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.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

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 , , , , , , , , , , . Bookmark the permalink. 4 Comments.

  1. It isn’t only mental health providers who are dropping out of Medicaid. The post-payment audits are also targeting physical, occupational and, particularly, speech/language therapists (because that is the most common developmental delay). One veteran private provider i know had a $55,000 payback, because she did not use the new “correct” terminology in her documentation. She went out of business, leaving 30 children in rural WNC without needed services. The extrapolation method, combined with vague requirements and subjective reviews, is killing us.

    • Maggie,

      I absolutely know that behavioral health providers are not the only providers who are hurting. The sad truth is that the audits started with behavioral health. Everyone else’s audits are coming.

  1. Pingback: Member Opinion: Providers of NC Medicaid | NASWNC

  2. Pingback: “If Freud Accepted Medicaid…” (Thoughts From an ACSW, LCSW) | medicaidlaw-nc

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: