Dayton, Ohio-based CareSource suspended repayment demands it previously issued to some Ohio behavioral health providers after therapists and social workers organized public opposition to the policy change, Cleveland.com reported May 25.
The organization, Ohio’s largest Medicaid managed care plan covering more than 1.4 million members, told some providers in April that it had overpaid them for treating Medicaid patients and sought recoupment for up to two years of claims. Repayment demands ranged from $6,000 to more than $10,000.
CareSource said the issue stemmed from providers being reimbursed at 100% of Ohio Medicaid’s maximum fee schedule rate instead of the 85% rate required for certain behavioral health providers under state rules. The payer said future claims “will be paid at the correct rate based on the terms of our provider agreements.”
Behavioral health providers said the lower reimbursement rates could lead some clinicians to stop accepting Medicaid patients, reducing access to care. One marriage and family therapist told the outlet she faced a repayment demand of $95,000.
In response, therapists have organized rallies, petitions and outreach efforts. A Facebook group for affected caregivers grew to 700 members in two days, the report said.
CareSource said it suspended the recoupment process but did not confirm whether repayment demands had been permanently canceled.
State Rep. Karen Brownlee, D-Symmes Twp, criticized CareSource’s planned recoupments and said they stem from administrative errors by the payer, according to an April 23 news release. She also said the move highlights broader issues with Medicaid administration in Ohio and led her to introduce the Medicaid Saving Act.
The development comes as state Medicaid budgets are estimated to decrease by $664 billion through 2034 following the signing of HR 1.
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