Ohio House Medicaid Committee - 6-8-2026

Representative Stevens? Here.

Representative Sweeney? Here.

Representative Williams? Here.

Here.

Chair, I move to accept Sub-Bill L-136-3280-5 for House Bill 795.

Thank you, Chair. After conversations and hearing from our constituents and interested parties, the sub-bill ensures that family caregivers may continue to provide personal care service to the family member, removing language from the earlier version of the bill, modifies prior authorization requirements to ensure that services are provided as determined to be medically necessary and may be implemented with fidelity by providers, clarifies EVV requirements for services provided in acute care settings, ICFs, and hospitals, additionally clarifies services provided in hospital settings do not automatically trigger fraud warnings, removes language related to SNAP categorical eligibility from the bill, eliminates the Medicaid program integrity fund, adjusts the penalties for committing Medicaid fraud, maintaining that committing Medicaid fraud is considered a felony-level offense for amounts less than $1,000 is a felony of the fifth degree for amounts from $1,000 to $7,500 a felony of the fourth degree for amounts $7,500 to $150,000 a felony of the third degree with a presumption of prison if the amount is over $75,000 for amounts $150,000 to $750,000 a felony of the second degree and amounts greater than $750,000 a felony of the first degree. Modifies the bill's restitution for committee Medicaid fraud to reflect actual restitution amounts rather than 200% restitution, removes the bill's newly added provisions concerning hospice provider licensure, removes language concerning the establishment of risk contractor systems, removes language establishing a fraud reporting incentive system, requires the Department of Medicaid to develop recommendations on how to implement a Medicaid encounters dashboard and risk matrix system by the end of March of 2027 and submit a report of its findings to the General Assembly requires ODM to develop a disclaimer for all newly enrolling Medicaid providers, explaining the penalties for committing Medicaid fraud, requires ODM to develop a standardized onboarding structure for new Medicaid eligible providers, adds clarifying language on ODM's ability to contract with or develop its EVV system, clarifies the MCOs shall seek ODM approval when suspending a provider for likely fraudulent activity and includes an appeal option in the bill modifies language regarding access to all payer claims database to clarify access to publicly available information and to permit rather than require subscription-based access ensures that MCOs identifying waste and abuse as well as possible fraud refer to ODM and requires ODM to submit likely fraud allegations to the AG's office in a timely manner. Codifies current ODM practices regarding disclosure of ownership interest above 5% for Medicaid providers to the department.

Mr. Chairman.

May I ask the sponsor about the family provision, and I didn't quite grasp all that, what you said.

If I may, Mr. Chair.

Witness, the floor is yours.

Thank you, Witness. Is there any questions from the committee? Hearing none. Thank you very much.

Oh, I'm sorry. Representative Baker.

Yes, through the chair to the member. I will be honest, I'm not fully versed in the DD system when it comes, I know that the waivers are very different in a sense between all systems and I think any carve-outs can be detrimental to the other side. So I think that's where I would lean on folks who are on the MyCare waiver and maybe pass forward to home care. And I was trying to quickly talk to them about that because I had concerns and they didn't see it initially. So I could always touch base with you after the fact, after I'm able to kind of debrief with them, and I can email you additionally that.

Thank you Chairman Thanks so much for testifying and thanks so much for getting up to speed on the sub bill in record time I just wanted you to expand a little bit on the high-risk provider comments that you made. I'm a little concerned that the sub bill doesn't fully address some of those issues that might accidentally or unintentionally mark some of our providers as high-risk. Could you just kind of elaborate a little bit on that? And thank you.

Representative Craig and then Sweeney will be next.

Representative Sweeney, thank you for your patience.

Yeah, through the chair to the member. I believe the conditional hire piece is back in a few years. There is a rule. The idea was that when we were going through this caregiver crisis that people can't just try and show up and wait two to four weeks to be fully certified or be A-OK to get provider payments because the payment system is also very laggy. And it still is today. So they did a conditional hire in that you could start working and then if anything came back or flagged, then you were unable to continue. But people were not losing care. So I think in the current version, there's still the opportunity for folks to lose care because it still takes ODM weeks. I have heard of people who their provider hasn't been paid for six months, and that's just now. So if we add even more provisions, then I think we're going to exacerbate the issue. And I think you bring up a point, too, where to the extent that ODM can provide a backup option, depending on where you are in the state, there may not be an option. And yes, we have family providers, but then you're adding that additional credentialing, right, making sure that we go through the process. And I know advocates have talked with ODM for a really long time and how can we speed up the process? How can we ensure that the certification from the front door getting to the person is as smooth as possible and in any issues that arise that those are addressed quickly because nobody in this day and age can go without payment. It's just not possible, right? So I think that the language is still a little too flexible and I still think there are areas where people could lose care and then not have care for weeks. And then additionally, I would say what could happen, so there is a House Bill 530 right now that has bipartisan support. It's the Long-Term Care Study Commission, and I think a lot of what we want to do in these bills is something, because there will be people who are on waivers, Medicaid agencies, that's a huge group of folks on that committee that would be able to address a lot of these concerns and take the time to really flush that out. And I think that's what should be done, right? We all want the system to be improved, and we want it to work better for the person who, at the end of the day, is going to be impacted. So if we took these ideas and took these thoughts and brought it to that commission with people who are actually receiving services, I think we could develop and reform the system much better in a real thoughtful, methodical way that takes time and really makes sure that people's voice is included.

To the chair, to the member, I think there still is a provision in the new one, and I think we currently are able to do conditional hire. So I think adding that was going to add confusion. So if we were going to remove that ability for people to conditionally hire, I think that's where I was flagging it. I'm pretty sure we're still allowed to do this, and so I think that adding that is going to exacerbate a problem.

Thank you. Yeah. Thank you. Thank you for your testimony Our next witness will be Laura Abu Abisi to provide interested party testimony Thank you for your testimony Our next witness will be Laura Abu to provide interested party testimony The floor is yours

Any questions from the committee? Representative Stevens.

Sure. In terms of the non-emergency medical transportation program. So through the chair, Representative Stevens, the sub-bill does require GPS tracking data for net providers that I believe is to be implemented over the course of an 18-month time frame. As we've talked with a lot of the county departments, the vast majority of their providers today have this type of technology. So really our questions remain around how do we operationalize what the bill speaks about in terms of electronic verification with that GPS data. The conversations that we're hoping to have are really around what IT systems are we talking about. Right now there is a statewide IT system for NET. Counties manage that individually. So we're really hoping to have a good glide path toward implementation and especially make sure that the technology can meet the needs of the folks on the ground.

The other question I would have when it comes to that is in an area that doesn't have very good cell service, how does that work for some of the counties down along the river or the hills? you go around the wrong bend and you lose health service. Sure, yeah.

One more.

so that there's some flexibility for the county's administration? Through the chair, Representative Stevens, based on my quick read of the sub bill, and I am not an attorney, so I want to talk to folks who are, I do believe that some additional flexibility may be warranted. You know, perhaps we might look at a little bit of a longer implementation date. We were also suggesting perhaps a work group to get state folks, county folks, transit folks all around a table to talk about the most efficient way to go about meeting the goals you have in the bill would be helpful.

Sure. Thanks, Chair Barhorse. So many of the county departments will work with their counterparts in local transit to actually provide net services. So we often see contracts between the county JFS and local transit. It's, I think, a very good partnership between those two systems. So to the extent that our JFSs are interacting with ODOT, it's likely through their local counterparts.

Thank you.

Good afternoon, committee. Thank you for having me. Vice Chair Barhorst, Ranking Member Baker, members of the House Medicaid Committee, We appreciate the opportunity to offer interested party testimony on behalf of Groundwork Ohio. We are the state's leading early childhood research and advocacy organization and appreciate the opportunity to present to you today. The testimony that you have access to includes quotes from families and other feedback that we have regarding specific context around the family caregiver provision. However, I do want to take advantage of this opportunity to be here and address you and really note the importance of Ohio's Medicaid system for Ohio's infants, toddlers, and their families. Ohio's Medicaid program covers 50% of all births in the state. That was as of 2024 and ensures access to health coverage for nearly 383,000 children from birth through age five in our state. Health coverage is the foundation of healthcare access. It enables young children, children and families to access preventive services, developmental screenings treatment and supports before concerns become more serious and costly to address We also know that when health coverage is threatened for caregivers for parents if parents lose access their young children are more likely to lose access to coverage as well I do want to note that Groundwork Ohio recognizes the importance of protecting taxpayer dollars and ensuring that public programs operate with integrity. Ohio families deserve confidence that their Medicaid resources, that Medicaid resources, are used appropriately and reach the children and families for whom they're intended. As the committee deliberates this bill, we encourage careful consideration of how proposed changes, apologies, no longer relevant, but how they impact young children and families. And in fact, I would like to tweak this and dig into it a little bit further just to note that I understand and have seen coverage that this is considered phase one of a broader strategy to address fraud, waste, and abuse in Ohio's Medicaid system. And would just love to encourage the committee to consider ways that future deliberations around mitigation around fraud, waste, and abuse may impact Ohio's infants and toddlers or sometimes left out of the conversation. It's especially important given the understanding in the early childhood brain science that indicates the earliest years of life are a period of unparalleled brain development. Children are, during the first five years of life, children are developing more than a million neural connections every second, and this is a period of development that is unmatched at any other point in life. I will note, while there were a few quotes in my testimony that are no longer relevant, given the change in the caregiver provision, one thing that I would love to encourage the committee to consider in future phases of this work are ways to activate the Medicaid Beneficiary Advisory Committee and other family feedback throughout the state as those with lived experience have deeply valuable insights. Thank you for your time, and I'll take any questions.

Representative Sanders. I have a question. One of the things that you mentioned, and it goes back to the prior authorization of, or the prior authorization I believe that Representative Baker was talking about, how would that apply to children? You know, they're either in a preemie or something of that effect. They're ready to go home. Do they stay in the hospital for 10 extra days if they don't get approved? How would this language affect that situation?

I really appreciate that question. I'm not prepared to offer a specific answer on that today, but I would love to get back with the committee and offer that. I appreciate your thoughtfulness around that. I will note that certainly the state has a lack of, generally a lack of infrastructure around care placements and arrangements for infants and toddlers. So when there are disruptions or delays, it can prolong length of stay for hospital settings or increase longer stays in settings that just aren't meant for longer caregiving options for infants, toddlers. However, I would love to get more specific and offer a more detailed response to your question.

Thank you. I am Sue Gregg, and I'm a family caregiver. I'm also employed by Careforth, a Medicaid provider of shared living and structured family caregiving services. We have worked with individuals with developmental disabilities and their live-in caregivers since 2011, and last year began to provide services to older adults and people with physical disabilities and their live-in caregivers through structured family caregiving. In structured family caregiving, the majority of caregivers are daughters. On behalf of those family caregivers, thank you for accepting the latest sub-bill, which no longer includes the prohibition on family caregivers. Like all of you, Careforth takes seriously our responsibility to ensure taxpayer dollars are used appropriately and effectively. We do that in our day-to-day work by confirming those who receive services are eligible for those supports and in many other ways, including by providing recommendations to ODM and the legislature to inform improvements in the delivery of Medicaid services. Families across Ohio depend upon our collective work to ensure the programs are both sustainable and acceptable to meet the needs of the varied populations served. We are all outraged when individual acts in a manner that undermines the integrity of Medicaid or casts doubt upon the complexity of care and burden that family caregivers carry. Serving families in structured family caregiving, they receive a stipend. They're not hanging out with mom and dad. They're meeting the daily needs which have to be assessed, reassessed, documented, and with the health plans we're basically making sure that the state has consistent, comprehensive, and current evaluations of needs. They receive hands-on care, and the caregivers provide bathing, dressing, eating, managing complex medication regimens, which include on the average about 11 medications for older adults because of the chronic conditions. 11 caregivers never clock out. Because the medical and behavioral health conditions of older adults are complex, and care for individuals who meet a nursing facility level of care is intense, structured family caregiving was introduced specifically to ensure that living caregivers have access to and support from nurses and other professionals employed by agency providers. We estimate that this service will contribute more than $500,000 in Medicaid savings by the end of this calendar year, primarily by deferring admissions to nursing facilities. We also know that there's not enough direct care workers in the state, so family caregivers will continue to need to meet this need, and they're doing that extraordinary care.

I am, I know. I was just going to say thank you so much, and if there's any questions, I'll be glad to answer them.

Representative Baker. Thank you, Chair, and thank you for being here. So my question is about the structured family caregiving and kind of that shared living, 24-hour-a-day care model. So in the sub-bill, we have exempted EVV clocking in and out for that care when it's provided to people with a DD waiver. Can you talk about whether it makes sense to you that that same service when it offered to a patient under a home care waiver or an aging waiver does it make sense to exempt those folks as well, or is there a difference in those services?

structured family caregiving is analogous to shared living. So both services are paid on a daily rated service. So in essence, we're not counting minutes of time. We get paid for a full day of care. So if we had to go under EVV, the caregiver would have to, first time they deliver any kind of care in the morning, clock in. And then whenever they end providing care, when somebody goes to sleep for the evening, they would have to clock out. to constitute a day of service, but in essence, you know, it's no matter how many hours they're providing care, we're getting one payment per day.

Representative Stewart?

Representative Pickle-Antonio? Thank you. Thank you so much for being here today. I have a question about some of the provisions related to GPS tracking. So the way my understanding, the current version of the bill, there is not a requirement that the care provider give consent for GPS tracking. And I guess my question to you, I think as a care provider, do you think that as an employee that you should be notified by your employer that there would be GPS tracking of your location? Representative Williams, Representative, I can't answer that question.

but I will be glad to research and get back with you. Follow up.

Thank you for being here. I also want to thank you for the work you do. Thank you. Could you expand on what does it take or what is required from a doctor or occupational therapist to say, yes, this individual is qualified for this type of care? Representative Williams, Representative Stevens,

that are contracted with the Department of Medicaid to do those roles. In that process, they would be collecting data through their assessments. they would be getting medical information, et cetera, and they're the ones that are making that determination. Based upon all the waivers in Ohio, nursing facility or intermediate care facility waivers, that person has to meet the same criteria that they would meet if they were being a resident of a nursing home or an ICF.

Thank you.

Vice Chair Barhost, Ranking Member Baker, and members of the House Medicaid Committee, thank you for the opportunity to testify today. I appreciate the committee's decision to remove the provision that would have prohibited family caregivers from providing services to their loved ones. My mother cares for my adult sister, so that change is incredibly important to my family. However, I remain concerned about the new family caregiver oversight provisions. The bill allows annual recertification requirements, enhanced audits, and the possibility that a family caregiver deemed high risk could be required to work through an agency rather than remain an independent provider. I am concerned that these terms are not clearly defined and could create uncertainty for families who are already providing safe, cost-effective care in their homes. I respectfully ask the committee to clarify these provisions and ensure that the compliant family caregivers are not subjected to the unnecessary barriers that could reduce access to care. Thank you.

Thank you. Through the chair, vice chair, ranking member Baker, and all you others, I have stressed, and you know I have stressed, because that video went crazy. I really broke down in tears today when I got the thing that said, okay, we're going to pull out all of the family caregiving. It is so important to me for disabled people to all be treated equally. When I read things that say, oh, we're going to carve this out for DD, and we're going to carve that out for DD, I lose my mind. I am an ODM, ODA, DOD provider, and I am a self-direction employee for someone that lives within my home. You were asking about GPS and this kind of stuff. I provide for them in my home. I don't care if you're watching where I go or anything else. All I care about is taking care of them. I don't care about the privacy and all of this. I have one job to do, and that's to take care of them. being a Medicaid self-directed employee we do use EVV clock end ours is just called a different form so I don't have any issues with any of that I have a bedridden son-in-law who's on a mind care waiver. I'm so tired of all the difference between all of these waivers while waiting to be a paid provider for him and being paid at less than $13 an hour. My house went into foreclosure and everything. But yet I go and get a DD client. I have to do something. I'm making $13 an hour taking care of my bedridden son-in-law. So I go and get a DD client. My DD client could wash herself, bathe herself do everything I just had to make sure she wasn eating extra food and stuff you know I made an hour doing that but yet my bedridden son who can even feed himself or take himself to the restroom, I got treated differently, all because there's a pay difference between these waivers. And someone here likes to talk about people don't want to pay property taxes. Well, we're drowning out here. You know, that's just reality. All of us are being taxed to death. And we have taxpayers out here that the medium income in Ohio is, what, $96,000. These people are making $78,000. And then we have these skyrocketing amounts. that we see IPs on the DODD side take. So thank you guys very much for removing all of that.

sorry are you able to okay Thank you. Yeah, that's good. Thank you. To the chair, vice chair, ranking member, and members of the committee, thank you for listening to us today. My name is Essence Easley. I am the founder and executive director of an organization called Enduring Minds, the foundation. Again, most of my testimony is no longer relevant. so thank you for removing the family provider provision that means so much to me I just want to state my caregiver is my mother who's here today I wouldn't be able to do the things my organization does be here today have the scooter my hearing aids be able to see or get around in the community without that that that family caregiver without the waiver program so I just again want to say thank you for removing those things and and just ask you to continue to take input from the people with living lived experience to improve on the Medicaid programs in Ohio we agree with you all fraud and ways should be should be done for but we know what it's like to live with the disabilities to live with having to decide if you're going to be able to you know get out of bed in the morning or get dressed and I wouldn't be able to take my son to school without the transportation and things like that that come with my Medicaid waiver so continue to hear our stories and listen to people with lived experience to improve the Medicaid waiver and again thank you for the provisions to the to the family caregiver part of the bill thank you and I'm going to try to back up without or get away without harming anyone.

Thank you so much, Chair. Essence, thank you so much for... being here today. Thank you for your service as a member of the Advisory Council, and thank you for your advocacy. I guess I just want to ask from your perspective, I'm sure that the Commission has had conversation about not necessarily things in this bill, but things beyond this bill that would make the system more workable for individuals? And I just wondered if maybe you could give us some of your thoughts about things that are not in this bill that would make the process more manageable for people who need services.

create. Thank you for your testimony. Thank you. I'll give you a moment. While we're in transition here, I just wanted to explain to you why some of the members are coming in and out of the committee. We have several committees going on, and the insurance committee had four votes, so members are trickling back in, and that's where we were. The next witness I'd like to call is Rachel Huffman to provide opponent testimony.

Are there any questions from the committee? Representative Brownlee.

we have a certain level of care right now that requires prior authorizations. that's called partial hospitalization. And when somebody comes through, we get the prior auth, and it takes about 14 days for that to get approved. If we get a decision, which is about 10% of the time, that that service is not going to be approved, then we eat the cost of those services rendered. It is extremely labor-intensive. Right now, for a small organization, we serve about 130 clients every day, and we have two people that are doing these prior authorizations for just that one level of care. So if we're adding this for all services, we're going to have to hire probably two to three more staff to help with that which we don get any reimbursed payment for obviously And then there continued issues with the length of time that we have to wait on that approval And so if we get a decision back from the payer that says they're not authorized, we're putting them into a lower level of care, which is oftentimes against what the licensed clinician had deemed appropriate for their treatment.

I'm not sure what that provision was exactly regarding six, was it six agents or entities or sites? Correct.

Thank you.

Thank you, Chairman. Thank you for being here today. I'm going to try to ask it as one question, but it will be three parts. Okay. So if you could give an example of how it works today versus how it would work under this language, number one. Number two is does that get some of the fraud, potential fraud, this, or, and then thirdly, I'll say, is there a better way to do it than the way it's written to make sure that people aren't doing stuff they shouldn't be doing?

Representative Stewart. Thank you, Chairman, and thank you for your testimony. Sonny, you know, without prior authorization, I guess, it seems like we have this system where it's pay first, ask questions, and determine whether somebody was actually eligible for the payment later. And that's a tough one when one out of every $2 we spend in this state goes into this program. So if why is simply saying that we're going to determine before we write the check whether you're eligible for the check, why is that not the most reasonable reform we could do here? I understand it may be some more hassle, but I mean, doesn't it common sense wise, isn't that the easiest thing to do is to ask more questions before you write the check rather than chase it afterwards?

Follow-up? This is the other part that I think we've been trying to get to the bottom of and I think is a little murky, is today somebody comes in, Medicaid pays for services, because we don't have prior authorization, and later on we determine, oh, shouldn't have paid that. What happens then, today? Who is making the taxpayer whole when we determine on the back end we shouldn't have written this check in the first place?

Good. I have one brief follow-up. I think this is important. I'm reading, I'm understanding your answer to be, well, if it's determined that the provider was paid for something that Medicaid has determined they're not eligible for, then the provider may write off their own time, right? It comes out of the provider's end, not the person who received services that they weren't entitled to. And my other job I built for my time, I'm not looking to have providers stiffed on their time, right? It sounds to me like without prior authorization, there's really no way to keep – once the benefits have been given to the person who's now eligible for it, cows out of the barn. There's not a lot we can do other than stiff the provider who gave the service and unintentionally didn't do anything wrong. Am I close?

Representative Baker. Thank you, Chair. And actually, I want to keep going on the same conversation. So is there a compromise in between this? So are there certain, knowing that there's 14 days typically for a prior auth in your experience, are there some services that a prior auth could be okay that you can wait 14 days? And are there other conditions where you can't wait 14 days to find out if you're going to get a check or not because of patient acuity, because of, you know, risk to the patient? Through the chair, Representative Baker, in my opinion, no.

Representative Timms, thank you for your patience. Thank you, Chair. and thank you so much for being here today and giving us some more, I guess, clarity and colors into how the law and your experience has applied in practice. I just want to go back to a few points that you mentioned on authorization. So as I said before in the last committee, I'm still new to the committee and I'm going to keep using that new card for a while. But in one of the earlier hearings, we had our auditor here and I looked at the website and there they had actually listed another behavioral health clinic of potential fraud. And it was because of these hospitalizations. And so based on your experience and in practice and I believe they worked something out so I want to also add that to the record But based on your experience how often are these clinician recommendations for care being rejected for payments

Follow-up? Granted. Thank you, Chair. and because that's 5 to 10 percent of loss just on those rejections, what do you potentially foresee in terms of additional costs based on the current sub bill or do you feel like it will keep things more or less the same in terms of that process?

Granted. Thank you, Chair. And then lastly, you mentioned about the 14-day timeline for having something approved in order to get those paid. And you mentioned in an ideal world, 24 hours would be amazing. Now, I do not work in health care, so I have a question. Does that exist in any state in the country where things happen that fast, or is there a standard in some state where they are moving things faster in terms of prior authorizations and preapprovals, or does that not exist?

Representative Brownlee for a quick follow-up. Thanks for your patience, Chair. and to the witness. The language in the bill, it starts on line 1393, it states, the department shall deny, refuse to revalidate, suspend, or terminate a provider agreement if the department determines that an individual or entity seeking enrollment as a provider of home and community-based services under the Medicaid program is principally located at the same address as more than six other active home and community-based services, Medicaid providers, or is principally located at the same address as another home. It goes on into the home care. But you mentioned several different entities sit within one location and I know this is very common within the medical field but definitely within the behavioral health field Do you think that up to six entities within a single location is sufficient, or should we look at perhaps changing that to reflect what's actually happening? Through the chair, Representative Brownlee,

Rep. Williams. Thank you, Chair. So we're talking about prior authorization. Do you provide services to private insurance recipients?

and I always had to get prior authorization for it. So tell me why private insurance companies are able to protect their funds by using prior authorization, but the taxpayers should not have that same protection. So essentially you're saying you're eating costs of 5 to 10% on denials, that services that were rendered,

So please tell us why the taxpayers of the state of Ohio, who we are taxing them to provide these services, that they should be giving you money for services you shouldn't have provided in the first place because it was denied. Through the chair, Representative Williams, we have licensed clinicians who assess people

So if they're ethical, if they're doing what's ethical, they're not fraudulently making a treatment recommendation. I would imagine that you said your son, I believe, right, may have not gone through a level of treatment. I don't know this for sure, but typically a higher level of treatment is not covered through commercial insurance. So for partial hospitalization, intensive outpatient, those services are not even covered by commercial insurance. And so I don't know what your son went through, but maybe there was a difference there. Follow up. Thank you. So you said that clinicians make the determination that these services were needed, but then when they were reviewed by the pain entity, it was denied. So they were wrong in their assessment. Tell me why taxpayers should pay for that wrong assessment. Because what you're asking for is for us to continue just automatically paying it out. There's no prior authorization before treatment is provided. And you're asking the taxpayers to eat the cost of bad determinations by clinicians. And we're saying submit for a prior authorization before you begin treatment. So explain to us why we should be eating that 5% to 10%. The taxpayer should be, you know, this is the money that we're taking from them out of their paychecks and providing free publicly funded health care. Tell us why we shouldn require prior authorization like what happens in private insurances Through the chair Representative Williams I a taxpayer too So if there is a better way to do this I am all for that But what doesn't make sense is that the provider is eating the cost either. So you have people who are licensed and educated who will see the client in front of them and make that determination. They document to the best of their abilities. and the payer who has never met with a client says, I'm sorry, we don't think that this is appropriate service, then we have been eating the cost. But if there was a shorter time frame, I think that would be a lot more reasonable instead of two weeks later saying, sorry, they don't meet that level of care. Even though we've never seen it, we have to respect that decision, make it a shorter turnaround time, and that would help overall with everything, the taxpayers and the providers. Follow up.

Thank you. So earlier you said, you know, when clinicians make that determination, they're not doing it for a fraudless basis. But we're not just looking for fraud. We're looking for waste and abuse as well. And we've seen the growth of our Medicaid payment to over 50% of our GRF funds now are expended for Medicaid. Much of it went to waste, fraud, and abuse. We saw this tremendous growth that was unprecedented here in the state of Ohio. Wouldn't you agree that given that increased volume of activity in Medicaid, okay, that's what could be causing the delays, and by getting rid of the waste, fraud, and abuse, we may be able to actually streamline the processing of claims. Through the chair, Representative Williams, no. I think from what I have seen, the fraud, waste, and abuse has happened in some concentrated organizations or with providers who have been the bad actors who have, I mean, fraudulently billed for millions of dollars of services, not these providers who across the board are experienced in the state. This is a normal thing in our space, is that we submit a claim, and 5% to 10% of the time we don't get it back. That is a normal thing. Thank you for your testimony.

Actually, it's just Kathy. To the chair, ranking member, and members of the House Medicaid Committee, my name is Kathy Kulick. I'm a mother, a grandmother, a retired teacher, and I am a facilitator with a program called Erase the Space. It's a program where we bring together students who would not normally meet one another because of socioeconomic differences, and they solve common problems. My original intent with the change that you made was to just walk up here and say thank you. I appreciate the changes you've made. You've addressed my concerns about personal care. And so, again, I would also, as others have said, I would encourage you to continue to collaborate with people who have real-life experience and can share that with you. Based on this last round of questioning, though, I'm also going to throw in something else. I don't really completely understand where the sudden concern about fraud has come from. We, since 2008, there have been bills that have been proposed by Democrats, at least six of them, to address fraud in the Medicare system, and none of them have gone anywhere. So I don't understand why. suddenly we have this concern about fraud. I don't want to see waste, fraud, and abuse either. I think that's kind of a buzz sort of phrase. I don't want to see any of that either. But I'd also understand why suddenly it's important. You know, Republicans have been in charge for 26 out of the last 32 years. Why is this suddenly something that's so important to you? So I will wrap up by saying once again, thank you for what you've done. I hope you're really sincere about what you're looking for and what you're willing to do for people. Any questions?

I am a special needs mom. This is Osaya Todd. He's my son. He's 11 years old. He was born with a rare genetic disorder called STX-BP1. There's not too many like him. He's nonverbal. He suffers from myoclonic seizures. He's completely on a three- to four-year-old level cognitively. When I first had Osaya, I had no assistance. Surprisingly, my son has only been on a waiver for three years. Medicaid denied me five times before he got on a waiver. I had to hire a lawyer to take the city of Euclid to court because they had my son in a regular classroom like this. They didn't have the right equipment. They didn't have the right staff. I had to hire two lawyers to take the city of Euclid to court. And I won during COVID on Zoom. I also had to get a Social Security lawyer because they denied me Social Security with him like this. When my son attended UCP where he goes now, I had to completely change my life. Instead of going to school for eight hours a day, he went to school for five hours a day, Monday through Thursday. I took a $20,000 pay cut because of that. So I'm standing here before today frustrated, angry, and I am pissed off. These programs that y'all give us is already poorly ran. This is what I deal with every day. How dare you tell me who can come in my house and care for my child? I'm not standing here before you telling you thank you like they did. Thank you for what? I drove two and a half hours from Cleveland, Ohio with my son, and nobody's here to help me. Let's talk about the program Ohio Rise. Y'all have care coordinators who have bachelor's degrees who don't even know what they're talking about when it comes to my son. I'm educating agencies every day on my son. I'm educating your people every day about my son. It's sick what y'all are doing. I'm not standing here saying thank you. Thank you for what? Give me my gas money back for me driving those two and a half hours that I didn't have to drive back with him. Mr Williams since you the sponsor of this Bill 795 come take a step in my shoes I go to therapy every week because of the mental torture that I go through You think I asked for this You think I knew I was going to have a child with all of this I did not ask God for this, but I stepped in it. I took this on the chin. My son went to therapy three times a week for years before he even got a diagnosis because Medicaid made me go through all these things. Let's talk about genetic testing and how expensive it is. They sent me to a cardiologist. They sent me to a developmental doctor. They sent me to a doctor to see if he was on the autistic spectrum. I went to all these different doctors before they sent me to genetics because that's how Medicaid works. They want you to rule out everything else before you go to the most expensive things. Yeah, show them what we deal with. Keep vocal stimming. When I was working full time, I'm also an ex-educator. I taught in Cleveland Public School District for 10 years. I just stopped last year because of his behavior. My son is going through puberty now. And we all know what that means if you have a child with special needs. All the heightened behaviors, the hitting, the vocal stimming, the tearing up my house. But I'm still willing to do it. I've never had CPS called on me I've never had anybody think that I abused my son I pay $60 every two weeks to have somebody come in my home to get his haircut because he can't go to a barbershop and y'all was giving me $87 in food stamps I have to pack his lunch every day and they're overeaters I have the school telling me he's still hungry he's still hungry I sent him 10 packs of fruit snacks in one day because they use them for therapies to motivate him. That's one box of fruit snacks. Y'all don't know what this life is like. And you talking about the taxpayers' dollars. Where else should it go? It needs to go to education. It needs to go to this. Where else is it going to go? It's not his fault that y'all allow fraud. It's his fault. Y'all trying to take the good from us because y'all let bad get out of control. Where is the systems at to filter out the bad? Y'all got all these qualifications. Go find the tech people. this don't make no sense i'm pissed off that i'm even up here doing this this is my first time here this is my first time here god actually called me here because i did not want to do this i don't want to be standing in front of y'all begging for help why i gotta beg y'all for help i'm not awarded the same natural supports that everybody get i can't even work in the summertime because he don't have care my son is off for the whole month of june ask me what respite centers in the east side of Cleveland take him. There's only one. And it's called Puzzle Piece Respite. That's the only respite center around my area that would take him. Now ask me how many hours a day would they take him? Five. You want to know why? Because that's all y'all pay for respite hours. How when a work shift is eight hours? Make it make sense. Make it make sense. You're talking about common sense? Mr. Stewart? Where your common sense at? Turn it on. yes I'm pissed off I am a mad mother because I been struggling the 11 years I done had my son I done had to make it work make it groove I didn have to do things I didn want to do to make sure we had a roof over our head My mom, no, I'm not done.

I do. I do. I do. I'm so mad they came up here and said thank you to y'all. Thank you for what? Why am I thank you for something that should already be awarded to me? This is my child. How you going to tell me I can't take care of my child? How you going to say my mother, which is his grandmother, who has been his provider the whole time he has a waiver, which is only three years, y'all. My son is about to be 12. He only had a waiver for three years. Look at him. Look at him.

have to keep to the rules we have. Yeah, but make it make sense. Get to the point.

since y'all sitting up here fighting for this. Is there any questions from the committee? Come on, Mr. Williams. You the

I'll ask you a question. Thank you for coming up.

but that I'm sponsoring and would love to talk to you about after. It is a bill that would offer daycare, medical daycare, which is staffed by elementary, early educators and by nurses.

Listen Listen Mr. Williams I'll reword

and we have to have rules and I know that you don't like

Representative Timms has a question for you.

Y'all picked the wrong one today.

I still needed to be here

I respect what you saying Ms Thames but I going to be real blunt right now This should have never been a topic of discussion I appreciate you trying to clean it up and dress it up man I not here for that I just told you I just drove two and a half hours with him like this. I'm not here for you dressing it up and polishing it. I shouldn't even have to do this. Nobody should have to do this. That should have never been a thing is what I'm saying. And I don't think y'all understand what I'm saying. Stop being rude and talking while I'm talking. Y'all done?

Thank you, Chair. Let me try again. Thank you for coming up and talking to us about this bill. Would you be supportive of a change to this bill that would introduce medical daycare that your son could go to during the day, stay safe with nurses and early childhood educators and provide respite for you?

I don't believe I have any more questions. I thank you for your testimony.

Our next witness will be Melissa Baer, opponent testimony. Good afternoon.

Thank you for your testimony. Do you have any questions from the committee?

Our next witness will be Lisa Morrison, opponent testimony.

Thank you for your testimony.

Yeah, you know, to the previous mom who was up here speaking, two moms ago, So allow her some grace. I will tell you, our lives can sometimes be unbearable, and it forces us to just live in the moment. So it can be that hard. So thank you. Thank you for testimony. Any questions for the witness? I think we're good. No, I appreciate your last comments, and that why we let her have her moment and I hope she feels that she got her opinion out I hope she feels fair that we let her do that The next testimony will be Emily Lark Good to see you again, Emily. The floor is yours.

in family caregiving environments for the Ohio Home Care Waiver. I also have concerns about the moratorium for new providers and also the establishment of a channel to remove the fraudulent funds from an already severely diminished program that helps Ohio's disability community. And again, I have questions about that because as I was driving down, that was revealed, and it's not safe to look at your phone while driving. so I did not get a chance to thoroughly read what is being done about the money that was supposed to go to the Attorney General's office from the fraud. I just want to talk a little bit with my one minute left about connection. As we've heard today from testimony in the committee, there are still many aspects of this bill that need more thoughtful consideration. And it seems that the committee had excellent questions that were not able to be answered because of the lack of time we had to examine the changes. I hope that the committee follows up with some of these interested parties and testifiers to get more detailed answers to these important questions as it is our family members. These are real lives. Some of the committee members made a connection between my daughter and their daughter. And I urge you to make a connection between Justin and your brother, between Isis and your sister, between Uzziah and your nephew, because these are real lives being harmed. And I just encourage you to slow down and consider this. and maybe it's not appropriate to rush through as there's so much that has to be considered that has been presented today.

I was not on the committee when you were here last week, but I watched the testimony and appreciate that you brought your daughter here to remind all of us that we are talking about real people with real lives, and I appreciate that reminder again today. In the scheme of everything that we're talking about, the question that I have seems minor, but I don't think that the privacy concerns that you have are minor. So I wanted to just ask if you could elaborate a little bit on your concerns related to the GPS tracking, and specifically if you have any thoughts about somebody being tracked without giving consent or being notified that they are being tracked. And also any thoughts about right now there is no period of time with which that data be retained or not retained. so if you have any thoughts about that I would love to hear those

Follow-up? Representative Sweeney.

No, I don't think that you should vote on something. Several of the interested party testimony answers to questions that you had was, you know, I can't speak to that right now, but I'd like to get back to you. I would really hope, because again, this is my daughter's life and other people's lives, that you do get back to them. This is a very serious bill. and I think that it needs some very thoughtful consideration and should not be rushed. I have concerns and questions. As a taxpayer, I'd like to see the evidence of fraud in parent caregivers. What I've looked at in the bill, and again, I am just an English teacher, who is now just a bomb. But what I have read seems to have a lot of stipulations and regulations and crack down on parent caregivers, but the people that I saw on the newscasts that were arrested were not parent caregivers. And that's concerning, especially when the federal mandates, the federal laws do not require things like EVV verification. That is concerning. so I think that you are all thoughtful individuals and I know that you all know what the value of life is and I encourage you and while I appreciate that you some of you were able to connect with my daughter even though, you know, or my teaching or my love of rescue dogs, I want you to know that if we are lucky, Ani will grow up. If we are lucky. And I want you to have that same concern for the adults that are trying to share their firsthand experience. I want you to think about what if that was your family member, and it's not a far stretch. And take the careful time and consideration that this bill deserves and that the Ohio taxpayers deserve on both ends, because a lot of these disabled people are taxpayers. or they are trying to be and they need support and caregiving. And they can still be productive members of society. And I hate that I just said that because I don't believe that you need to produce anything to have value as a person.

Thank you, Chair. Thank you for being here today. So I have a question. I represent a rural Appalachian district, and we've, if anybody's followed this, has seen asking about the EVV if you don't have cell service or whatever. And I hear your point on GPS and monitoring of your home is what it feels like is being done with this bill. That may be a simplification of it. But my question is, what would be the best way to make sure, where parent caregivers are concerned, to say, yeah, this person is doing that without the GPS? Is there another way that you've thought of that could verify what's going on?

On these visits that they come every 60 days, do they give you 24-hour notice? Do they just knock on the door? Or is it a schedule every 8th Tuesday or whatever?

I'm not going to ask you another question. Are you okay for another question?

If you want to sit down, you can.

Yes.

Per hour.

but that wouldn't apply to you, correct? Can you phrase the question? Yeah, so even if we exempted out people that were receiving per diem pay, that wouldn't technically apply to you since your pay per hour. So the carve-out is for DD waivers only, and I'll be very honest, there are a lot of developmentally disabled and medically complex kids that can be serviced with the DD waivers, but that are told to go to the Medicaid waivers. So that's different. So it's not a difference in per diem. There's no option of per diem on the Medicaid.

I don't see any more questions for the witness. Thank you for your testimony.

Our next witness will be Guadalupe Bright, opponent testimony. The floor is yours.

Representative Stewart with a question.

It is reasonable, but the other concern is in that some of my caregivers have brought up is privacy. They're logging in through their phone. Like, what privacy are they having now that they're logging in, things that are being tracked? And so, yes, it's reasonable, three minutes, okay, six minutes, okay, log in, log out, but then you have the privacy concern where caregivers are already questioning, like, I don't know how I feel about this, my phone, and we already have a shortage of caregivers. Like I had to find my own caregivers because the county and the state system could not find caregivers, and they wouldn't allow me to be a caregiver due to all the hoops. So yes, it is reasonable, but I think we also have to consider how caregivers are feeling about this because they're the ones providing the service.

Thank you, Chair. Thanks so much for coming in today. You kind of highlighted an issue that I have been very uncomfortable with. I have a kiddo, has a DSP, logs in through EVV. By the time he's done that and logs into the billing system for his agency, there's three to four minutes of a discrepancy. meanwhile my son is running around the house like a maniac and it becomes very difficult to maintain good like shift change if you will. Can you talk a little bit about what happens in those stressful situations and what the likelihood is, you know, if we're flagging people as having a frequent mismatch of time and categorizing those as high-risk providers, what do you think is the potential that providers will continue to remain in the field and wanting to do this work? And thank you so much.

Representative Brownlee.

Turnover, oh, through the chair, turnover was very high at first. It was having one person come in, let me see how you work with my son, another person, another person. Right now, continuity of care, he has some providers. One of them is grandma, so that's a little more stable, thankfully. but the other providers also have clients, other clients, because this is what they do for a living because this is their passion. And so if I am asking for time, like today, for example, and if my mom wasn't available and they weren't available, I have one friend, one friend that will take the boys in because she has worked with kids like them, and I am blessed to have that, right? But then their day is mumble-jumbled, right? They're expecting to maybe go to the park or do this or do that. And so even now with the aids that my boys have, the continuity of care is very difficult to keep.

Thank you.

Hi. Okay. When I originally wrote this, it was the beginning of the year. and a co-vice president of Ohio Grandparent Kinship Coalition. And so I originally wrote this when we did some Protect Medicaid events. And I feel like I need to change it, but I'm going to read this. And so here we go. My name is Stephanie. I live in the Columbus, Ohio area with my husband and our 7-year-old grandson. We have been raising him since birth. Being a grandmother, raising a grandchild is not something ever imagined, but it is the most important role of my life. When we gained custody, we were thankful that our grandson was already enrolled in Medicaid. We live on my husband's teacher salary alone. Because of his gross income, we do not qualify for any other government assistance. That makes Medicaid absolutely vital for our family. Having Medicaid means we can meet our grandson's health needs without the constant fear of medical debt hanging over our heads. It allows us to take him to appointments, seek specialized care, and say yes to treatment when he needs it instead of asking, can we afford this? Most importantly, Medicaid has allowed us to address our grandson's mental health needs. Through Medicaid, he is enrolled in OhioRise, a program that has been life-changing for our family. Ohio Rise has connected us with coordinated care and multiple types of therapy that help him function at home, in public, and at school. The progress he has made would not have been possible without the support. The therapies he receives are not optional extras. They are essential to his stability, growth, and success.

Thank you for your testimony. I don't believe we have any questions from the committee. Thank you very much. Our next witness will be Amanda Lynch, opponent testimony.

Thank you for testimony. I haven't heard of any questions from the committee. Thank you. Thank you. Next witness is Sherry Talley, opponent testimony. Going once. Following witness will be Brenda Dykes, opponent testimony. Next we will have Susan McNabb Are you present Susan? The floor is yours

We have a question from the committee. Representative Brownlee.

So MUI is if there's something, if the client is hurt or hurts someone or something unusual, you report that to the county, they investigate it. With my son, he doesn't, yeah, it's hard, it's not predictable. Yeah, like he broke away, window a couple months ago, but he's been fine. He takes a lot of heavy medications, and yeah, you can't track an MUI. And yeah, that's a very good question about that. It's, like I said earlier, it was, they said, because my son, he can't talk. He can't advocate for himself or say what happened. And the workers basically blamed him, and that's when his oldest brother stepped in. But, yeah, with the MUI, it's a good point. You can't really track. Like, my son, his days are different every day. Depending on his mood, he takes about seven medications, very heavy medications. It depends on his workers. You never know. Sometimes they have a behavior out in the community There be an MUI his former provider he someone thought like that the workers were hurting him but they weren't. He was having a meltdown in their vehicle at, like, a speedway, and police were called. And, yeah, but usually, I say 80% of the time he's okay, but it's at 20%, and it can't be predicted. Sorry, I was verbose with your answer, with my answer.

Well, MUI is like the most extreme. He does have incident reports, UI. Like MUI is like a major incident report where MRDD investigates and contacts like the provider, the people there, and does a phone investigation. I would say with just incidents, like it's really hard to say. I would say that like would be more like 40 percent because his days are very unpredictable. You know, he can get upset. He's violent when he's upset. and it just depends. I visit him at least three times a week and he'll have behaviors when I visit. And that's not technically an MUI, but it's a UI. But there's still behavior happening. But it's very hard to track. And that's a really good question. That's something that hasn't been discussed that much. I think one other person talked about it. But just, you know, you can't predict. predictability with severe autism. You just pray they have a good day. And so I don't think anything concerning alerts for providers with unusual activity. Noah has two-to-one staffing, so he has two people there all the time. I've had providers quit on Noah because he was too much. and I will tell you in the four years he's been with DOD, the waiver, they've earned their money, you know, and they don't get paid that much. I mean, he can be a lot to take care of. So I do appreciate that service. But, yeah, I don't think I get it. You want to track people clocking in and clocking out to make sure there's no fraud, but the activity of the clients, that's really hard to say because my son has severe autism, but somebody else might have level 2, and they might be a lot more predictable. So you really have to have, sorry, a knowledge of the different levels of disabilities, you know, and it's just too, yeah, it's very hard to predict. Thank you.

Hi, everybody. My name is Lauren Flynn, and I am a parent provider. And as a parent provider, I'm so grateful to hear about the changes to this bill. But I still wanted to speak to help the elected officials gather today, understand how crucial it is that safe, accessible care can be as readily available as possible for our disabled populations, both pediatric and adult. I'm here to speak up for my children who are unable to do so for themselves. I'm the adoptive mother of three boys with significant and extensive disabilities. My 16 has cerebral palsy My 14 son has autism is blind and is a shaken baby survivor and my youngest has autism and epilepsy They are the light of my life and my purpose and reason on this earth and there nothing I wouldn do for them including standing before you today despite my own anxiety around public speaking Also, to speak on some of the tracking that's being suggested, after this is over, I need to drive two hours to Akron to my son's specialized summer camp, because he's only been there for 24 hours of the week that he'll spend there, and they've already managed to break his G-tube. I will not be paid for the four-hour drive time to go and change the G-tube, which is a service that the specialized facility-based care that he's currently in so that I can have one week break of the entire year is not able to provide. And I will not be compensated for the drive time because that's currently not allowed. So there is plenty of fraud going on against parents. We're not the ones doing it, but I will be giving my four unpaid hours while I'm paying for him to be there. As someone who has children who have benefited immensely from tax-dollar-funded programming, I will always be the first to say that funds need to be allocated with care and appropriate oversight, because when your child has extensive needs, every dollar, every resource is precious. However, any changes that slow access to care are not humane ways to save funds. And as a member of the disability parent community for eight years since adopting my oldest son, I can tell you that a more selfless and honorable group of people than the disability parent community does not exist. So to hear that our community was being accused in this way of fraud, even indirectly, was very painful, given how much we give of ourselves every day for our children, every ounce of our energy, our very lives. In my lived experience, the training, charting, and oversight required to access continued care through parent-provider services is already extensive, difficult, and places undue burden on family caregivers in the current system. So to make it more difficult to access would absolutely cause interruptions in care. It's easy for most people to think of me and parents like me as a stereotype, a welfare mom living off of benefits. That could not be further from the truth. I've actually been able to maintain a career teaching full-time because of the extra resources of my second income as a parent provider. I'm proud to be an Ohio homeowner, public school teacher, and taxpayer, and I want services to continue to be easily accessible to my children so that our family can continue to contribute in positive ways to our community and economy. Everyone wants their child to have the best possible care, and for children with complex health needs that's often not able to be replicated by anyone but their parent who knows what every nonverbal signal means. I am not replaceable as caregiver to my sons, even if other caregivers weren't in incredibly short supply, if impossible to find. Under the current system, when we try to staff hours with other providers, it takes an extremely long time already to get new staff boarded, leading us to lose most of the new providers that I find through aggressive recruitment before they even start. Adding even more provisions will only worsen these issues. Please, I beg you, don't put us back in the dark. I want to continue to facilitate my children thriving in our home, not an institution. We need these programs to stay funded and efficient in order to maintain quality of life for our families. I commend the changes made, but I do think additional oversight is needed to ensure quick patient access to care, as many others have stated today. These changes should not be made quickly to the Medicaid system because the impact will directly affect an extremely vulnerable population with potentially devastating consequences is not made thoughtfully with their needs at the forefront. For example, one of the current provisions of the bill is that IO waiver clients like my son, which they have an IO waiver because they are a higher level of care, are not exempt from some of these extra measures. So I don't understand why that would be because the IO waiver is the highest need. You will save more money by trusting your families your constituents and by involving us in these conversations than you will on making quick snap decisions Thank you

Thank you. My name is Owen Stamler. I'm a family member to my sister Avery, who has autism. I am also a public servant and an Ohio taxpayer. I'm speaking today in opposition to House Bill 795, and my intent is to shed some light into what my perspective is as a family member, a previous independent provider who used EVV with much difficulty, and a public servant whose job it is to authorize these Medicaid services to people with developmental disabilities and monitor these services so that fraud is not happening. A day in the life of what it's like to be a sister to Avery, my parents, despite their best efforts, were not able to get her eligible for Medicaid, county board services, a SNAP card. I had to help her do all of that, and it took me years. So just by getting all of her paperwork in order, understanding the systems in place, what we needed to do, there's your prior authorization, okay? Not anyone can just sign up for these programs. There is a lot that needs to be put into place to achieve that. As a previous independent provider, I used EVV. I still probably have the app on my phone from years ago. The app crashed more than it worked. It also requires you to reset your password very often, which also delays the care. I was a care provider to a woman who lived alone who had cerebral palsy. She needed to get in and out of bed quickly. She's been waiting for hours for me because she was only awarded a few hours of care. But instead I'm sitting there refreshing the app, closing, turning my phone on and off, just going inside anyways because I care about her and want her to be relieved. And instead I can't get the app to work so I have to plug in my hours on my computer at home anyway. So I could have just as easily put in whatever hours I wanted to commit fraud than sit there on my phone. So there's an example of my experience with EVV. As a case manager, a day in life looks a lot like having my caseload of 30 to 100 people. I actively monitor their programs, their funding, their services, their quality of care, reporting on MUIs, making sure no one's being neglected, no one's being taken advantage of. The programs we authorize, within 30 days of authorizing a service, such as a day program or job coaching or transportation, I have to go witness the service being authorized. We have a 30-day meeting to ensure that things are working swiftly. I monitor each new service every time it's adjusted, which is often, and just keep in touch with people to see how things are going. So each of these times I'm visiting, I'm looking at doc sheets. I'm looking at the services to ensure that they are in fact being provided. If they're not, if I am suspecting fraud, I report it. The barrier to me addressing that fraud is my caseload. How can I do that for over 30 people every 30 days? I have more people on my caseload than I do in a month, right? Some of the other barriers that are in place are the providers. If there's a strain on the providers, then they're also spread too thin. They're also doing overtime. They're also combining their clients. So it adds a lot to the barriers in place. One other thing I wanted to touch on is county boards. the services in place are payer of last resort. County boards are the payer of last resort. We need to look at busing first. We need to look at other public programs before a Medicaid service is authorized. That needs to be exhausted, documented, and then I can justify enough support that they are disabled enough to have that service in their plan for Medicaid to pay for that service. So there is another layer of fraud prevention that I have ensured that this is, in fact, going to meet their needs. A large part of what we do is innovation. We have an agency picnic this Friday. I am nominated for an innovation award. That's a core value of our agency. All case managers do is innovate ways that we can meet the needs of the folks we serve in a safe, healthy way. So if you all have questions about ways to be innovative about fraud, prior authorizations, or family caregiving, I would love to answer your questions.

Ooh, one thing to change about EVV, logging in. I would love to have one password that I don't have to change every few weeks. That would be a start.

Thank you, Chairman. Thank you for your testimony. You looked my way. I guess the question is, is it your position we should not have EBV?

Is that another way of saying that you don't think we should have EVV?

Thank you.

Thank you so much, Chair. Sorry, we are also just making our way through some of the details of this. So the question that I have, first of all, thank you for coming. You shouldn't have had to be here, but thank you for being here. The question that I have is related to tools used to detect fraud. And one of the things that we haven't really talked about today is the use of artificial intelligence.

I don't think AI is there enough yet to accurately detect or catch the fraud. I think seeing the services in place, the doc sheets in place, monitored by quality assurance, provider relations, the case manager themselves, the DODD's own certification renewals, increasing those perhaps, would be a much better use of money and time than AI. I don't know if any of you have used it or looked for things, but it's almost always wrong. It needs proofread. It spells things wrong. It does, like, characters that don't even exist. I don't know if you've ever looked at the hand of an AI image. It's scary. So I firmly am against the use of AI for fraud detection.

Thank you, Chair. While we're on the topic of technology, I know we talked about EVV. I don't think that we really had a lot of conversation with you about the GPS tracking. Wondered what your thoughts are about GPS tracking. Specifically, as the bill is currently written, there's no retention schedule for how long that data be kept. I don't believe that there's a requirement to notify someone that if they accept a job as a caregiver that their location will be tracked. If you could share your thoughts about that. Thank you.

Representative Brownlee.

Yeah, reducing the caseload size is the first thing that comes to mind, allocating more resources into the county boards and the case management agencies. If I had less than 30 people, I could provide more visits. I could oversee the care more frequently. I can monitor each of the services more frequently and ensure they are indeed being met. All of the services are driven by a plan. This plan is written by the case manager. This plan is very detailed in the scope of service of what that person's needs are. It's driven by an outcome that we have to monitor as well. So if all of those things are not multiplied but instead divided, subtracted, I could ensure that it is in fact being delivered in the way that Medicaid has approved, that the county board has approved, and that the provider has agreed to complete.

Thank you.

Sarah.

Thank you, Vice Chair Barhurst, Ranking Member Baker, and members of the Medicaid Committee. I am so grateful to be here and speak with you today. My name is Sarah Davies and I am a person who has worked in the ID field since I was 18 years old I started off as a direct support professional have worked for a county board of developmental disabilities as a service and support administrator and a provider supports person. I have run a CE... I've been the CEO of a nonprofit provider agency, and I was the director of relationships for a national financial management service. We support self-direction, which I heard some misconceptions about. So if you have questions. I know that sounds like maybe I'm bragging and I do love a good word of affirmation, but it's so that you understand that when I tell you my most important role within the IDD field is that of mom. I am the very proud mother of five, five mom, oh she left, five mom club, very vibrant children, ages 13, 11, 9, 7, and 5. My 13-year-old daughter, Evangeline, or Evie as we call her, is, I don't like labels, but let's give her the label of profoundly disabled. That's what she's called per the rules. And it has multiple medical complexities. When Evangeline was five, we began the process of seeking support through home and community-based service waiver. Now I have heard people say, oh, you can get on this program with a doctor's note, and if only in my dreams that happens. We had to meet with countless developmental specialists. We had to plead our case. We had people observing, professionals observing my daughter for a total of two hours and then telling me all the things about her as her mom that were quite shocking. We had to go to case conference within the county board. There was a process. One of my favorite quotes is by Rabbi Abram Heschel, and he says words create worlds. And I kind of live by this motto, right? What we say matters, what we write down matters. It all matters. And when I tell you that I'm a pretty resilient lady, the process of going through what we had to go through to get a waiver nearly broke me. Eight years later, and I still feel the despair. I had holding a six-page report on how my daughter would never amount to anything, how her life would always be miserable. my life would always be miserable, and her siblings' lives would always be miserable. We were also pushed strongly to a straight ODM waiver. So while I'm here to advocate for my daughter who is on a DODD waiver, we also cannot ignore the fact that just as many people are using ODM waivers. So to carve out specific things for specific groups when the disability group spans everything could potentially be harmful. I think, and I understand that I'm up, I just really wanted to share the experience that we had in seeking this help that we desperately needed and hearing things, again, about her value, her worth, our life, and even questioning our ability to effectively be parents because we were seeking help within the system. This is a hard journey that a lot of us are on. It's completely worth it. And while I'm up here fighting for my daughter and what I feel she deserves, I also recognize there's a million other people out there, a million could be an overstatement, that need those services as well. I don't know how long, echoing some of Emily's thoughts, I don't know how long she's meant for this world, probably not an exceedingly long amount of time, but there's plenty of people with disabilities living in their homes living in their communities that deserve access and trust and the ability for those home and

Thank you, Chair. Thank you for coming in today. And one of the things I've picked up on today in today's testimony, and maybe you can speak more to this, is you go to your local county board of DD, developmental disabilities, ask for a waiver, and I think I've heard a witness or two say they were encouraged to go through the Department of Medicaid. Are you able to explain the difference between the waiver from the DD and the waiver from Medicaid? Is there really a difference? And if you could talk about that a little bit.

I am not an amazing expert on the Ohio Department of Medicaid waivers. However, there is a big difference in the way they're funded. So DODD waivers that are administered through the county boards have a local match, which is very reliant upon levy dollars, right? You're having those levies passed within your community or not passed lately. and so that is there is a 40% match it's about 60-40 there could be little nuances in there what is being matched by the state and what's being matched with local dollars there is still regardless so an ODM I don't know why well I have theories but we'll keep those to I don know why there is so much push towards those waivers right But it was and it really depends on the caseworker So if your caseworker or that person that there to support you through that process doesn't have good knowledge of both systems, you're going to take the first waiver you get because they're lifelines, right? You're not going to sit there and say, oh, no, no, I'm waiting for the next one. I worked in the system, and I put up a fight because I knew that there were differences and key differences and things that I wanted from her HCBS waiver for her. So because of that, I was able to push through, but not with ease by any means. And sometimes I think it would have been easier had I just gone a different route. That's what I was looking for.

That spurred a few more questions from the committee. Rep. Williams would answer. It was the very same question. He answered that, and then we got Rep. Baker.

That is 100%. I also have been very fortunate to be involved in the Ohio Olmstead Task Force. The majority of my career is through DODD and different provider agencies and everything like that. And being able to interact with these advocates who are on ODM waivers has really expanded my knowledge because I used to think I was fighting the good fight for all people with disabilities, Gomi, and I wasn't. And I was actually doing a lot of harm to the disability community. So I personally feel that it is, if we are supporting people with disabilities, then we are equally supporting ODM, DODD, and Area Office of Aging.

Thank you, Chair. Thanks so much for your testimony. You have such a unique perspective. You're doing it professionally. You're living it. I wanted you just to talk. I think you clarified a little bit about how we have a lot of intersectionality of people, of varying abilities across all waivers, but in particular the non-DD waivers. I wanted to see if you could illuminate a little bit about how long you waited for a waiver. and in your professional experience, how long it typically took for a family to go from needing a waiver to getting a waiver. And thank you.

So that's a question. So something that's very interesting is prior to, I don't have the exact year, but Ohio has technically ended or at least through DODD has ended the waiver waiting list So Evie was placed on a waiver waiting list when she was about two years old and we were told when it comes up it comes up right Now they have adjusted that, and I am not sure. Again, I am more familiar with DODD, not ODM, that there is what's called a waiver wait list assessment, and you can request this from your county board at any time, and it goes through like immediate need, emergency need. I'm going to get it wrong, but do I need it now? Am I going to need it within a year? Or is it going to be two to three years out, right? And especially when getting a waiver for a child, I recognize that is not something that's very common. But there are so many assessments that are done for people seeking services that it's very thorough, right? And Evie falls into a category that's called extraordinary care, where what I do for her so surpasses what a typical 13-year-old would need that she qualifies for a lot of things and would even qualify for family caregiving should I need to go that route in the future. Thank you.

Just one real quick question. What county do you come from and your main experience you're telling us about?

Okay. Thank you.