How to get mental health services via Medicaid for someone who does not YET have Medicaid
This is a conversation associated with the example of 'Debbie', a woman with a serious mental health issue, who has been written about by Scott Sexton of the Winston Salem Journal. The link to that article: cut and paste it into your browser:
http://www2.journalnow.com/content/2008/sep/07/
debbies-case-confirms-that-mental-health-reform-fa/
opinion-columnists-ssexton/
Here is my explanation of HOW TO GET MEDICAID FOR SOMEONE. Most people do not understand the process and it is not that complicated and it certainly is not explained well by the various county DSS's in NC.
***************
The woman associated w/ Debbie's care, stated, in a letter to Scott Sexton:
"Where are the trained people who have the common sense to see the problem and not send them away to further destroy themselves."
There is very little transparency re: 'how to get to a provider' re: NC mental health reform.
When NC Mental health reform started cranking in 2002-2003, the notion of CHOICE was foremost in the mind's of the LME's as it was a core agenda item associated w/ NC mental health reform.
Choice meant that clients, whoever they were, were given information about a range of providers from which to choose, should they call the LME.
As the years have proceeded, this is what happened re: choice: there is no choice as there are so many providers now who are not willing to see state funded clients (I am assuming that Debbie is a state funded client).
Why is that?
the paperwork is overwhelming. The time spent to process a patient it prohibitive. I do not have hours to call the LME in order to set up some very very minimal amount of outpatient therapy, begging for it.
This is what I have done. LISTEN CAREFULLY.
Go the county's dss office; get an application for disability which will include an application for medicaid. fill it out w/ for the client. take it back to dss. once you have turned the paperwork in the clock starts. clients can generally be seen by qualified providers e g., psychologist, etc., if they understand how the medicaid system is laid out, immediately and it can be back-billed. sometimes sessions can be back billed beyond even when the paperwork is turned in.
LISTEN CAREFULLY: medicaid applications and ssi applications are turned in at the same time. MEDICAID CAN BE OBTAINED FAIRLY QUICKLY if the therapist or professional who has seen the client will DO THE PAPERWORK and send it to the medicaid adjudicator when the client is INITIALLY DENIED MEDICAID. This kicks in a process such that the adjudicator gets involved.
THE PAPERWORK IS NOTHING MORE THAN ACCURATE, DESCRIPTIVE THERAPY NOTES.
As re: my state funded client which I did this for, I went to the adjudicator's house in Asheville (they work out of their homes, I believe) and explained the situation to him in a 5 min talk; I forwarded my notes to SSA/ Asheville as well as to the adjudicator, my therapy notes, and fairly quickly the client began to receive paperwork from the local DSS so that she could receive medicaid.
IN ORDER FOR THE MEDICAID TO CRANK, THE DISABILITY APPLICATION ALSO HAS TO BE KEPT 'GOING' BY THE SENDING IN OF THE PROFESSIONAL'S PAPERWORK TO THE SSA OFFICE AS WELL AS TO THE ADJUDICATOR WHO FUNCTIONS INDEPENDENT OF THAT PROCESS.
YOU CAN FORGET THE STATE FUNDED CLIENT STUFF; THEY WILL NOT BE ABLE TO GET WHAT THEY NEED VIA THAT LME MANAGED SYSTEM.
http://www2.journalnow.com/content/2008/sep/07/
debbies-case-confirms-that-mental-health-reform-fa/
opinion-columnists-ssexton/
Here is my explanation of HOW TO GET MEDICAID FOR SOMEONE. Most people do not understand the process and it is not that complicated and it certainly is not explained well by the various county DSS's in NC.
***************
The woman associated w/ Debbie's care, stated, in a letter to Scott Sexton:
"Where are the trained people who have the common sense to see the problem and not send them away to further destroy themselves."
There is very little transparency re: 'how to get to a provider' re: NC mental health reform.
When NC Mental health reform started cranking in 2002-2003, the notion of CHOICE was foremost in the mind's of the LME's as it was a core agenda item associated w/ NC mental health reform.
Choice meant that clients, whoever they were, were given information about a range of providers from which to choose, should they call the LME.
As the years have proceeded, this is what happened re: choice: there is no choice as there are so many providers now who are not willing to see state funded clients (I am assuming that Debbie is a state funded client).
Why is that?
the paperwork is overwhelming. The time spent to process a patient it prohibitive. I do not have hours to call the LME in order to set up some very very minimal amount of outpatient therapy, begging for it.
This is what I have done. LISTEN CAREFULLY.
Go the county's dss office; get an application for disability which will include an application for medicaid. fill it out w/ for the client. take it back to dss. once you have turned the paperwork in the clock starts. clients can generally be seen by qualified providers e g., psychologist, etc., if they understand how the medicaid system is laid out, immediately and it can be back-billed. sometimes sessions can be back billed beyond even when the paperwork is turned in.
LISTEN CAREFULLY: medicaid applications and ssi applications are turned in at the same time. MEDICAID CAN BE OBTAINED FAIRLY QUICKLY if the therapist or professional who has seen the client will DO THE PAPERWORK and send it to the medicaid adjudicator when the client is INITIALLY DENIED MEDICAID. This kicks in a process such that the adjudicator gets involved.
THE PAPERWORK IS NOTHING MORE THAN ACCURATE, DESCRIPTIVE THERAPY NOTES.
As re: my state funded client which I did this for, I went to the adjudicator's house in Asheville (they work out of their homes, I believe) and explained the situation to him in a 5 min talk; I forwarded my notes to SSA/ Asheville as well as to the adjudicator, my therapy notes, and fairly quickly the client began to receive paperwork from the local DSS so that she could receive medicaid.
IN ORDER FOR THE MEDICAID TO CRANK, THE DISABILITY APPLICATION ALSO HAS TO BE KEPT 'GOING' BY THE SENDING IN OF THE PROFESSIONAL'S PAPERWORK TO THE SSA OFFICE AS WELL AS TO THE ADJUDICATOR WHO FUNCTIONS INDEPENDENT OF THAT PROCESS.
YOU CAN FORGET THE STATE FUNDED CLIENT STUFF; THEY WILL NOT BE ABLE TO GET WHAT THEY NEED VIA THAT LME MANAGED SYSTEM.
posted by Marsha V. Hammond, PhD at 4:28 PM
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