Ohio to Require Background Checks for Medicaid Providers

By Michael Klazema on 10/9/2018

The Ohio Department of Medicaid recently announced a new rule that will require background checks for all Medicaid providers in the state. Medicaid providers are health services practitioners who accept Medicaid payments and bill the state directly for these services. The new rules from the Ohio Department of Medicaid—which went into effect on July 1—require Medicaid providers to obtain a Medicaid billing number through the state to receive reimbursements for services provided. No Medicaid provider can get this billing number without passing a criminal background check.

According to a report from Ohio Watchdog, this new policy has drawn ire from the American Civil Liberties Union (ACLU). The ACLU argues the new rules are at odds with the stance Ohio Governor John Kasich has taken on criminal justice reform throughout his term in leadership. Kasich called for the background checks in July by way of executive order. ACLU lobbyist Gary Daniels compared the policy to a “big door shutting in those people’s faces,” with “those people” being healthcare practitioners with criminal records.

Not all crimes would prevent a person from becoming a Medicaid provider. Per coverage, the list of crimes that would bar someone from playing this role in the health care system is primarily comprised of violent offenses. Convictions for crimes such as murder, rape, aggravated assault, kidnapping, and aggravated robbery would all bar someone from becoming a Medicaid provider in the state of Ohio. Several non-violent offenses are also on the list, including prostitution, drug trafficking, and theft.

According to a report published by WOSU Public Media, a Columbus-based radio station, the new background check requirement is most likely to hit practitioners with drug use (and drug convictions) in their pasts. WOSU spoke with several counselors who work with drug-addicted patients and try to help them get and stay clean. In some instances, these counselors can offer the assistance and advice they provide because of their backgrounds. One counselor interviewed in the WOSU segment has a heroin trafficking conviction in her past. She chose her field because she wanted to give back to the community and help people who were in a similar situation to the one she once knew.

Under the new Ohio Department of Medicaid background check rule, practitioners such as these would likely be barred from participating in the state’s Medicaid program.

WOSU spoke with Tom Betti, the Department of Medicaid spokesperson, who said the rule might be tweaked to allow for a “tiering structure.” The background check requirement currently applies to all healthcare professionals—from doctors and nurses to dentists all the way to behavioral health counselors.

Legislators are meeting this month to discuss whether certain fields ought to be given more leeway with their criminal background checks. Those discussions began on October 1. In the meantime, practitioners with criminal backgrounds have been able to go to court and receive temporary qualifying certificates to be Medicaid providers.



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