Health

Managed care dominates children's mental health conversation

Providers, parents say it is necessary to address barriers created by Medicaid program for successful system

Brad Niebling, bureau chief for learner strategies and support at the Iowa Department of Education, speaks to the 50 or so gathered at the public listening post for a new statewide Children’s Mental Health System at Grant Woods Area Education Agency in Cedar Rapids on Thursday, Oct. 11, 2018 (Michaela Ramm/The Gazette)
Brad Niebling, bureau chief for learner strategies and support at the Iowa Department of Education, speaks to the 50 or so gathered at the public listening post for a new statewide Children’s Mental Health System at Grant Woods Area Education Agency in Cedar Rapids on Thursday, Oct. 11, 2018 (Michaela Ramm/The Gazette)
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CEDAR RAPIDS — The call to action is appreciated, but some attendees at a public listening post placed an emphasis on state officials earlier this week to back a new initiative to establish a statewide children’s mental health system with adequate funding.

Until officials put aside enough resources to ensure success, the state’s effort seems disingenuous to some. As one attendee to the Cedar Rapids public event put it, providers and families of children with behavioral and mental health needs “are over unfunded mandates,” and local agencies only can see results if the state puts its money where its mouth is.

These comments were made at Grant Wood Area Education Agency in Cedar Rapids Thursday evening at a public listening event hosted by the Children’s System State Board, an entity that has been directed by Gov. Kim Reynolds to make recommendations for the implementation of a children’s mental health system.

Cedar Rapids’ event was the last of nine public comment sessions the board hosted across the state to gather provider and family input into the system.

Officials plan to review information gathered during this listening posts and other existing resources to develop a strategic plan for the system.

Officials plan to present the governor and the Iowa Legislature with a report by Nov. 15, said Brad Niebling, bureau chief for learner strategies and support at the Iowa Department of Education.

“There are other things that obviously need to happen for those things to come to fruition, but this board has been charged to explore those and to learn about what the concerns are and to provide recommendations on the path forward in the strategic plan,” Niebling said.

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Medicaid played a prominent part in Thursday’s conversation, as many parents at the event expressed their frustration at the barriers the managed-care program places in their efforts to obtain mental and behavioral health services for their children.

Some parents recounted experiencing months-long waiting lists to see a psychiatrist, of repeated denials for services, and of days waiting in an emergency room for a hospital bed to open.

Providers, too, expressed their frustration with the managed-care organizations that handle the state’s privatized Medicaid program.

The conversation facilitator, Grant Woods AEA Chief Administrator John Speer, at one point asked health care providers to raise their hand if they had dealt with late or incorrect reimbursements for services provided to patients from the insurers. The majority of those providers present raised their hands.

Carol Meade, director of UnityPoint Health-St. Luke’s Behavioral Health Services, said a major reduction in reimbursements to their department occurred after the managed-care organizations took over the state’s Medicaid program. Before the program was privatized, the hospital could receive up to eight weeks of funding if a child needed in-patient care. Nowadays, the provider is now funded only up to 12 days.

Meade said St. Luke’s — which is one of the biggest in-patient mental health providers in the state for children and adolescents at 24 beds — said it’s not unusual for the hospital to have five or six kids waiting in the emergency room for a bed.

“It’s a challenge,” she said.

However, Meade said the need isn’t for more hospital beds — it’s for outpatient services and other preventive measures to ensure these children don’t have to experience a crisis to receive care.

“We don’t need more beds — most of those kids do not need psychiatric inpatient care,” Meade said during the meeting. “There’s no prevention services, there’s no school services.

“So what do you do? You take them to the hospital.”

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Other providers echoed Meade’s comments, adding other issues they see as important for the state to address — most having to do with Medicaid.

Kim Venner, vice president of operations for Tanager Place, pointed out as an example that the managed-care organizations require a diagnosis to receive authorization for mental health services. But that prevents some from getting immediate care, and she said long-term outcomes are almost always better the earlier providers work with children.

“We are in trouble when we head down that road,” Venner said. “It’s a barrier to getting the right services at the right time.”

Officials hosting the listening posts are still compiling public stories to compare how similar they are to each other. But Niebling said he has heard common complaints on managed care at other events he’s attended across the state.

Niebling said the board has been charged by the governor’s executive order to make recommendations within their strategic plan around legislation or policies relevant to the development — or the challenges — of a children’s mental health system.

But despite the tone of disillusionment that was presented at the Cedar Rapids listening post, Niebling said Iowans have been very willing to share their personal stories on mental health with state officials “in a very clear and meaningful way.”

“It’s really remarkable we’ve seen that across the board,” he said. “They have given the children’s board a lot of incredibly helpful information that they’re going to need to develop the plan they’ve been charged to develop and carry it forward, depending on what the governor decides to do.”

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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