[NYAPRS Enews] WP: Mental Health Providers Grapple With Medicaid Expansion

[Harvey Rosenthal]

Mental Health Providers Grapple With Medicaid Expansion

By Darryl Fears  Washington Post Staff Writer  October 12, 2010

 

For District health officials, it was an easy decision.

The federal government handed them an opportunity to save $56 million
over four years by expanding Medicaid this summer and they jumped at it
<http://www.washingtonpost.com/wp-dyn/content/article/2010/05/13/AR20100
51304995.html> . They switched 35,000 low-income residents from the city
-funded D.C. Health Care Alliance insurance plan to a Medicaid plan and
reaped the reward.

It looked like a win-win: The city got some financial relief and the new
Medicaid beneficiaries got mental health coverage, which was not part of
the Alliance plan. But it creates a problem for the city's mental
health-care providers, who said this week that they are faced with
serving thousands of new clients they are not prepared to manage.

"We support expanding Medicaid eligibility, but you have to have the
provider capacity to do it," said Shannon Hall, executive director of
the D.C. Behavioral Health Association, an advocate for providers. "If
you do one without the other, you're going to have a bad experience for
the people who need care."

The complaint by Hall and local mental health providers echoes general
concerns
<http://www.washingtonpost.com/wp-dyn/content/article/2010/06/13/AR20100
61304096.html>  about the health-care overhaul raised by hospitals,
doctors, nurses and their advocates nationwide who say the mammoth
program is being built on a network that cannot support it.

Officials at the D.C. Health Care Finance office, which was in charge of
the changeover, said there is no evidence that the local mental
health-care network will be overwhelmed.

And Sharon Baskerville, executive director of the D.C. Primary Health
Care Association, an advocate for comprehensive insurance coverage, said
the complaints are speculative.

"Advocacy is great . . . but it's not to be always about crying," said
Baskerville, who noted that children are already being treated for less
severe mental health problems under the plan. "It's also about working
out solutions."

Mental health screening and treatment as part of primary care is
important, experts say, because problems such as depression, anxiety,
post-traumatic stress disorder and attention deficit disorders often go
undiagnosed until they are severe, and patients show up in hospital
emergency rooms, which increases health-care costs.

Between 11 and 36 percent of primary-care patients have a psychiatric
problem, according to estimates in studies cited by the American Academy
of Family Physicians
<http://www.aafp.org/online/en/home/policy/policies/m/mentalhealthcarese
rvices.html> .

"If you talk to [emergency room] doctors, they'll say they're
overflowing with people suffering from a mental health crisis," said Ron
Honberg, legal director for the National Alliance on Mental Illness.
"They don't have space to put these people."

Federal officials hope to reduce emergency room visits with the
overhaul. The Department of Health and Human Services announced last
month that it will offer a grant package that includes $20 million to
help providers incorporate mental health services into primary care.

Despite arguments for expanding mental health care, and grants to
implement it, mental health providers have their share of sympathizers
because of the enormous task they face.

According to the Centers for Medicare and Medicaid Services, only
Connecticut and the District took advantage of the government's offer to
expand Medicaid for Americans who earn 133 percent of the federal
poverty level - $14,400 for an individual and $29,300 for a family of
four, a category that included more than 13 million uninsured adults in
2008, 17 percent of whom had a fair, poor or chronic mental health
condition, according to a report
<http://www.kff.org/healthreform/upload/8052.pdf>  by the Kaiser Family
Foundation.

The health-care law requires all states to expand Medicaid when changes
are fully implemented in 2014. As states prepare to expand their
managed-care programs under Medicaid, many have cut Medicaid
fee-for-service reimbursements to doctors who deal primarily with
chronic health conditions such as HIV, substance abuse and various
mental disorders.

In the District, one clinic, Mary's Center <http://www.maryscenter.org/>
, said it experienced a 70 percent increase in screenings for depression
after beneficiaries were switched to Medicaid under the expansion.

The center was already stretched thin to care for patients with severe
and chronic forms of mental illness such as schizophrenia, dementia and
bipolar disorder under a contract with the Department of Mental Health.
Joan Yengo, vice president of programs for the center, which treats
17,000 patients a year, said one solution would be to hire a few
managers so that the center can deliver services more efficiently.

"But if they're cutting rates, [care] will be hard to sustain," Yengo
said. "We're a federally qualified health center and we can't turn
people away. You have this demand on your staff, but you're not getting
more resources to increase your staff."

In Southern California, Los Angeles County is bracing for the impact
that expanded Medicaid will have on its mental health services. County
facilities traditionally have cared for residents with illnesses such as
schizophrenia, dementia and bipolar disorder.

"We already have a workforce challenge, a capacity challenge," said
William Arroyo, regional medical director of the Los Angeles County
Department of Mental Health. "We're going to have to absorb people with
less serious conditions. This will force the public mental health system
to manage more efficiently than it has."

In the District, city health officials downplayed concerns over the
proposed rate cut, saying that it offered doctor reimbursements of only
50 percent of Medicare just two years ago. Health Care Finance raised
the rate to 100 percent at that time before proposing to cut it back to
80 percent recently because of budget shortfalls
<http://www.washingtonpost.com/wp-dyn/content/article/2010/09/27/AR20100
92706346.html> .

"Our proposed changes allow us to not have to cut coverage or benefits
for residents who need health insurance, and this puts our rates still
ahead of what most other states pay," Julie Hudman, director of the
finance office, said in a statement.

Federal and city health officials are not overburdening mental health
providers, Honberg said.

"D.C. has spent more for mental health than just about any jurisdiction
in the country," Honberg said. "I sympathize with providers who have to
worry about rate cuts, but they just might have to absorb some of the
impact.

"In the long run, this creates the potential for positive change. In the
short run, some significant adjustments have to be made."

http://www.washingtonpost.com/wp-dyn/content/article/2010/10/12/AR201010
1202647.html?hpid=topnews

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