In recent years, there has been a general recognition that the mental health care system in the United States and in Connecticut is in a state of crisis. Unfortunately, Governor Ned Lamont may be on the cusp of making a decision that could negatively impact access to mental health care for low-income people who are often the most vulnerable: allowing the privatization of the Medicaid system by turning it over to managed care organizations (MCOs) run by private insurance plans.
As a mental health provider, I currently have experience in both MCO and non-MCO Medicaid programs. The non-MCO programs in Connecticut are much easier to practice in. If this plan is adopted, it could lead to further disempowerment of the mental health provider workforce.
The need for mental health care is great and appears to be growing, but the system made up of community agencies, private practitioners, and pharmaceutical providers cannot meet the demand. As a licensed clinical social worker and psychotherapist, I have heard numerous stories from people looking for therapists that they are struggling to find available therapists since the COVID-19 pandemic began, including myself, who are nearly full. Surely, making mental health care available to as wide a range of people as possible should be a priority for both federal and state governments.
There are many reasons why I’m happy to live and work in Connecticut, but one of them is that since 2012, Connecticut has had one state-run Medicaid plan called HUSKY. Everyone on Medicaid in Connecticut is on HUSKY. This makes it super easy to accept clients on Medicaid and bill them for the services you provide to them. There’s one application process for credentialing and one organization providers need to interact with for all their Medicaid clients. This makes my job a little easier and motivates me to continue accepting HUSKY and working with low-income clients who are often the ones most in need.
I am also licensed in New York State and provide telehealth sessions there. New York State has a fragmented, privately run Medicaid system with many approved plans, some of which are run by for-profit health care companies. This means that providers must go through the lengthy process of signing up for each plan, each of which has different billing requirements. This can make interacting with providers very complicated and frustrating.
I have personally had to terminate a client’s contract because they needed to change Medicaid plans to continue receiving the medication they needed, and the new plan did not accept the new therapist. This, of course, disrupted the client’s mental health treatment. In fact, I became so frustrated with the New York State system that I terminated two of the three Medicaid plans I was originally accepted into.
Community mental health agencies serve low-income populations and provide critical services. They accept all insurance plans, and under the privatized Medicaid system, they accept clients regardless of plan. I have worked in this system and know firsthand the dedication of the providers.
Mental health agencies tend to hire young therapists straight out of graduate school who, while always well-intentioned and well-trained, lack experience and expertise in their field. As anyone who has received services from these agencies can tell you, there is high turnover as many of the therapists work for the agency for a few years and then move on to higher-paying jobs or private practice. When agencies are overcrowded, clients usually don’t have the time to meet one-on-one with the therapists they need.
I choose Medicare and Medicaid because I have seen first-hand how inadequate the level of trauma care is in the agency system and I feel strongly that access to skilled care should not depend on an individual’s income level. But as an independent private provider who does all of the billing myself, I only have a limited amount of time to spend on credentialing and billing, which takes time away from caring for people who need my help. When the process becomes too onerous, I have to opt out. That’s what happened with the New York State plan. I’ve spoken to many colleagues about this issue, and I’m far from alone.
In HUSKY’s case, the only reason the claim was denied was because the client did not have insurance on that particular day. In the case of the New York plan, the denials were confusing, unclear, and occurred so frequently that it was untenable for me to continue with the plan. It is not uncommon for private practice therapists, who have far more skill and expertise than agency therapists, to not accept insurance. Of course, this limits the availability of the most skilled providers at a time when there is widespread agreement that we need more access to mental health, not less.
If HUSKY were privatized and allocated to a number of private companies, each with their own requirements, credentialing processes, etc., the added burden would very likely cause therapists in private practice to abandon the plan, depriving low-income clients of much-needed care from the most experienced providers. And, as a result, clients would turn to the agency system, where they would be very unlikely to get the care they need because they would be assigned to therapists fresh out of grad school who will move on to higher-paying jobs or private practice when they are able.
Turning HUSKY over to an MCO would be a disaster for low-income clients, therapists in private practice, and the region’s already overburdened mental health care system.
If it ain’t broke, don’t fix it – your Husky is working just fine the way it is.
Donna Nicolino is a licensed clinical social worker in Willimantic.
