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Medicaid Providers Say Background Checks Make It Harder To Get Opioid Treatment. Medicaid Disagrees.

Ohio Medicaid says it will continue to enforce a new rule requiring background checks of Medicaid providers. Some of them say the new practice will cost some good providers their jobs and will worsen tight staffing situations. 

Waverly area resident Amy Fife knows what it feels like to be addicted to opioids. Years ago, she was battling that herself. She was convicted of trafficking heroin. But she eventually got treatment. She went to college and graduated with honors and for the past five years, she’s been a counselor and clinical supervisor at the Pike County Recovery Council. But she thinks she won’t be able to hold that job much longer if the Ohio Department of Medicaid, following an executive order from Gov. John Kasich in July, enforces a rule requiring background checks for Medicaid providers. And she says she’s not the only person who would be affected. “Just thinking about the people at my site. There would be 24 people directly affected and almost 50 people indirectly affected," she says.

Lisa Ashata, Director of Peer Services at Coleman Professional Services in Kent, says the Medicaid department’s new rule is unfair to care providers who have moved on from troubled pasts. “People do recover. People can get better," she explains.

Ashata says there are hundreds of people who are now working in the recovery field are giving back to their communities and are relatable to the drug addicted clients they now serve. And The new rule requires providers to go through a background check to obtain a personal Medicaid number to bill the program. Because of their criminal convictions, some of these licensed clinical providers won’t be able to work in their jobs without restrictions or maybe at all. And Ashata says it is already having a devastating effect on agencies like hers.“We are a smaller agency even though we provide so many services in so many different counties, it’s non-profit, we don’t have money rolling in the doors," Ashata says.

Lori Criss, the CEO of the Ohio Council of Behavioral Health and Family Services, says there is already a shortage of treatment providers. She says those in the field are working long hours, often seven days a week, to keep up with the demand. She says eliminating people like Fife just exacerbates an already bad situation. “These are folks who are in these communities doing this ground level work and helping people participate actively in positive things in the communities, stay sober and actively go to their appointments with court and child services. This is a part of the workforce that’s really, really hit hard by this rule," Criss says.

Criss, Ashata and Fife pleaded with lawmakers who sit on a rule-making board to compel the state’s Medicaid Department to scrap it. They say it also appears to conflict with legislation that prohibits new restrictions on job opportunities for people who’ve left prison.

Tom Betti with the Ohio Department of Medicaid says while the agency might tweak it somewhat, the rule should stand. "Our ultimate goal is to allow more qualified providers into the program while also protecting the safety of Medicaid enrollees. We are open to having a conversation with all stakeholders about the tiering structures and disqualifying offenses but there will always be circumstances under which Ohio Medicaid will require a criminal records check," Betti says.

Betti notes Ohio Medicaid isn’t singling out behavioral health workers with this new rule. “The rule allows for more providers, including peer supporters, chemical dependent counselor assistants, physicians, dentists, nurses, advanced practice registered nurses and any other individuals seeking a Medicaid provider agreement. In other words, the rule is for all provider types, not just behavioral health," Betti explains.

For now, those with criminal backgrounds who’ve gone back to court to get qualifying certificates are allowed to continue to work until at least October 1, when lawmakers on this panel will revisit the rule. But permanent changes are unlikely before the lame-duck legislative session this fall. 

Contact Jo Ingles at
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