. My parents and my friends have been trying to get across to me for years. I just need to thank you for saying those things and for somehow finally getting some of this through my head because every time we do this, it's more damage, not just to the waiver system, but to our idea that we are worthy people. It's hard to maintain that in the face of all of this. And I just need to thank you for helping us, the disabled people in this room, hear that. Is it all right if I give him a hug? Yes, absolutely.

Thank you so much, you guys. We did hear you. And I know there will be some good changes that you will be happy with, I'm sure. So thank you very much for everyone who came today. We appreciate you being here today and all of the time that it took for you to be here. I would like to direct the committee's attention to the written testimony for substitute House Bill 795. Please see those on your iPads. And with no further business, before the committee, the House Medicaid Committee stands adjourned.