TOPEKA — Practices by Medicaid managed care organizations jeopardize Kansas’ already fragile mental health system, one expert says.
Tara Wallace is a native Kansan who has spent her career as a social worker and trauma therapist helping vulnerable people and advocating for resources and support in her profession.
“I was community-based when I started working and just fell in love with advocating for so many people that I worked with that weren’t getting the resources that they needed, the voices that they needed to be speaking to people in power, people that make policies,” Wallace said on the Kansas Reflector podcast.
Recently, in multiple online groups, Wallace noticed mental health professionals were posting that their Medicaid contracts were terminated for no cause. The frustration expressed by others in the field inspired her to speak out.
In a state that ranks 37th in mental health workforce availability and where 96 out of 105 counties are designated as Mental Health Professional Shortage Areas, such contract issues worsen the situation, she said.
“There’s a long-term impact, and there’s a snowball effect to this,” Wallace said. “Providers are so busy doing the work, they don’t have the time or the capacity to reach out and say, ‘Hey, this is what’s happening to us.’ If we’re already in a crisis, eliminating the workforce is not the way to address it.”
Providers are credentialed through managed care organizations, filling out 20-plus page forms and going through the approval process for each network, Wallace said.
“Once we’re approved, we become providers in that network,” she said.
Medicaid networks can cut providers off for no reason, and often with short deadlines to transition clients to other providers, Wallace said. Sometimes, the terminations are linked to mental health providers that aren’t meeting a certain level of revenue. Other times, the provider has no idea why they’ve been cut out of the network.
In fact, the provider may not know they are no longer in network until their insurance claims are denied, she said.
“When that happens, we usually don’t find out until months later, when we start getting denials or the money
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that we were paid is recouped, or you’ll get a reimbursement of $0 saying that this individual was not covered,” Wallace said.
It can take hours on the phone trying to figure out what happened, she said.
The main concern is how to keep providing support and therapy for patients, Wallace said.
“They’ve been seeing me consistently. We’ve established trust. We have created a plan,” she said. “They are working that plan, and they’re being successful, but I can’t continue to see them for free, because, unfortunately, social workers don’t live on love.”
Therapists are left to determine if they can move the client to a sliding scale or help them find a different therapist, all the while worrying they will retraumatize their client, Wallace said.
Terminations from Medicaid managed care organizations seem to be happening more often, Wallace said, sometimes to entire organizations and smaller rural community mental health centers.
Those rural areas often have more sparse services in the first place, she said.
“It’s disheartening to explain to someone that the provider that they used to have to drive an hour to see is no longer in the network, and so they have to drive three hours to the next provider, and there may be a wait list to get into that provider,” Wallace said.
The uncertainty and difficulty of managing Medicaid contracts means fewer therapists are willing to deal with the program, she said.
“My personal opinion is that we don’t have a shortage of providers,” Wallace said. “We have a shortage of providers that are willing to take Medicare and Medicaid because of how the policies are able to do the things that they’re doing. It’s risky.”
Especially with high-acuity clients — like the foster children Wallace works with — the uncertainty is scary.
“People aren’t widgets that need to be adjusted, and then they’re fine,” she said. “That’s not how therapy works. It’s not how anything that we do works. But the expectation is that we are to follow this line and do it in a way that gets it done and gets them out the door, and that’s not ethical for us.”
Managed care organizations often define rigid timelines for therapy work, but helping clients may not fall within those timelines, Wallace said. If she provides more than 45 minutes of therapy, for instance, she likely will be audited.
“It’s frustrating to me that we have to walk this tightrope in order to protect that relationship that we’ve been working on so hard, because that’s at the core of the work that we do,” she said. “If we don’t have the trust, they’re not going to put in the work.”
Other states have changed statutes to protect clients, and Wallace would like to see changes in Kansas.
New York, she said, has statutory due process.
“You have to have detailed written notice explaining why a termination is proposed,” she said. “The provider has 30 days to request a hearing … and the termination cannot take effect less than 60 days after the notice.”
The New York rules apply to all providers, not just Medicaid, Wallace said.
“It’s beautiful because it saves a lot of disruption to the process,” she said. “I think that we should look at something like that, because it helps everybody. If you want a healthy state, it can’t just be based on the financial condition of the (managed care providers). It has to be the mental, emotional, physical, economic, all of that of the people involved in the state.”
