Delay Medicaid behavioral health changes
Ohio is facing the most gripping addiction and mental health crisis in our history, and the Ohio Department of Medicaid is about to make it worse. Policy changes implemented on January 1 slowed resources for the current capacity of addiction and mental health treatment, and additional modifications scheduled for July will negatively exacerbate the situation. These next strategies, if implemented, threaten to blemish Gov. John Kasich’s admirable record on Medicaid expansion.
The Department of Medicaid has undertaken a process known as Behavioral Health Redesign with the goal of modernizing regulations and resources to increase service capacity and move coverage for services to managed care plans on July 1. This transition is supported by providers who have been collaborating with the administration and managed care to successfully implement the new approach. As expected, there are abundant challenges with such a massive change, and many problems are taking longer to overcome than originally believed.
In public meetings, the department shares the hopeful message that everything is going exactly as planned. But a deeper look at the state’s data and providers’ metrics for success tells the real story of what is happening quietly, nearly invisibly in every community. Fewer resources are flowing to communities for addiction and mental health treatment. Nurses are being laid off, so it is more difficult for people to access medications that keep them stable. Group counseling is being cut, so fewer addicted Ohioans get needed treatment. Crisis intervention capacity is diminishing, leaving the mentally ill with few options but the streets or jail. Families have less help for children who are suicidal.
A survey of members of the Ohio Council of Behavioral Health & Family Services Providers demonstrates that Behavioral Health Redesign has fractured an already fragile system meant to help Ohioans living in the shadows with mental illness and addiction. To ensure that no one gets turned away from services even when resources aren’t flowing, providers have used cash reserves, lines of credit and are selling off assets. While this helps providers serve people already in their care, they can’t increase capacity to fully respond to the unrelenting opiate and mental health crisis at their doors. When organizations receive less than 70 percent of the resources needed to provide services, it is only a matter of time before they can’t help anyone at all.
The next big change for behavioral health is set to occur on July 1 when all recipients of Medicaid will have these services turned over to managed care. This will result in the further slowing of resources when cash flow becomes the responsibility of five managed care plans instead of one Department of Medicaid. Again, the department says it is ready for this change, but the data tells a different story. Currently in the implementation of Behavioral Health Redesign through MyCare Ohio — a demonstration of managed care coverage of behavioral health services — 25 percent of claims are being rejected and resources are reportedly flowing at about half of what was planned.
The state’s original timeline called for a 12-month transition between the two phases, which has been reduced to six months. The July 1 timeline was set by the Ohio Department of Medicaid to accomplish a goal during its leadership tenure and nothing more. In recent months, providers have been unfairly portrayed as resistant to change or dragging their feet and hoping these changes go away. In fact, providers have invested hundreds of thousands of dollars and hours in preparing their workforce and technology to successfully participate in these changes.
Given everything that’s known, modifying the implementation plan and timeline would demonstrate sound management of Ohio’s resources to ensure that Ohioans don’t permanently lose access to care.
The best option for successful implementation is for the Department of Medicaid to move forward with the transition to managed care only when criteria for both fee-for-service and MyCare Ohio claims indicate readiness. Such metrics include reducing claim denial rate to the historical 10-percent threshold, ensuring actual payment received is consistent with budgeted resources and achieving higher successful claim testing rates with managed care plans. The state also must fully resource providers to sustain current capacity for behavioral health services after July 1.
Ohio has historically had a social contract for a safety net between the government and behavioral health providers that take care of our most vulnerable loved ones suffering from mental illness and addiction. Providers are doing their part by drawing upon their assets to make sure that people don’t suffer because of bureaucratic changes. We urge the Department of Medicaid to carry out its responsibilities to Ohio’s citizens by ensuring a strong and stable behavioral health system now and into the future so that Ohio’s next governor has a legacy to build upon and not a mess to clean up.
Lori Criss is the chief executive officer of the Ohio Council of Behavioral Health & Family Services Providers, a statewide trade and advocacy organization.