More Medicaid Reimbursement Woes

Providers of services for children with autism are the latest group to describe the harm caused by the state’s low Medicaid reimbursement rate.

Wisconsin Health News (9/22) includes an interview with Jackie Vick and Mike Miller, the president and treasurer of the newly formed Wisconsin Autism Providers Association.  One of the five goals of the WAPA is to “Increase reimbursement rates for Medicaid treatment.  Low reimbursement rates are the primary cause of client demand exceeding the supply of providers…”

Miller and Vick conducted a survey to see if other providers shared the problem of “putting families in a holding pattern” because of an inability to take more Medicaid clients.  The answer was “yes across the board for all of those providers.”

Miller estimated that over 500 children in the state are waiting for treatment under Medicaid funding.  The lists are growing by 15 to 20 children a week and could total 1,000 by the end of the year.

Vick said that providers have responded to the challenges of the reimbursement rate in different ways.  Some limited the number of Medicaid clients in order to maintain fiscal stability.  A related problem, she said, is the difficulty of hiring therapists and technicians because of the low rate of pay.

She pointed out that access to treatment for young children pays off for them and for  taxpayers.  Vick said, “…the research shows that they make great gains and the lifetime costs of care for a child on the autism spectrum go down.”

The low Medicaid rate affects children with other behavioral health problems.  Here is an excerpt from the Kids in Crisis/Legislative Action Tracker article that was part of a series by USA Today-Wisconsin (June 2016)

There is evidence that Wisconsin’s Medicaid reimbursement rates – among the lowest in the country – are shutting children out of accessing outpatient behavioral health care and leading to higher costs associated with emergency psychiatric care.

A report by Milwaukee’s Public Policy Forum found that in Milwaukee County, low reimbursement rates were stopping mental health providers from accepting Medicaid patients. A 2014 survey by the Wisconsin Statewide Medical Home Initiative found that only 20 percent of Wisconsin pediatricians said they could find therapists when needed for their patients on Medicaid, and just 5 percent could find psychiatrists for patients on Medicaid.

Check out “Voices from the Front Lines: NAMI’s Lindsay Wallace” on this blog for a report on how people with mental illness in Dane County are affected by the rate.

Click here to read a study by Pew Trusts that reports experiences of states that supplemented Medicaid rates for primary care doctors.

 

 

 

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Look for the Tiny Rays of Sunshine in Walker’s Budget

Wisconsin Health News (9/22) offered comments by advocacy organizations about small steps forward in this year’s budget.  Here are excerpts.  WHN is a subscription service.

“The Survival Coalition of Disability Organizations said the budget would help eliminate long-term care wait lists for 2,200 children with physical, developmental or emotional disabilities. And they called a 2 percent increase in Medicaid personal care rates “an important first step in addressing the workforce crisis.”

“Wisconsin Health Care Association and Wisconsin Center for Assisted Living Executive Director John Vander Meer lauded the budget for including a 2 percent increase for skilled nursing facilities and a $60 million increase for Family Care over the biennium.”

“Linda Hall, executive director of the Wisconsin Association of Family and Children’s Agencies, said the budget makes a “significant investment” in student mental health by providing $3.25 million in new grants along with Medicaid-funded consultation services.”

On the other hand, WHN also reported that Walker vetoed a resolution passed by the Joint Finance Committee stipulating that the state’s requested Medicaid waiver could not be implemented without its approval.  The requested waiver is the most Draconian in the country.

Voices from the Front Lines: NAMI’s Lindsay Wallace

Lindsay Wallace, executive director of NAMI-Dane County, published a blog post that offers a good explanation of how Medicaid reimbursement rates can limit access to care for many people.  She titled her article, “The Quiet Crisis in Dane County Mental Health Services.”   Here it is.

“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 action alerts at : https://www.namidanecounty.org/policy-issues/.    The website for NAMI-Dane at http://www.namidanecounty.org has information about its advocacy committee and other events.

Check out the post “Low Reimbursement Rates for Medicaid Limit Access to Care” on this blog for more information.

 

State’s Low Reimbursement Rates for Medicaid Limit Access to Mental Health Services: Tell Legislature to Act

Medicaid, which is Badger Care in Wisconsin, is the most important source of funds for mental health services.  Private insurance companies are second.

State governments set reimbursement rates for the people and institutions that provide those services.  Rates in Wisconsin are among the lowest in the country, meaning that many mental health professionals and institutions can not afford to provide care or find it more profitable to work only with private insurance companies and Medicare.  The result can be limited or no access to mental health care for Badger Care recipients.

Click here to read an excellent story about the debate between a state senator and the WI Department of Health Secretary Linda Seemeyer about raising those rates.

Here are some excerpts from reporter Keegan Kyle’s article.

“Department of Health Services Secretary Linda Seemeyer repeatedly ducked requests to state a position on hiking Wisconsin’s rates, which are among the lowest in the nation.”

“A hike in Medicaid reimbursement rates for mental health providers wasn’t included in Walker’s proposed state budget this year, and legislative leaders haven’t been confident about boosting rates, citing competing budget priorities.”

“At the March 29 budget hearing, Seemeyer first told Sen. Jon Erpenbach, D-Middleton, that the state has been “trying to look at” rates for mental health services. Then she deferred rate hike decisions to state lawmakers. Then she said more study of rates was needed and suggested using a “pay-for-performance” system to reward providers who produce results. Asked if higher rates would help expand treatment services, she said, ‘Perhaps.'”

According to a video of the testimony accompanying the article, reimbursement rates for counseling in Wisconsin are $32/hr, as contrasted with $70/hr in Minnesota and $65/hr in Iowa.  The Department of Health returned $330 million to the General Fund .

UPDATE:  At an event sponsored by Wisconsin Health News in early June, Sen. Alberta Darling, co-chair of the Joint Finance Committee, said. “Would we like to give personal care workers more? Of course we would. But we cannot at this time. … I think provider rates in general for Medicaid are a huge issue. We’re, I think, at the bottom if not second from the last. Our provider rates are not good enough and it’s going to be a challenge significantly in the years coming up.”

UPDATE:  In July 2016, the Dane County Department of Human Services convened a meeting of contracted providers for behavioral health services to discuss issues and opportunities for collaboration.   Medicaid reimbursement rates was the top issue mentioned by DCHS.  Others were acceptance of new Medicaid patients by psychiatrists and some therapists and access to prescribers.

UPDATE:  Here is an excerpt from the Kids in Crisis/Legislative Action Tracker article that was part of a series by USA Today-Wisconsin  (June 2016)

There is evidence that Wisconsin’s Medicaid reimbursement rates – among the lowest in the country – are shutting children out of accessing outpatient behavioral health care and leading to higher costs associated with emergency psychiatric care.

A report by Milwaukee’s Public Policy Forum found that in Milwaukee County, low reimbursement rates were stopping mental health providers from accepting Medicaid patients. A 2014 survey by the Wisconsin Statewide Medical Home Initiative found that only 20 percent of Wisconsin pediatricians said they could find therapists when needed for their patients on Medicaid, and just 5 percent could find psychiatrists for patients on Medicaid.

UPDATE: (Aug 23,2017) New Richmond News reports that “In 2014-15, long-term care facilities in Wisconsin reported a $331.8 million “Medicaid deficit.”  The deficit is due to the low reimbursement rates for long-term care services.  Click here to read  “A Never Ending Death Spiral: SV Health and Rehab Faces Closure.”

UPDATE:  See “Walker Raised Medicaid Reimbursement Rates for Mental Health and Substance Abuse Providers” on this blog for recent information.

 

 

Gov. Walker Proposes Funds for Children’s Mental Health Services

Thanks to the Advocacy Committee of NAMI-Dane County for this information about Gov. Walker’s budget proposals for children’s mental health services.

Walker proposes  a categorical aid program of $3 million to pay for social work expenditures of school districts and independent charter schools, a grant program of $2.5 million to help connect youth to mental health services; and $1 million to provide training for school employees about how to provide mental health screening and intervention services.

A policy advisor to Wisconsin School Supt. Tony Evers will meet with the Advocacy Committee at 5:30 on February 13 at the NAMI office,  2059 Atwood Ave., Madison.

Check back here for more information about Walker’s budget proposals affecting mental health services.

Wisconsin Coalition Finds Nearly $900 Million for New Investments in the State’s Families and Workers

A coalition of health, welfare and labor organizations is pushing back on the idea that the state can not afford to spend money to improve the lives of its middle-income and poor residents.

“For too long, we’ve all been told that there’s not enough money in the budget to help our communities thrive. That is not true,” a spokesperson claimed.

Where did they find the money? In two tax loopholes that benefit those in high-income tax brackets. Elimination of a tax break that greatly reduces the state income tax for certain manufacturers and agricultural producers would yield about $284 million annually. Nearly 80 percent of the credit goes to people earning over $1 million. Treating capital gains like ordinary income would yield about $164 million annually. The top 2 percent of earners receive almost half of the capital gains tax breaks. The analysis assumes a two-year legislative budget.

The savings could buy a lot. “A Wisconsin Budget for All” proponents offered a list that includes an increase in living wages for caregivers, an expansion of the earned income tax credit that would help low-income workers, free tuition at technical colleges for seniors and some older workers, a new funding stream to hire and retain teachers, and other programs that would improve the lives of Wisconsin residents.

The coalition includes 18 organizations. Its website is: http://www.facebook.com/WisconsinBudgetForAll.   Click here to access the full budget report.

UPDATE:  The Wisconsin Budget Project reported that 19 states increased the minimum wage this month.   Most states exceed the federal requirement for a minimum wage of $7.25/hour.  Wisconsin’s minimum wage remains at $7.25/hour.  Click  here to read the full report.

UPDATE:  The Wisconsin Budget Project updated its information on the cost to taxpayers of the tax break for agricultural producers and manufacturers.  Below is an excerpt from the report.

“The Manufacturing and Agriculture Credit (MAC) is on track to cost the state an estimated $299 million this year by cutting taxes for manufacturers and others – and more than $650 million in the two-year budget period that starts in July 2017.  The cost of this tax break is running more than double the amount that lawmakers originally anticipated when they approved the credit in 2011.”

Prison Reform Saves Money and Cuts Crime

Wisconsin’s crime rate increased 12 percent from 2009 to 2014, while Minnesota’s rate decreased by 6 percent.  Consider those figures along with the fact that state and local governments in Wisconsin spend nearly twice as much per capita on corrections as those in Minnesota.  In FY 2013, the figures were $259 for each resident of Wisconsin and $163 for each Minnesota resident.

WISDOM, a network of faith-based organizations in Wisconsin, used those figures and other analysis to make a strong case that criminal justice reform saves money and reduces crime. Their representatives spoke before the state’s Legislative Council Study Committee on Reducing Recidivism on October 17.

The bad news: Wisconsin is the only state during the last decade to have moved backwards in terms of reform. Eighteen states have enacted “big and comprehensive reform” and 15 states have enacted “significant reform.”  A “driving motivation of reform is the crippling cost of incarceration.”

The good news: Several common sense steps could be taken quickly that would move the state towards a more humane, effective system and save taxpayer dollars.  Fully fund the Treatment Alternatives and Diversion (TAD) program that has reduced recidivism and costs of incarceration; review the status of 2,800 parole eligible prisoners, many of whom are caught in administrative limbo, and reinstate a successful early release program.

Even better news: The Council of State Governments Justice Center and the Pew Charitable Trusts have worked with 23 states to promote “justice reinvestment,” intended to reduce corrections spending and reinvest the savings in strategies that reduce recidivism.  Technical assistance is available free of charge if a state is selected for help.

For resources and more information about WISDOM’s Restore our Community project, click here.

UPDATE:  Click here for a letter from Sen. Lena Taylor published in the Milwaukee Courier describing outcomes of the hearing.