Medicaid Carve-In Conundrum
Opposing the Medicaid Carve-In
Recently, legislation was introduced in Maryland that would drastically alter the way behavioral health services are offered in our state.
Currently, PDG and other behavioral health organizations operate as “carve out” services; meaning that the administration and oversight of behavioral health services functions separately from the remaining medical health system. By working apart from the general healthcare system, behavioral health groups are better able to credential staff, target consumers in need, maintain high quality of services, and navigate the world of insurance reimbursement rates with relative efficacy.
However, this new legislation (SB 482/HB 846) threatens to push behavioral health care back under the umbrella of general medical services. Managed care organizations (MCOs) would monitor the delivery of these vital services, instead of the one streamlined vendor that does so now.
Not only do increased administrative needs deflect services from consumers, but the new system may not enroll vulnerable populations such as those 65+ years old or those coming from incarceration. Specialty behavioral health services such as Supported Employment are also especially affected, since their “blended” funding sources may not survive the change to a multiple MCO system.
While a holistic approach to medicine sounds nice on paper, the reality is that by carving behavioral health services back in, we reduce the time spent helping others and increase the bureaucracy. The proposed system is a “jack of all trades and master of none” solution that jeopardizes the very ability of many behavioral health programs to continue.
This month, PDG’s Executive Vice President Sondra Tranen testified before the Maryland Senate in opposition of the carve-in. She explained,
“Instead of having the State accept its participating providers and set rates, this model puts nine MCOs (and potentially nine sub-vendors) in charge of credentialing providers and negotiating the rates for services. Given the vast differential in negotiating power that my small organization would have with nine insurers, it isn’t clear how a managed care model would protect providers like me and the people I serve from unilateral contract changes, poor rates, credentialing barriers, and other unfair business practices.”
Sondra and other behavioral health organizations spoke eloquently on the many obstacles a carve-in would create for behavioral health. Join Sondra and the rest of us at PDG in opposing SB 482/HB 846 and maintaining the current Medicaid carve-out.