Considering Medicaid: Success in advocacy
By Rebecca A. Clay
No matter what happens to Medicaid in the current health care debate, the program will still be enormous, says Shirley Ann Higuchi, JD, associate executive director for Legal and Regulatory Affairs (LRA) in the APA’s Practice Directorate and the APA Practice Organization.
“Medicaid is not going to go away,” says Higuchi, noting that it’s the nation’s largest payer for mental health services. And with all the debate going on, she says, it would behoove psychologists to “jump in” as advocates for maintaining and expanding psychological services in the program.
LRA and APA’s Education Directorate have three advocacy priorities when it comes to improving Medicaid:
Reimbursement for services provided by supervised doctoral psychology interns. Only 19 states currently allow Medicaid reimbursement to facilities for services provided by doctoral-level interns supervised by licensed psychologists. In addition to offering an important training opportunity, such reimbursement expands access to care, while building the pipeline of psychologists trained to work with the underserved Medicaid population.
Promoting integrated care by expanding reimbursement for Health & Behavior codes. Currently, 33 states allow psychologists to use Health & Behavior codes, which cover services they provide to patients with physical diagnoses. APA and the Practice Organization are focused on adding the other 17 states to that list.
Including independent practitioners. APA and the Practice Organization are working to make sure independently practicing psychologists can receive Medicaid reimbursement. Seven states currently prohibit psychologists in independent practice from participating in Medicaid. In those states, only psychologists who work in facilities like community mental health centers or federally qualified health centers qualify for Medicaid reimbursement.
To push these priorities, says Higuchi, APA and the Practice Organization are taking a 360-degree approach. That means targeting advocacy efforts to all players in state Medicaid programs, including regulators, legislatures and Medicaid managed-care companies. “It looks different in every state, so we have to figure out which puzzle piece might fit the best, or create a new one,” says Caroline Bergner, JD, an attorney in the Education Directorate, noting that they have worked with 20 states so far, often partnering with the state psychological association.
In Louisiana and New Mexico, for example, the Practice Organization and APA are collaborating with psychology licensing boards as they develop policies on intern reimbursement that the state association and the licensing board will use in advocacy efforts with regulators.
In Washington state, both organizations are assisting the Washington State Psychological Association as they prepare to reach out to the state’s five Medicaid managed-care plans about intern reimbursement.
And in Washington, D.C., the Practice Organization and APA have developed a partnership with the district’s largest Medicaid managed-care company, AmeriHealth Caritas, and the Mid-Atlantic Internship Consortium. The partnership is working on training psychologists and primary care physicians to work together on integrated care. The partnership is hoping to launch a pilot project by the end of 2017 to place doctoral psychology interns in primary care offices to increase integration of behavioral health services.
The Practice Organization encourages psychologists to get involved in this advocacy work. “It’s best to reach out to us, so we can help our members work with their state psychological association and loop them in early on,” says Bergner. “There’s strength in numbers. It’s almost always more effective to have a group like your national or state association behind you.”
“There’s the old saying: Be the change you want to see in the world,” she says. “In this case, be the change you want to see in Medicaid, but you can’t do it from the sidelines.”
To get involved with advocating on Medicaid issues, contact Bergner via email.
“Considering Medicaid” is a six-part series. See the following links to read the other articles in the series: