Thursday, August 30, 2007

Why mental health providers don't want to work with state funded mental health clients: the poorest of the poor

RE: Raleigh News & Observer article; Privatizing treatment left gaps in the system, an expert says, and people without Medicaid can end up with no place to go by Lynn Bonner, Staff Writer

August 29, 2007


Ms. Bonner's welcome article stated the following, which is referring to state funded clients: "...Local mental health offices say it is harder now to find treatment for poor people without Medicaid because companies don't want patients whose bills are paid with limited state money...."

Here is a comment from a provider who directly services state funded clients. State funded clients are people who cannot access Medicaid because: 1. they are not under 21 or over 65 and, 2. they have no children. Given such a democraphics, one can speculate that these are indeed the poorest clients for Medicaid does give one a leg-up in terms of services which advantage one e.g., medical care, etc. Thus, such clients commonly have no transportation and commonly are jobless.

These are the problems re: the state funded clients from the perspective of a provider who has worked with them for several years through all the well-meaning mental health reform changes-----which have been vast:

1. the authorizations are more numerous for state funded clients (every 3 mos instead of once/ year for Medicaid clients)

2. in association with authorization for state funded clients, the overviewing of the paperwork in terms of Diagnostic Assessments, the initially submitted Person Centered Plan (short form), the demanded longer (as in 15 pages plus) Person Centered Plan, which has to be updated with every authorization, is a prohibitive amount of work for a provider. This filling out of paperwork pays no money.

3. if a client merits community Support Services, which entails working with the client in order to make a liveable life and learn skills, the state only allows 2 hours/ week/ client which is not enough to pay for the Community Support worker's gas associated with working with the client. Medicaid clients can receive 12 or more hours/ week/ client of Community Support services. Hooker Odom cut the hours by gigging providers with post payment reviews beginning in April, 200. Now no provider is willing to be endlessly scrutinized by the quality control taskmasters at LME's who, directed by DHHS, go over every document associated with a client should they receive 'medically necessary' Community Support Services of more than 12 hours/ week/ client.

Please don't paint a picture of providers as refusing to work with these clients because 'they don't pay enough money'; contrarily, the problem is that DHHS and the LME's have created barriers to providers working with these state funded clients. The money is the same as for Medicaid; however the barrier of the authorizations, associated, assumably, with the LME's wanting to keep a close eye on the money, has created a situation wherein the providers are not willing to spend many unpaid hours creating paperwork so that the LME can then deny or pass them through the portal----every three months----to work with the state funded clients on a very limited basis.

While your story may be grossly accurate, Ms. Bonner, and while I appreciate it, you do not understand WHY providers do not want to work with state funded clients.

Thank you and I am looking forward to more coverage on these important issues.

Marsha V. Hammond, PhD


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