Personal statements of the risks of not getting care
Allowed one day to stabilize a suicidal teenager – can’t do it.
Short List of Recommendations for Reforming Medicaid
During the last legislative session -- without public hearings and despite the complaints of large
numbers of healthcare providers and groups like NAMI -- the Missouri legislature expanded
managed care statewide. The result: private insurance providers have been placed in charge of
federal Medicaid dollars. Missouri already has serious problems with access to mental health
services: Only 10 of 114 counties in Missouri have adequate access to care. There is a serious
shortage of expert diagnosticians because there are too few psychiatrists and psychologists
available to work with Medicaid recipients. Rural areas are experiencing the greatest crisis in
access and expertise. Managed care reduces services to our most vulnerable citizens at a time
when we need MORE rather than less access to care.
Compassion and common sense demand that our legislators establish controls and accountability
over public funds allocated to mental health services. We know that mental health services
enable people to learn to handle their feelings, improve their relationships, and learn the skills
they need to become productive citizens. We need to provide high quality treatment by licensed
professionals in an efficient, cost effective timely manner. Repeated studies have shown that this
is the most effective way to deliver care, and it is also the most economical. Untreated mental
illness, substance abuse, and tobacco use costs the State of Missouri some 19 billion dollars a
year in lost productivity, healthcare, traffic crashes, crime, and disability costs. Licensed mental
and behavioral health professionals have the tools to help resolve all these problems
In order to protect our Medicaid mental health system and those it serves, the legislature needs to
pass a law or write regulations that:
1. Protect children and other vulnerable populatiosn from harm.
2. Understand that accurate diagnosis is the keystone of high quality and cost effective
treatment. Specify in state contracts and Medicaid waivers that psychiatrists and
psychologists, our best diagnosticians in mental health, are essential staff.
3. Require that paraprofessionals involved in mental health work be supervised by an onsite
psychiatrist or psychologist.
4. “Carve out” safety net programs from managed care, like children’s inpatient psychiatric
services, aged, blind and disabled to prevent their elimination.
5. Avoid medication only approaches to treatment. Require that psychological and
counseling interventions by licensed providers be made easily available without undue
administrative barriers and paperwork. Mandate that psychosocial issues associated with
a child’s inpatient admissions be included in continuation of care criteria.
6. Establish strong controls over how managed care conducts business to ensure that
managed care companies actually provide adequate mental health services to patients,
particularly for those with serious mental illness not eligible for specialty programs, and
work well with providers. We are putting Missouri tax dollars in the hands of companies
from out of state.
7. Create a single set of rules for the Medicaid companies and a standardized billing
interface for providers to replace the current burdensome four sets.
8. Place managed care under the Department of Insurance, Missouri’s appropriate
monitoring agency and levy consequences for failure to perform as contracted.
9. Require managed care and state funded agencies contract and refer to all available, local,
licensed mental health providers of Medicaid mental health services to improve
immediate access to service.
10. Require that managed care companies continue to reimburse services provided by
provisionally licensed psychologists and begin to reimburse provisionally licensed
clinical social workers, licensed professional counselors and psychology interns.
Although the state-run Medicaid system reimburses provisionally licensed mental health
providers, they should also reimburse psychology interns as well.
11. Require that managed care or other state funded companies cover basic psychological
testing for children without preauthorization.
12. Improve coordination of care. Provide consultation codes (such as those used in
Arkansas), so that licensed providers can receive payment for consulting with other
professionals.