Why does Medicaid money flow toward Cincinnati?

Three paragraphs in a 2,300-page bill passed in the 2005-2006 session of the Ohio General Assembly is costing nursing homes in the Mahoning Valley tens of millions of dollars in Medicaid reimbursements each year.
And, yes, we said the bill, H.B. 66, was 2,300 pages long. Download a PDF copy from the Ohio House Website if you dare.
It's easy to understand how something could almost get lost in a bill of such size. But it's impossible to understand how anyone in the Legislature could have seen those three paragraphs as being fair.
Peer problems
The section at issue established three geographic "peer groups" for all the nursing homes in the state that accept Medicaid reimbursement. Essentially, those groups are rural, which get the lowest reimbursement; urban, which get the middle reimbursement, and the six-county Cincinnati area, which gets the highest.
In round numbers, the difference is about 10 per day per patient from group to group. So a nursing home in a rural area would get about 150 a day, in an urban area about 160 and in the Cincinnati area, about 170.
On the face of it, the plan looks fair. Logically, it costs more to run a nursing home in an urban area than in a rural area, and maybe it costs the most to run one in Cincinnati.
Or maybe Ohio politics has a lot more to do with who is getting what out of this deal. Because, you see, while the Republican Legislature put the heavily Republican Cincinnati area in the top tier, it put the entire Mahoning Valley -- Mahoning, Trumbull and Columbiana counties -- in the lowest, "rural" tier.
The differentiation is no small matter. A group of nursing homes and nursing home employees from the three Valley counties plus Stark County are banding together under the name Northeast Ohio Senior Rights Advocacy group to call for changes in the formula.
Big numbers
There are about 10,000 nursing home employees in the four-county area taking care of as many as 10,000 nursing home residents. In fiscal year 2005, there were 1,983,899 Medicaid patient days in the area, being reimbursed from the state at the lowest rate. If reimbursement were at the urban rate, there would be almost 20 million more a year added to the area economy. The gain would be twice that at the Cincinnati rate.
We are not arguing for the state to waste money on Medicaid reimbursements. Indeed, we have said in the past that the state should be prudent in overseeing Medicaid costs and should work to keep people in their homes, rather than in nursing homes, for as long as possible. Home care is not only preferred by most people, but it is less expensive.
However, when a nursing home is the only place in which a patient can get the care he or she needs, the reimbursement should be fair and should be based on the cost of doing business, not on the political bent of a county or area.
Certainly, Cincinnati and Hamilton County, in which it is located, are urban. But it doesn't get much more rural than adjacent Clinton County, which has a population of about 43,000, 96 percent Caucasian and a per capita income in 2005 of 27,073. That income is 12,000 less than Hamilton County, and about 400 less than Mahoning County. Yet Clinton County nursing homes are eligible for the highest reimbursement while Mahoning County gets the lowest.
Members of the area nursing home advocacy group have their work cut out for them. They're soliciting the support of local legislators, which they'll get. And they may be able to get the ear of Gov. Ted Strickland.
But getting relief from the General Assembly is going to be tough, regardless of how unfair or even illogical the existing peer groups may be. But the effort must be made before inadequate reimbursements affect the level of care that patients in this area receive.