Managed Medicaid might cut back in-patient psychological well being remedy for youths in DHS custody
OKLAHOMA CITY (KFOR) – With Oklahoma’s transition to a managed Medicaid system, there may be changes to the mental health services for children in DHS custody.
Some fear that this will reduce services to those who need them most.
Oklahoma lawmakers are trying to guardrail Medicaid’s privatized expansion
“The very fact that behavioral health is being reduced is very alarming,” said Verna Foust, CEO of Red Rock Behavioral Health Services.
Frontier said psychiatric benefits for children in DHS custody under Medicaid’s leadership could decrease by as much as 20 percent.
That’s about 31,000 children.
A company called Centene would be in charge of the plan.
In a proposal to the state, the company said it will reduce inpatient and inpatient treatment for children with behavioral problems and use more preventive and outpatient services.
Both the Oklahoma Health Care Authority and DHS said no one could do an interview on camera on Friday.
The governor of Oklahoma is fighting with members of his own party over the Medicaid privatization plan
Instead, OCHA published a statement with the words:
“Our goal is to improve the health of Oklahomans, which means higher quality care and better health outcomes. We believe this will include increased investment in basic and retirement provision, along with other factors that will reduce the use of more expensive services. The -20% for behavioral health is not a planned reduction in Medicaid services. It is a single assumption among a multitude of assumptions relating to a particular set of services for particular members. It is only used to set interest rates in order to create a fair and equitable capitalization rate to be paid to MCOs. When a medically necessary and appropriate service is provided and a clean claim is made, OHCA expects mussels to be paid for.
The rationale for this specific assumption is that with MCO resources there is a significant amount of opportunity for greater cost efficiency and effectiveness, including program integrity considerations, within behavioral / mental health services when moving from an FFS reimbursement model to risk-based management care is passed over. There are fewer public references from Medicaid when we look at non-physical health services, but some show it.
The assumption of a reduced savings factor for the children in the care of the state merely reflects the belief that the effects of use on these more vulnerable populations may be smaller. “
The DHS said in a statement:
“When the state made the decision to move to managed care, OKDHS was asked to help work with the Oklahoma Health Care Authority (OHCA) to plan how managed care would serve children in foster care. In consultation with national experts, it was decided to develop a special managed care plan that focuses on the special needs of children and adolescents in foster families and in the care of the Office for Youth Affairs (OJA) and is also available to children and adolescents those who have been adopted, those who are no longer cared for and, where applicable, families who are being cared for by prevention services. OKDHS has worked closely with OHCA, OJA and the selected Oklahoma Complete Health Special Plan to implement the plan by the target date October 1, 2021, and to work together to improve the health, social and wellbeing outcomes of children and adolescents who are on have encountered the system of child welfare or youth affairs. “
The Oklahoma Association of Health Plans adds:
“Managed care will not limit psychiatric services for adolescents in foster families. Instead, the latest early intervention and support services like in-home therapy are directed and provided to improve outcomes. MCOs exist in more than 40 states and operate on a mission to improve health outcomes under the supervision of local and federal governments. We applaud the modernization of healthcare in our state of Oklahoma, which has been stuck in last place for far too long. “
The organization Youth Villages says:
“We support the implementation of a managed care system in Oklahoma as it enables more children and families to receive intensive in-home services that help children avoid internships outside the home. We work in 23 states, including Oklahoma, and we’re particularly excited that the state is addressing the Tennessee Model. Youth Villages has provided intensive in-home services to children with emotional and behavioral problems and their families since the TennCare system in Tennessee began in 2000. The managed care system there has made it possible for us to provide intensive help to thousands of children and families within their own four walls. We think this is best for kids. “
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However, some are still concerned about the prospect of the plan.
“When children don’t get the psychiatric services they need it is a tragedy because not only are they suffering at this time, but they can also lead to lifelong problems,” Foust said. “Behavioral health problems in children need to be addressed immediately.”
KFOR contacted Centene but received no response.
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