NewsCovering Colorado


Colorado reforming Medicaid as mental health providers push for change

Posted at 8:08 PM, Jan 26, 2022
and last updated 2022-01-27 08:51:35-05

COLORADO SPRINGS — Some mental health providers are pushing for Medicaid reform as they continue to struggle with the current healthcare system.

The grassroots group plans to testify at the state capitol Thursday for the annual Smart Act Hearing, which is a yearly review with state lawmakers.

Finding a mental health provider while on Medicaid can be a challenge in Colorado. Essiace Chandler, a Colorado Springs resident, experienced this firsthand.

"I didn't have any problems until yesterday. I emailed her and told her I was trying to get in touch with her again, and she responded by saying she no longer accepts Medicaid," said Chandler.

Chandler had gone to her therapist off and on for five years after having her first child.

"Sometimes I'm great with my mental health, but other times I struggle. I thought I had that person that I could be like hey could you get me in and now I'm just like what am I supposed to do. I have to try and find someone that accepts medicare
and that's apparently going to be a struggle," said Chandler.

She was upset to hear that this is a common issue in the state due to the problems with the system.

"I'm in one of those periods where I need that person and for her to tell me that she no longer accepts it, and to find out this is probably the reason why it's heartbreaking. I've built this strong connection with this person over years, and now I'm just like oh I'm just that easy to toss away," said Chandler.

Danielle Patterson with the Patterson Center for Resiliency says providers aren't taking Medicaid patients because of the problems with Medicaid.

"We've had prospective patients call and say they've called ten to fifteen places and there are no openings. We have clinicians who have openings, but the problem is getting insurance to take these clinicians who are unlicensed or in their training program. They've done years of school, they've passed many tests, and they've done hours of internships and supervision. There are also some issues with getting paid on time, getting paid fairly, and there is something called a Clawback which is where Medicaid has seven years in Colorado to take money back for appropriately performed services and change their mind about it. Many other states have six months to one year of that. Many of us got letters for tens of thousands of dollars that they wanted this year, and that could bankrupt us," said Patterson.

Patterson is among a group of mental health providers planning to take some of these concerns to state lawmakers.

"We're lobbying for a few things. One is allowing pre-licensed clinicians to be able to serve patients, another is setting a minimum reimbursement rate for services. Medicaid has the lowest reimbursement rate compared to other carriers. Setting minimum credentialing times because it can take six months to a year to become paneled with Medicaid," said Patterson.

The Colorado Department of Health Policy and Financing says they understand behavioral health needs improvement. The department has already started implementing reforms.

"We've been working for a few years on behavioral health and a transformational task force to identify what we need to change and improve some of our numbers that show people aren't getting the care when they need it. We want to make sure we're making changes throughout the system, and we're in the process of undergoing some major transformative reforms, including funding that can go directly to communities to help build out services that are available there, investments in technology and data tracking systems, provider training, and workforce development. Our behavioral workforce is something that we want to build out and support," said Cristen Bates, Population Health Division at the Colorado Department of Health Care Policy and Financing.

The department says some of the reforms are already being rolled out.

"We're aligning our data and billing systems across different payers. There are a lot of ways we pay for behavioral health, not just Medicaid, and we want to align those systems. That's in progress," said Bates. "For providers who want to join the system, we've just changed and should expect in the next week or so, impacts to our regional health plans that say you must be able to credential and contract new providers within 90 days. We know some people have had long delays, and haven't been able to get into the system to get a Medicaid contract."

Bates says they have a robust plan to expand and strengthen the behavioral health safety net.

"This includes helping current providers provide more services and access to things like intensive outpatient services, recruiting small and medium providers, and we want to make sure we have an equitable reimbursement system for those providers. That's one of the ways we want to expand our network," said Bates.

For information on treatment, the state recommends checking the back of the insurance card for the number to call for help finding providers. Immediate assistance can be found by going to this website.