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COLUMBUS, Ohio — Wheelchair manufacturers and suppliers fear they’ve been sacrificed in thestate’s budget negotiations ina way that would cost jobs, damage their industry and threaten nursing home patients’ access torehabilitative wheelchairs.

Those are the complexwheelchairs that are custom-made for patientssuch as paraplegics or those with multiple sclerosiswho have moderate or severe physical challenges that can’t bemet by standard wheelchairs. Industrymembers hearthey could lose a direct reimbursement from Medicaid, see that amount cut and then diverted through nursing homes where many of their customers live.

Carol Gilligan, president ofHealth Aid of Ohio in Cleveland, spent the last two days in Columbus trying to find out about the behind-closed-doors addition to Ohio’s budget bill. Health Aidspecializes in customizing, assembling and delivering the wheelchairs –a $15 million-a-year industry in Ohio, Gilligan said.

She learned of the possible cut when nursing homes started calling to cancel wheelchair orders because they, too, hadheard of the change.

Legislators on Friday compromised on an overdue state budget by agreeing to add slot machines to help close a $3.2 billion shortfall. Some health-care interests that thought their industries were going to see cuts now appear to have gotten a reprieve. The state, for example, has re-funded portions of its mental-health budget.

The finer points of Friday’s compromise are still unclear, and details were scarce this evening. Better information will continue to trickle out as legislators review the budget early next week.

Here’s what Gilligan is telling people: In an effort to get more federal matching dollars for Ohio’s Medicaid program, legislators have proposed bundling fivesupplemental services — physical therapy, occupational therapy, outpatient ambulance services, and the supply of over-the-counter drugsand complex rehabilitative wheelchairs– that are provided to nursing home residents.

Right now these servicesare provided by suppliers — like Health Aid of Ohio — that are independent of the nursing homes, Gilligan said. Medicaid then pays the suppliers a fee for their services. The result of the change,Gilligan has been told, is nursing homes would be reimbursed $4 a day per patient for all five of the supplemental services.

Under the proposed change, nursing homes would receive the Medicaid payments in a convolutedfee transaction with the state, Gilligan said. The wheelchairs would belong to the nursing homes, not the patients, she said. So if a patient left a nursing home, the wheelchair would stay behind.

Bundling these services for nursing home residents increases the expenses of thehomes, enablingthestate toqualify for moreMedicaid dollars, Johnny Miller, homecare manager of Miller’s Sales & Rentals ofAkron, told legislators during testimony on Tuesday.

Gilligan and others fearthe change would make it next to impossible for nursing homes to afford the complex wheelchairs, which can range from $3,000 to $15,000.

What’s more, the change would devastate businesses in the industry. Gilligan said she would lay off 20 workers and Miller testified he would cut 25 to 35 of his 100 employees.

The budget change also couldaffectInvacare Corp. in Elyria,which makes many of the complex rehabilitative wheelchairs and accessories supplied by Health Aid of Ohio. “I’m concerned because it means (loss of) jobs at Invacare, andpatients don’t get the chairs they need,” said A. Malachi Mixon, Invacare’s chairman and chief executive.

Mixon also thinks there’s no guarantee that the newfunding to nursing homes wouldbe spent on wheelchairs and could be used in other ways.

The possibility of this change has been discussed for about a week,and some legislators oppose it. Sen. Dale Miller wrote aJuly 8letter to Ohio Rep. Ron Amstutz outlining the likely outcomes of the budget change: “First, nursing home patients will go without needed services, since not enough reimbursement is provided for them, and the savings from any services not provided fall to the bottom line,” Miller wrote

“Second, nursing homes will essentially bid the services on cost, and higher quality providers will be put out of business,” Dale Miller continued. “Third, failure to provide wheelchairs will leave patients bedridden, leading to more illness, more hospitalizations, and higher costs. Fourth, if a patient changed providers or moved to PASSPORT or assisted living, their wheelchair would not move with them because it would belong to the nursing home.”