Large Number of NC Mental Health Providers No Longer Accepting Medicaid
Since the onslaught of the Medicaid audits on NC health care providers who accept Medicaid, I have been curious as to how many providers have determined that they no longer wanted to accept Medicaid. Most of my clients have mentioned the fact that after their current issue (whatever that issue is), they were not going to deal with Medicaid anymore. They are sick of the erroneous audits, the difficulty in dealing with the MCOs, the pile of paperwork they have to provide to state agencies over and over due to post or prepayment review. They are done with Medicaid.
Why should we care whether these providers continue to accept Medicaid?
Let’s not lose sight of the Medicaid recipients. All these MCOs, RACs and other state agencies are so hell-bent on saving/recouping money, that Medicaid recipients’ mental health care has been lost. 1.5 million North Carolinians rely on Medicaid for their insurance. Yet, less than 60% of physicians/providers accept Medicaid. Even less accept Medicaid when you get into specialized services (approximately 30% dentists in NC accept Medicaid). We need the providers who are willing to accept Medicaid. Medicaid recipients need providers who are willing to accept Medicaid.
This is not the first time providers have been squeezed out of the Medicaid system. Remember back in January 2011, approximately 1800 mental health providers were squeezed out of the system with the implementation of CABHA. All the Medicaid recipients that were seen by providers who were squeezed out, were forced to transfer to other providers. Again, no apparent thought to the care of the Medicaid recipients.
Now, in 2012 and 2013 and beyond, more mental health care providers are being squeezed out due to Medicaid audits, prepayment reviews, post-payment reviews, and suspensions of Medicaid reimbursements (all of which are grossly incorrectly administered).
So what happens to the 1.5 million Medicaid recipients? Somehow the Medicaid recipients’ needs are being lost. MCOs are terminating good provider contracts; RACs are auditing good providers out of business. The Medicaid recipients are not receiving services.
Until now, I have seen no data on the number of providers that have recently decided to no longer accept Medicaid.
Mecklenburg Psychological Association (MPA) has calculated the decrease in mental health providers in Mecklenburg County by analyzing changes in members insurance participation from 2011/2012 to 2013 ( 2011 & 2012 are combined).
The data do not indicate a reason as to why providers dropped their Medicaid participation. And remember, this data only apply to Mecklenburg County. But here is the data:
Insurance Participation Changes of MPA members from 2011/2012 to 2013
2011 & 2012 2013 Change Number of Members 180 176 -4 None (take no insurance) 34 54 20 Aetna 56 60 4 BC/BS 87 90 3 BC/BS State 58 63 5 BC/BS Fed 50 60 10 CBHA 42 53 11 Cigna 29 30 1 Medcost 36 43 7 Medicare 34 35 1 Medicaid 56 25 -31 Magellan 29 30 1 NC HealthChoice 22 17 -5 TriCare 17 24 7 United Behavioral Health 29 29 0 Value Options 24 27 3 Wellpath 12 14 2 Medicaid Changes No longer accept Medicaid -27 Moved – did not renew MPA Membership -5 Did not renew MPA Membership in 2013 -1 New – members who accept Medicaid +2 MPA 3013 Non-renewers 15 Moved 8 Declined 3 No response 4 Deceased 1 New Members 2013 13
Wow. In one county in NC, from 2011/2012 to 2013, 31 providers have opted to no longer accept Medicaid.
Makes you wonder where the Medicaid recipients are now that their providers no longer accept Medicaid. I guess the Medicaid recipients’ needs are still lost.
Posted on May 17, 2013, in DHHS, Division of Medical Assistance, Harassment, Health Care Providers and Services, MCO, Medicaid, Medicaid Appeals, Medicaid Audits, Medicaid Contracts, Mental Health, Mental Illness, North Carolina, Prepayment Review, Provider Medicaid Contracts, RAC, RAC Audits, Regulatory Audits, Termination of Medicaid Contract and tagged DHHS, Division of Medical Assistance, Health care provider, Managed Care Organizations, Mecklenburg County, Medicaid, Medicaid Audits, Medicaid recipients, Mental health, North Carolina, Recovery Audit Contractor. Bookmark the permalink. 4 Comments.