Considering Medicaid: Why participate

“Considering Medicaid” is a six-part series where practicing psychologists and legal experts offer real life perspectives on what it’s like to be a Medicaid provider.

By Rebecca A. Clay

Why you should take Medicaid patients

Expansion of the Medicaid program under the Affordable Care Act has helped push the uninsured rate among non-elderly adults to historic lows. Providing more people with health insurance results in greater access to mental health care services for some of the nation’s neediest individuals.

According to an issue brief from the Kaiser Family Foundation, 31 states plus the District of Columbia have expanded their Medicaid programs. The result? By 2015, about 11 million Medicaid participants were adults newly eligible because of the expansion. In addition, the uninsured rate among non-elderly adults dropped from almost 17 percent in 2013 to an all-time low of 10 percent in 2016.

Psychologist Emily Selby-Nelson, PsyD, has seen the impact of that increased access first-hand at Cabin Creek Health Systems, a federally qualified health center with locations around West Virginia. “Our population of uninsured patients has dropped from 20 percent to 5 percent,” says Selby-Nelson, the center’s lead behavioral health provider. “The members of the rural community we treat are now able to access health care they may have not considered as a possibility for them in the past.”

Medicaid expansion has also brought new opportunities for psychologists. “Medicaid is one of the few places that’s not trying to restrict provider panels; it’s trying to grow them,” says Gerald Nissley, Jr., PsyD, a private practitioner in Marshall, Texas — a state that did not expand its program. Nissley sees the value in providing services for Medicaid patients even if Texas has not expanded its program to include low-income adults.

While some providers refuse to participate in Medicaid, citing low reimbursement, excessive paperwork and other hassles, that hasn’t been Nissley’s experience. “The fees here in Texas are better than what some private insurers pay,” he says. The rules are reasonable, including virtually no preauthorization requirement. “And I actually do a little less paperwork for Medicaid patients than for patients with traditional insurance,” he says.

There are plenty of other reasons to get involved:

  • Embracing social justice. For Nissley, taking Medicaid is rooted in his values. “If you’re going to take third-party payment from Blue Cross Blue Shield, how are you not going to take third-party payment from Medicaid?” he asks. “It comes down to saying folks with less privilege are going to be treated differently.”
  • Growing your practice. “Medicaid is a great way to boost your practice,” says Nissley, noting that Medicaid is the nation’s single largest payer for mental health services. “There are lots of patients with Medicaid and relatively few providers who take it.” Accepting Medicaid is a great way for early and mid-career psychologists to expand their practice. Adding a few Medicaid patients to your client roster can augment and diversify your practice. Additionally, because Medicaid is such a large government program, taking these patients can broaden your practice to include other governmental programs. Like any other insurance plan, you can opt out of Medicaid later if it isn’t working for you, Nissley adds.
  • Enriching your training. The clients that Medicaid expansion has brought to Selby-Nelson’s office have forced her to hone her skills. “There’s a much greater diversity in terms of the life experiences patients are going through,” she says. There’s also a much higher percentage of clients with moderate to severe psychological issues, she says.
  • Advocating from within. If you want to improve mental health care in this country, says Nissley, you must be involved with the systems that drive it. “When I talk to politicians in our state about the management of Medicaid, they take me seriously because I’m a provider,” he says.

Though the future of the Medicaid expansion is uncertain under the new U.S. presidential administration, it is important to note that Medicaid will not be eliminated. Medicaid may look different if the Affordable Care Act is repealed, but a Medicaid population, with significant mental health needs, will still exist.

APA and the Practice Organization have dedicated considerable resources to advocating for expanded psychological services for Medicaid patients. This issue will continue to be a priority going forward.