In December, the Nevada Division of Health Care Financing and Policy (HCFP), the state Medicaid agency, switched to a new Electronic Visit Verification (EVV) vendor that takes payment claims from Personal Care Agencies (PCA) for service provided to thousands of people living with disabilities.

During the transition, many PCA providers were not paid correctly or paid for hours provided by caregivers since the end of December. The new system, Sandata, incorrectly calculated claims, or deleted them. In addition, there was a health care cybersecurity hacking which also deleted payments.

As a result, many companies have been struggling to stay open, and pay their caregivers for in-home care. Personal care aides provide services such as bathing, grooming, dressing and eating, helping people get out of bed to begin the day. Many clients are low-income and receive their care through Medicaid, the state health insurance agency.
Las Vegas based Good Samaritan PCA employs about 95 personal care workers that provide service to more than 100 Medicaid clients. Agency owner, Ana Bailetti said “These people that receive these services, they are under the poverty level, they can barely make rent, buy a little food and that is it.” Bailetti said she is having to go into her 401(k) to pay her caregivers to do the work.

HCFP Administrator Stacie Weeks has worked to rush emergency funding to the Medicaid contractors, but the billing has been incorrect, shorting companies for services performed. Emergency funding totaling $2.5 million to personal care service providers was given to more than 200 companies serving people on Medicaid as of March 8, but because the funds did not total the correct billing, many companies are still plagued with inaccuracies and panic they may go out of business.

The Personal Care Association of Nevada (PCAN) met March 19, and Medicaid providers voiced their concerns. Bailetti told the association, “Medicaid needs to be held to the same standards they hold us to; we continue to have issues that need resolution.”

PCAN has requested five or six times that Medicaid contractors be allowed to participate in the decision-making process so they can understand what is going on while the transition from Authenticare to Sandata is occurring. To date, that has not happened, leaving many agencies frustrated.