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Missouri health care advocates decry Indiana contractor

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An Indiana company hired to determine the eligibility of Missouri Medicaid patients for in-home care has instead "been a complete disaster from the beginning," statewide health care advocates charged on Tuesday.

Indianapolis-based SynCare LLC won a state contract in February to assess whether Missouri's 55,000 Medicaid recipients, many of whom are senior citizens or disabled, qualify for home-based medical services or even help with cooking, cleaning and other daily chores. The contract is worth more than $5 million a year.

Several groups that represent such patients instead want the state to cancel the company's contract, which took effect in mid-May. They say SynCare has been unable to fulfill its responsibilities and is keeping needy patients from receiving vital care with comically inept customer service.

"These are not isolated incidents," said Imre Komaromi, a legislative advocate with the Independent Living Resource Center in Jefferson City. "It's something that's happening systematically, statewide."

Komaromi spoke Tuesday morning at a Columbia press conference, joined by several patients who shared stories of being made to wait on the phone for hours, seeing drastic reductions in the number of hours of care they receive or simply being ignored entirely. Similar rallies were held in Cape Girardeau, Springfield and St. Louis.

SynCare is a certified minority enterprise that helps evaluate and coach Medicaid patients at high risk for hospitalization—those with multiple chronic diseases or high-risk pregnancies, for example.

Last June, SynCare withdrew a request for a property tax abatement from the Indianapolis Metropolitan Development Commission tied to the creation of 114 jobs, citing "changing market conditions." At the time, the firm had 31 employees.

Telephone and e-mail messages to the company's Indianapolis headquarters and its Missouri offices in Ballwin both Monday and Tuesday went unanswered.

A spokeswoman for the Missouri Department of Health and Senior Services, which oversees the SynCare contract through its Division of Senior and Disability Services, said the state is taking the complaints seriously.

"We are aware of the problems SynCare has encountered in these initial months of the contract, and will continue to demand they deliver the services required by the contract," agency representative Jacqueline Lapine said in a written statement.

Troubled by skyrocketing costs in its health insurance program for low-income residents, Missouri lawmakers approved the move to third-party Medicaid eligibility screenings in 2010.

The state had previously allowed client assessments by the same organizations that ultimately provided home-care services — and saw the number of people receiving home services increase by 15 percent, while annual costs grew by one-third.

A consultant estimated Missouri could save $3.4 million annually by using an outside group to determine eligibility, which involves verifying patients' income and health conditions. But groups such as Services for Independent Living and the Missouri Alliance for Home Care say the quick-fix approach will cost the state more as patients receiving less help wind up in nursing homes rather than on their own.

Marcellus Walker, 48, said he's waited two months for SynCare to respond to his request for state services— far longer than the contractual requirement that contact be made within three days, and home visits within 15 days. He described a precarious daily balance caused by schizophrenia, multiple sclerosis and high blood pressure.

"Without (home services), we're kind of lost," Walker said. "It seems like they're just as lost as we are."

Soon after its selection as the state contractor, SynCare announced it would hire an additional 157 workers in Missouri, plus 10 in Indiana. Earlier this month, the company fired 29 employees at its Ballwin office, the St. Louis Post Dispatch reported.

Patients and advocates at the Columbia protest called the SynCare staffers unprepared, overwhelmed and poorly trained. Seventy-two-year-old Russel Hughes of Ashland described spending six hours on the phone one day trying to resolve his concerns — "And they still haven't called me back," he said.

"They don't even fully understand what it is they're doing," Komaromi added. "When you even get somebody (on the phone), they are unable to answer questions, or have no authority."

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  • Addition facts
    As a nurse who did the assessments for an agency I think the public needs to know some additional information. Yes, we did the assessment of the consumers/clients face to face in their homes. Those assessments were then sent to the State of Missouri's Division of Health and Senior Services to determine eligibility. The agencies had no control over their approval or denial. The State made that decision and then notified the agency of their decision. This important fact is not being forwarded to the public by the media although it has been mentioned numerous times. The real problem was the Department was making cuts, laying people off and transferring people within their department and had no one assigned to taking care of the assessments on a regular basis and thus far they became backlogged and a problem. As a registered nurse I am required to practice nursing under the guidelines of the Nurse Practice Act of Missouri. If I do not stay within the guidelines of the Nurse Practice Act I would be reprimanded by the State Board of Nursing and eventually lose my license. I am not going to falsify information just to make a consumer/client meet Level of Care(LOC) to get on the program. I worked to hard to secure a nursing license and will not jeopardize it for the sake of anyone or any company.
  • Logical conclusion
    So the provider used to do the verification on eligibility and "surprise", cost to the state went up. So the lawmakers say "privatize" or "outsource" to a 3rd party, so that the provider's vested interest is neutralized...SynCare was a competitive bidder, who knows their job is to drive down the cost of the program...and since they have to work for a fixed contracted amount, they want to do that with as few employees as they possibly can, the fewer people who qualify for services, the better Syn-care has done by state standards, why not just stonewall people who need services? You maximize the contract benefit while achieving the state's goal...so both the providers and Syn-Care were/are cleaning up at the public's expense (except that the providers did actually provide service). It is the same old story...the state program always is abused, and people who should not get services do...then you privatize and put in the profit motive and business model, and now almost no one can get services, needy or not....which is how the state got involved in the first place. one thing is for sure...the taxpayer always loses...

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