Advocates slam state Medicaid review, urge focus on fixing reimbursement rates

CT Examiner – Tuesday, November 19, 2024
By Emilia Otte

Janine Sullivan-Wiley, head of the Northwest Regional Mental Health Board, likened Gov. Ned Lamont’s proposed Medicaid services review to “hiring an interior decorator … while the roof is caving in.”

“An expenditure of this kind when Connecticut already has what is notably one of the more functional systems in the country seems to me an extraordinary waste of money, where money is desperately needed to shore up the [Medicaid] rates,” she told members of the state’s Behavioral Health Partnership Oversight Council last Wednesday.

Earlier this month, a group of advocates wrote a letter to Lamont warning against moving from the state’s current fee-for-service model — in which insurance pays medical professionals based on the number of services a patient receives — to what is called a “capitated” model, where states pay Managed Care Organizations a fixed amount per person each month to manage the Medicaid system.

Council members echoed these concerns, saying they feared the change could damage some of the more functional aspects of Connecticut’s current system, such as the efficiency of receiving pre-authorization for medical procedures and processing claims. They also worried that patients would have more difficulty getting treatment.

“The way managed care is able to save money is they deny access. That’s just the way it is, and we hear that every day,” said Terri DiPietro, council chair and the director of outpatient behavioral health services at Middlesex Hospital.

“I haven’t heard a worse idea about anything going on with what we do with HUSKY than this in the last almost 15 years,” added Kelly Phenix, an advocate appointed to the committee to represent consumers. She said she didn’t expect any effort would be made to educate HUSKY recipients about the change or why denials had suddenly increased.

“This is a bad idea. Leave it alone. We may have somewhat of a broken system now, but it will be bottom-of-the-barrel horrible if we were to move into this kind of a system. We can’t afford to do that for the people that we serve,” she said.

Prior to 2011, the state operated under a managed care system. In their Nov. 1 letter, advocates noted that the change improved the quality of care and saved residents money.

Sheldon Toubman, an attorney for Disability Rights Connecticut, told CT Examiner earlier this month that when the state was operating under Managed Care Organizations, a larger percentage of people’s tax dollars was going toward administrative costs and profits, rather than the actual health care services. He said it was a “nasty situation” until Gov. Dan Malloy eliminated the system when he assumed office.

“We’ve really done well [since] in terms of quality, which is what the advocates care about. But from the point of view of the legislators and the executive, we’re doing really well on cost control. So this whole thing, to us, makes no sense,” he said.

In October, the Department of Social Services contracted with the firm Accenture to analyze “Innovative Delivery and Payment Models” for the state’s Medicaid system, including managed care organizations. Accenture subcontracted with the consulting firm Manatt to perform the study — a move that the letter signatories criticized.

The letter noted that Manatt’s clients include Aetna, Blue Shield of CT and Kaiser — organizations running managed care plans — and that it has filed amicus briefs supporting the Medicaid Health Plans of America trade group.

Julia Bergman, spokesperson for the Governor’s Office, said policymakers had a responsibility to regularly review their policies and that Lamont’s goal was to ensure Medicaid recipients were “receiving access to high quality, equitable care.”

“This review will provide the administration and the General Assembly with information on whether there are improvements to achieving this goal that we can implement, and we shouldn’t be afraid of receiving that data. At this time, Governor Lamont is not proposing any policy changes — whether administratively or legislatively — on this topic,” Bergman wrote.

Council members also criticized Manatt, arguing that the state should skip the study and instead use the funds to raise Medicaid reimbursement rates for therapists, social workers and other mental health specialists.

“Taking a system that is currently broke and deciding that the way to fix it is to turn it into a managed Medicaid program is really ridiculous,” Community Health Resource President and CEO Heather Gates said. “You don’t start with a base of financing that is inadequate [and] decide to turn it over to companies whose principal goal is [to] deny care rather than improve access and have that improve the quality of what people are going to receive.”

According to the contract between the state Department of Social Services, which subcontracts with Manatt, Connecticut agreed to pay $400,000 to conduct the study.

Meanwhile, DiPrieto said agencies statewide are laying off hundreds of employees despite growing demand. Steve Girelli, CEO of Klingberg Family Centers, said his organization hasn’t had layoffs but struggles to retain staff.

“We are turning referrals away at a time when the need for behavioral health services for children and families is extremely high, and we can’t meet that need in large part because we can’t adequately staff the clinic in order to provide the services that those folks are asking for,” he said.

Nonprofits have long complained about gaps between the cost of providing mental health services and what Medicaid will pay. A 2022 report released Monday by the Office of Healthcare Strategy found Medicaid paid less than half the amount that commercial insurers paid for a visit with a psychiatrist. And a report published in February by the state Department of Social Services highlighted the low rates that HUSKY paid for mental health services in comparison to other states.

“Low reimbursement rates may cause fewer providers to accept insurance, exacerbating the workforce shortages and further limiting access to behavioral health care,” the Office of Healthcare Strategy report read.

In a meeting of the Transforming Children’s Behavioral Health Policy and Planning Committee last Wednesday, New Haven-based Clifford Beers CEO Alice Forrester gave examples of three clinics where the payment gap fell between $50 and $140 per clinical session. She said one clinic faced a loss of more than $1 million per year.

“It’s absolutely unacceptable that the state pays 50% — or more, sometimes — below what the actual cost of the service is,” she said.

The Department of Social Services said in a Tuesday statement to CT Examiner that the state has made significant investments into behavioral health, and that future investments would be determined based on the outcome of the second phase of the legislature’s two-part study on Medicaid rates.

“Over the past two years, the state has prioritized behavioral health services, investing an additional $29.3 million on access for children and adolescents,” the statement read. “As investments were made based on the information from the first part of the rate study we will work on any additional investments based on information from the second part of the rate study, which will be released to the legislature in January.”

Access this article in its original source.