By Debra Jasper
and Spencer Hunt
Enquirer Columbus Bureau

SPECIAL SECTION

• Extreme Choices: Thousands of parents with severely ill children face decisions most of us cannot imagine, as cash-strapped states are slashing Medicaid and cutting off families who desperately need help.

COLUMBUS - Ohio agencies must do more to help parents who face "heartbreaking" choices while trying to get health care for their severely ill children, Gov. Bob Taft said Wednesday.

Responding to a three-day series published this week in The Cincinnati Enquirer, the governor said he supports a plan to create a special Medicaid program that would help some of the most medically fragile kids in Ohio.

At the same time, the governor said he opposes any move next year to fund new health-care mandates, such as a proposed high-risk health insurance pool that would help families with sick children pay for coverage. The state and businesses just can't afford them, Taft said.

"We are being forced into very heartbreaking and painful decisions about where to spend our limited dollars," he said. "It's a tragic situation. The problem is overwhelming."

The Enquirer's "Extreme Choices" reports found that middle-income parents are spending their savings, selling their homes or considering divorce or bankruptcy to either qualify for government health care or to pay for their children's care themselves. The tough choices fall on families as state and local governments confront hard times by cutting programs that once helped thousands.

The governor said he backs efforts by Ken Ritchey, director of the Ohio Department of Mental Retardation, to create an initiative that would waive income guidelines and help hundreds of children who need ventilators or other expensive care.

Ritchey said he would like to offer as much as $160,000 a year in state aid for each severely ill child who qualifies. "Our goal is to keep people out of hospitals or institutions," he said. "More kids are surviving because of medical technology and it's my goal to support them in their own homes."

Taft said he also wants to crack down on agencies and companies that waste Medicaid dollars. The Enquirer found that some Medicaid patients have private insurance that is supposed to cover their medical bills, but when claims are denied, the state picks up the tab. Medicaid is a federal and state program to help the poor.

Doctors and others say the state could save millions by simply challenging insurers who deny those claims. Kentucky saved $63 million last year when it denied nearly 240,000 claims that could have been paid by private insurance.

Taft said he was unaware that the Ohio Department of Job and Family Services didn't follow up to make sure Ohio doesn't wrongfully pay claims. Officials said the department was too short-staffed for such checks.

"That's a specific area we will home in on in response to the series," he said.

In addition, Taft said he will make sure the department goes after misspent Medicaid funds and more closely track payments. An analysis of state audits revealed that private companies misspent at least $135 million in Medicaid funds since 1995. Yet the state has recovered only 10 percent of the money that companies overbilled for doctor visits, oxygen, ambulance trips and other health-care services.

The lack of a serious collection effort is "disappointing," Taft said. "We have to be more aggressive in pursuing waste and fraud."

'Absolute mess'

Some Cincinnati lawmakers expressed disbelief that the department wasn't already taking such action. "It's a mess, an absolute mess," said Sen. Mark Mallory, D-Cincinnati. "Of course, we should be going after money, and making sure that private insurers are doing their part and paying claims they should cover."

Mallory said the state could afford to help more families in need if it saved or recovered millions of dollars.

"Ohio has a responsibility to provide a safety net to people in tough situations who have no clear way out," he said.

Mallory and several other local lawmakers say they plan to back a bill in the Ohio Senate that would create a high-risk insurance plan to help more families pay for their health care.

People in 33 other states, including Kentucky and Indiana, can buy state-backed plans that cover treatment for conditions such as cancer, heart disease or hemophilia.

Ohio instead makes insurance companies sell coverage to anyone at no more than 2.5 times the normal rates. That can put premiums out of reach for some families.

Lynn Wachtmann, R-Napoleon, the bill's sponsor, says the measure is needed because families with seriously ill relatives can't pay their bills. Supporters say the program would cost Ohio employees about $1 more a month in higher health-insurance premiums.

Taft reiterated a call he made last week to place a one-year moratorium on all new health-care mandates on businesses. He says such mandates hurt businesses, hurt jobs and further reduce coverage to families.

"There are only two ways to pay (for them)," he said. "Either the state pays, and we've been in fiscal crisis because of high Medicaid costs. Or the other option is to spread the costs to businesses."

Taft says he doesn't like the situation, but there is little he can do.

"The miracles of medical care are much greater now, but there is a cost that comes with that," Taft said. "I'm frustrated, because I just don't have a good answer."

E-mail djasper@enquirer.com and shunt@enquirer.com