Hello Penn State: what do you know about Buncombe County, NC? And why would the editors of the NC Medical Journal allow researchers who do not understand the lay of the land to publish an 'Original Article'?
My comments, sent to the editors:
From: Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 5197
To: North Carolina Medical Journal editors
Re: July/ August 2012 article: "The Cost of Medicaid Coverage for the Uninsured: Evidence From Buncombe County, North Carolina" ; authors: Hwang, W, Griffin, K, Liao,K, , Hall, M.
I would like to submit this as a "Correspondence" comment which I see you feature in the journal which I have been taking for several years. Thank you for considering this submission. I did have a 'commentary' submitted in the past, about a year and a half ago, which was published.
Disabled vs Non-Disabled Buncombe County Residents Would Have Provided a Clearer View of Possible and Future Medicaid Usage in Buncombe County, NC
In the July/ August NCMJ, Hwang, W., Griffin, L, Liao, K, and Hall, M, located at Penn State University, which is decidedly not in NC, provided information concluding that "...uninsured adults would have incurred costs 13% greater than those of the actual non-disabled adult Medicaid population." It would have been useful if the authors had defined, "disabled" and "non-disabled" or if the editors of the journal had required them to define this.
As a resident and mental health provider who lives in Buncombe County and who has at least taken a look at the Project Access (volunteer providers) participation which these authors outline to be a cornerstone of their data gathering----and which they conclude in their Limitations as problematic in that, "some volunteer physicians provided no treatment information, and those that did provide such information had less incentive to report all possible diagnoses", I have to conclude that the basis for their conclusions is erroneous re: the 13% greater costs if the uninsured in Buncombe County were to be enrolled in Medicaid.
What is the basis for the authors' conclusion that these two populations are comparable?
As a clinical psychologist, I know very few adult clients who are Medicaid recipients and not disabled. Indeed, Western Highlands Network (WHN) LME, the mental health administrative entity, located in Buncombe County, published in January, 2012, that there are approximately 80,000 Medicaid eligible citizens in Buncombe County. Given that the authors stated that "Non-Disabled Medicaid Enrollees" total about 22,000, this means that the bulk of the Medicaid recipients in Buncombe County are Disabled. To paint a picture of the uninsured who are serviced by the very difficult to work with Project Access (I have spoken with them in the past) as representative of Buncombe County's Medicaid recipient is disingenuous. Did the Penn State authors understand how underutilized the Project Access is? Did they understand that mental health providers do not work at all, best I understand it, with Project Access? What, indeed, is the usage rate of mental health services for the approximately 80,000 Buncombe County Medicaid Enrollees?
Moreover, is a "Non-Disabled" adult someone who receives Medicaid but no Social Security Benefits? This would outline someone who has not been able, or is not inclined, to move through the rigorous Social Security Disability procedure, a matter which commonly requires the assistance of an attorney. The basis for the authors' conclusion is associated with the comparison of 'non-disabled' Medicaid Enrollees and uninsured patients who have approached and been serviced by Project Access (though how complete the record gathering was for these patients who were given free treatment is very questionable).
The population that the authors seek to compare to the non-disabled Medicaid Enrollees, in the parlance of NC mental health care, would be 'State Funded Clients': non-insured/ non Medicaid clients living at or below the Federal Poverty Level. And until the Medicaid Waiver program was put into place as of January 3, 2012, by Western Highlands Network (WHN) LME-MCO, the administrative arm of NC DHHS as regards Medicaid mental health clients, very few providers would work with these 'State Funded Clients' as associated with the onerous paperwork required to be filed w/ WHN LME.
Now, however, as associated with the Medicaid Waiver, which was hoisted onto the backs of providers across NC, providers who continue to see their disabled and non-disabled Medicaid recipients must have filled out 45 pages of re-credentialing paperwork in order to continue to be paid by Medicaid---if they were allowed to remain "In Network", and the procedure for being paid to see Medicaid clients has become as difficult and time consuming as was previously true of working with the State Funded Clients.
Thus, a more timely article, from authors who understand what is taking place regarding the fairly disastrous NC Mental Health Reform, which started in 2000, would have reviewed these overlapping issues: 1. what is a non-disabled Medicaid patient; 2. why choose non-disabled Medicaid recipients as a population useful for comparison with the Project Access non-insured when approximately 75% of Medicaid recipients are disabled in Buncombe county if one takes the authors' adult non-disdabled Medicaid Enrollees as accurate information.
There are many more salient questions that could be researched by those who have some understanding of just where we have been and where we are regarding NC mental health reform----if you consider mental health care to be part of health care, that is. Project Access may not have much to do with mental health care, but to paint a picture of 20% of Medicaid recipients as comparable to non-disabled non-insured Project Access patients has muddied our understanding of who out there needs Medicaid and what this might cost. We need clarity, not research that does not relate to what has mostly taken place in Buncombe County and NC, in general.