Michigan Medicaid removes 20-visit limit on psychotherapy

The decision brings Michigan a step closer to achieving mental health parity.

By Hannah Calkins

Psychologists in Michigan can now provide their Medicaid patients with more than 20 sessions of psychotherapy a year.

On Oct.1, the Michigan Department of Health and Human Services (MDHHS) removed the state’s 20-visit annual limit on psychotherapy services (PDF, 60KB) for Medicaid patients. This was welcome news for Michigan psychologists and mental health parity advocates, particularly those who have been working on parity issues in the state for years.

“Medicaid-covered individuals often face significant challenges that can exacerbate mental health problems, and it can be difficult to adequately treat those problems in 20 sessions. Now, these individuals will be able to receive more comprehensive care,” said Louis Post, PhD, former chair of the insurance committee in the Michigan Psychological Association (MPA).

The removal of the visit limit comes two years after MDHHS began including psychologists among its eligible providers (PDF, 68KB), a change that MPA’s insurance committee advocated for persistently during Post’s term as chair.

“If psychologists were still unable to participate in Medicaid HMOs, the removal of this limit wouldn’t be meaningful,” Post said. “There simply wouldn’t be enough providers to meet the needs of Medicaid-covered individuals.”

Psychologists push for parity

Erin Emerson, chief of staff for the Medical Services Administration at MDHHS, said the decision to remove the limit was the outcome of a yearlong “stakeholder engagement” effort around behavioral health integration and improving the Medicaid mental health system.

While Emerson did not cite MPA on a list of “stakeholders” — which included community mental health providers, hospital systems, payers and consumer advocates — Post verified that MPA was included and did participate in the engagement effort.

 “One of the things we learned that was that the 20-visit limit was a huge barrier for individuals and caused disruption in their ability to continue receiving services,” Emerson said. “We felt that removing the limit was the most effective way to serve them and to meet parity requirements.”

The fight for mental health parity in Michigan has been blocked by both Republicans and Democrats, said Sandi Jones, a multi-client lobbyist who represents MPA. This is in some part due to the influence of the Economic Alliance for Michigan, a statewide business-labor coalition that opposes health care mandates.

“MPA pushed hard for mental health parity,” Jones said. “It’s been a huge effort, and we’ve maintained ongoing relationships in the state legislature and in MDHHS to work toward it.”

That work is far from complete. While Jones said that MDHHS made the right decision in removing the visit limit, she did caution that the decision isn’t an unequivocal victory.

“Our Medicaid system is privatized, and so the HMOs still determine prior authorizations for each visit,” she said. “So even though someone may need more than 20 visits, that doesn’t preclude the HMO from deciding that six, or eight, or any other number of visits are enough.”