Considering Medicaid: A provider’s perspective

In the fifth part of a six-part series on Medicaid, we profile a psychologist who has nearly a decade of experience working with low-income clients.

By Rebecca A. Clay

Psychologist Samantha Slaughter, PsyD, doesn’t understand why all private practitioners aren’t Medicaid providers.

“If I truly believe … that anybody and everybody should have access to mental health services no matter their socioeconomic status, then why wouldn’t I be a Medicaid provider?” asks Slaughter, chief executive officer of a group practice called Integrative Psychological Services of Seattle. “From a social justice perspective, it makes sense to be empaneled on at least one of the insurers managing Medicaid in your state.”

Being a Medicaid provider makes sense clinically, too, says Slaughter, who earned her doctorate from Seattle’s Argosy University in 2008 and helped run a mental health clinic for low-income clients until 2014. “You have no idea what’s going to happen in your clients’ lives,” she points out. “If all of a sudden somebody loses their job and their only option is a Medicaid plan but you’re not on it, what do you do? See that person for free? Refer them somewhere else?” Noting the importance of the therapeutic alliance, Slaughter is committed to maintaining that relationship no matter what.

Before the Affordable Care Act prompted Washington State to expand its Medicaid program, able-bodied adults didn’t have access to benefits. Now, says Slaughter, the state’s five Medicaid managed care organizations don’t have enough providers to meet the pent-up demand. “As far as I know, I’m the only doctoral-level private practice mental health clinician on all five plans,” she says.

While the Medicaid clients Slaughter works with sometimes struggle with basic needs, such as housing, they’re much the same as other clients in her trauma-focused practice. Whether you’re insured by Medicaid or Blue Cross Blue Shield, she says, “trauma doesn’t discriminate.”

What is different is their intense determination to do what it takes to get better. They are “some of my most hardest-working clients,” says Slaughter, noting the need to educate some clients — who may never have received psychological services before — about how psychotherapy works. “Being able to see the clinician of their choice on a weekly basis, just like anybody else who has different insurance, is something that they appreciate,” she says.

Logistically, being a Medicaid provider is no different from being a provider for other third-party payers: You apply, go through a credentialing process, bill electronically and have the option of direct deposit of reimbursements. “It’s exactly the same,” says Slaughter. The only difference? Washington State’s Medicaid program doesn’t pay as much as commercial plans.

Early-career psychologists shouldn’t let those lower rates deter them, says Slaughter, who is spreading the word about Medicaid through the business consulting she does as well as a series of columns for the Washington State Psychological Association’s website (see Wa. Psych Association's website for her first column). “They don’t pay great…, but they pay better than zero,” she says. Try it and see how it goes, she suggests.

“That doesn’t mean you have to fill your practice with Medicaid clients,” adds Slaughter. In fact, the Practice Organization encourages providers to augment their client base with all types of patients, including a few Medicaid patients, as a way to diversify and increase one’s visibility in the community.

“Considering Medicaid” is a six-part series. See the following links to read the other articles in the series: