In recent years, the recognition that the mental health care system in the United States and Connecticut is in something of a crisis has become commonplace. Unfortunately, Gov. Ned Lamont may be about to make a decision which could negatively impact access to mental health care for low-income residents, who are often the most vulnerable: allowing our Medicaid system to be privatized by turning it over to Managed Care Organizations (MCOs) run by private insurance plans.
As a practicing mental health provider, I have current experience with both MCO and non-MCO Medicaid programs. Connecticut’s non-MCO program is far easier to practice in. We could lose even more mental health provider capacity if the plan is adopted.
The need for mental health care is great and seems to be increasing, and the system, comprised of community agencies, private practitioners and medication providers, can’t meet the demand. As a licensed clinical social worker psychotherapist, I can attest that since the start of the COVID-19 pandemic, the psychotherapists I know, including me, have been almost entirely full and I have heard numerous stories from those looking for a therapist who have struggled to find one with any openings. Certainly, making mental health care as accessible as possible to the widest variety of people should be a priority for both our federal and state governments.
One of the many reasons I am happy to live and work in Connecticut is because since 2012 Connecticut has had one Medicaid plan called HUSKY which is directly run by the state government. Everyone in Connecticut who has Medicaid has HUSKY. This makes accepting clients who have Medicaid, as well as billing for services provided to them, very straightforward. There is one application process for credentialing and one organization with which a provider needs to interact for all of their clients who have Medicaid. This makes doing my job a bit easier and encourages me to continue accepting HUSKY and working with the low-income clients who often have the most need.
I am also licensed in New York State and provide telehealth sessions there. New York has a fractured, privatized Medicaid system which allows for a number of plans, some of which are run by for-profit health care companies. This means that a provider has to undergo the time-consuming process of applying to each of those plans, and they have varying requirements for billing. This makes interacting with them at times very complicated and frustrating.
I have personally had to terminate with clients because they needed to switch their Medicaid plan in order to continue on needed medications, and their new plan was not accepting new therapists. This of course is disruptive to the client’s mental health treatment. In fact, I have found the New York State system so frustrating that I ended up dropping two of the three Medicaid plans I initially accepted.
Community mental health agencies serve low-income people and provide a vital service. They take all insurance plans and under a privatized Medicaid system will accept clients regardless of their plan. I have worked in this system and know firsthand the dedication of the providers.
Mental health agencies tend to hire young therapists right out of graduate school who are invariably well-intentioned and who have gotten some good training, but who lack experience and expertise in their field. As anyone who has sought services at these agencies can tell you, the turnover is high, as many therapists spend a few years at an agency and then move on to better-paying jobs or private practice. The flood of people coming into the agencies means that clients typically never get the one-on-one time with a therapist they need.
I choose to take Medicare and Medicaid because I saw how very inadequate the level of trauma treatment was in the agency system and I feel strongly that getting skilled care should not depend on a person’s income level. However, as a solo independent provider who does all of my own billing, there is only so much time I am able to spend on things like credentialing and billing. It takes time away from caring for people in need. If the process becomes too onerous, I need to drop out. This is what happened with the New York State plans. Having spoken to many of my colleagues about this issue, I am far from alone in this.
With HUSKY the only reason I have ever had a claim denied is if a client was not covered on that particular date. With the New York plans, the denials were confusing and obscure, and happened often enough that continuing to take the plans was untenable for me. It is not unusual for therapists in private practice, who typically have a much higher skill level and expertise than those in agencies, to not take insurance. This of course limits the availability of the most skilled providers at a time when there is wide agreement that we need more mental health access, not less.
If HUSKY becomes privatized and gets doled out to numerous private companies, all of which have their own requirements, credentialing process, etc., the additional burden of this will very likely cause therapists in private practice to drop the plan, depriving lower-income clients of much needed care from the most experienced providers. And this in turn will make those clients turn to the agency system, where they are very unlikely to get the care they need as they are assigned to a therapist who is likely fresh out of graduate school and moving on to a better paying position or private practice when they are able to.
Turning HUSKY over to MCOs would be a disaster for low-income clients, for therapists in private practice and for the already overburdened community mental health care system.
If it ain’t broke, don’t fix it. Husky is working just fine as it is.
Donna Nicolino is a Licensed Clinical Social Worker in Willimantic.