By: Lindsay Wallace, Executive Director
Recently, we’ve received a high volume of calls on our support line from people on Medicaid who were finding it increasingly difficult to get care. It’s not hard to imagine the frustration and sense of helplessness these individuals felt when every provider they reached out to told them they were no longer accepting Medicaid patients.
As a result of the high volume of calls we were receiving, I’ve spent the last few months meeting with community mental health providers and private practitioners to get a better understanding of why people in need of treatment and on medical assistance (MA) were being turned away.
It became evident that the issue affected individuals on straight MA, or fee-for-service, and not those served through BadgerCare HMO contracts or SSI Managed Care contracts. Under fee-for-service, qualified Medicaid providers are paid for each covered service such as a psychiatric evaluation, outpatient therapy, or targeted case management according to rates set by the state. Currently, the fee-for-service rate paid by Medicaid is, on average, about 50 cents on the dollar.
Over the years, there has been little increase in the reimbursement rate even though the cost for delivering mental health care services continues to rise. With this in mind, providers like Journey Mental Health Center (JMHC), who offers services to many MA clients, have faced significant financial losses.
Lynn Brady, CEO of JMHC, said, “In the past, we used some of the general purpose revenue (GPR) we received from the county to supplement the fee-for-service rate. However, the county has to control their costs also, and no longer allows us to do this. They are focusing county dollars on the uninsured.”
Given the toll the financial losses were taking on JMHC’s budget, they made the decision to no longer admit straight MA (fee-for-service) clients into services from their Central Intake Unit. However, this does not mean that Journey is not seeing straight MA (fee-for-service) consumers. In fact, they are seeing high numbers of them.
Lynn explained, “The difference is that now, straight MA consumers get into service here because they had a crisis and were seen in our Emergency Services Unit.”
The result of the above change? Unfortunately, rates that are not reflective of the full costs to provide services mean straight MA clients must deteriorate to a point of crisis in order to get timely access to care. We know that early intervention leads to the best outcomes but stagnant fee-for-service rates guarantee poorer access to care and sicker adults and children. This is unacceptable.
Though the county and community providers like JMHC have advocated for change, as well as many other human service providers across Wisconsin, there has been no movement in bringing about the needed changes. It appears that this is largely due to the lack of awareness on the part of policymakers about the severity of the issue. This lack of awareness may, in part, be due to the fact that unlike a sudden crisis, poorer access to care has been progressive in nature, happening slowly over time. As a result, there is little to no media coverage of the “quiet crisis”, which often serves as the catalyst for change.
So, where do we go from here?
It’s no surprise the solution is adequate mental health funding to cover the costs of delivering care; however, accomplishing that goal rests with the state. NAMI Dane County and community mental health partners and providers, and other key stakeholders can educate policymakers about the negative consequences poor reimbursement rates have on the people they believe they are covering.
Our greatest asset and most powerful tool for accomplishing this goal is to use our voices by contacting legislators and leveraging relationships with various media outlets. Power in numbers exists when policymakers hear from a large number of their constituents advocating for the policies that ensure those affected by mental illness have access to quality mental health care support and services.
To stay up to date on this issue, sign up for our action alerts at www.namidanecounty.org/policy-issues/ or join the Advocacy Committee, which meets on the 2nd Monday of every month from 5:30pm-7:00pm at the NAMI Dane County office. You can also contact your state representatives directly. If you do not know who represents you, go to legis.wisconsin.gov and click “find my legislators.”