Report urges caution in planned Medicaid shift

June 26--CHARLESTON, W.Va. -- Pending changes to West Virginia Medicaid could mean people with mental illness get fewer services and are committed to institutions against their will more often, says a new report commissioned by a behavioral health providers group.

The report, issued by the West Virginia Behavioral Health Care Providers Association, urges caution as the state moves to transfer the physical and mental health Medicaid benefits of 55,000 disabled residents to managed care organizations.

The proposed setup is complicated and could mean that some people will lose access to essential mental health services, said report author Laurie Helgoe, a Charleston psychologist and West Virginia University professor.

"When it's confusing to the providers, how much more confusing would it be to a consumer?" Helgoe said.

In a managed-care system, people must visit providers who belong to a managed-care company's network. Under the current fee-for-service model, a patient can visit anyone who accepts Medicaid.

Providers and advocates for people with mental illness say the new system could be difficult to navigate for a vulnerable population. People who receive SSI are very low-income and may suffer from chronic, severe mental illness.

If such people lose access to services that help them function on a day-to-day basis, Helgoe said, they are more likely to end up in psychiatric hospitals.

State Department of Health and Human Resources officials say the plan is meant to integrate Medicaid recipients' physical and behavioral health services.

The state will contract with three managed-care companies. Two of them plan to subcontract administration of behavioral health services to other managed-care companies.

West Virginia Medicaid already contracts with APS Healthcare to manage behavioral health services for Medicaid recipients.

"We're talking about complexity on top of complexity," Helgoe said.

The system also could drive up costs, with less dollars going to services and more to administration, she added.

Her report also questions whether the managed-care organizations have the expertise to serve a chronically mentally ill population -- and whether a state as rural as West Virginia can support a managed-care network.

The Behavioral Health Care Providers Association previously had not commented publicly on the planned transition. Now, it has hired Charleston lobbying firm TSG Consulting to represent providers on the issue.

Association director John Russell said his group is not necessarily against the changes, but believes DHHR is moving too fast.

"There seems to be a headlong rush without proper thought," Russell said. "When we do ask questions, such as, can somebody articulate for us how care will improve, there doesn't seem to be an answer for that."

He and others -- including advocates for people with mental illness and some state lawmakers -- say the situation reminds them of when the state rolled out its redesigned Medicaid plan called Mountain Health Choices three years ago. The switch led to confusion and some people lost access to health coverage.

In recent months, advocates have complained about a lack of transparency in the process.

In a statement, DHHR spokesman John Law said state officials have "already engaged in extensive dialogue with providers" and sought their input.

Last week, the department hosted a discussion with providers, managed-care companies and others.

The planned changes are meant to address "the total health-care needs of our Medicaid clients," he said.

"Individuals receiving behavioral health care may be suffering from physical problems that go untreated in the health-care continuum just as individuals receiving treatment for physical complaints may require behavioral health services," he said.

Law said Helgoe's report neglects to examine the way managed care-companies can help coordinate care.

"They have greater flexibility in meeting the patients' needs than Medicaid," he said. "This is because of different regulations that govern the managed care of Medicaid members."

Enrollment for SSI recipients into managed-care organizations is set to begin Dec. 1.

Beginning Nov. 1, the dental and behavioral health benefits of children and families receiving cash assistance will also be transferred to managed-care companies, which already administer that group's physical health benefits.

Reach Alison Knezevich at alisonk@wvgazette.com or 304-348-1240.

-----

To see more of The Charleston Gazette, or to subscribe to the newspaper, go to http://www.wvgazette.com.

Copyright (c) 2010, The Charleston Gazette, W.Va.

Distributed by McClatchy-Tribune Information Services.

For more information about the content services offered by McClatchy-Tribune Information Services (MCT), visit www.mctinfoservices.com, e-mail services@mctinfoservices.com, or call 866-280-5210 (outside the United States, call +1 312-222-4544).

A service of YellowBrix, Inc.