Amid a crowd of more than 200 people Wednesday, mental health providers fiercely debated the impact that a proposed Medicaid change will have on some of the poorest children and adults in the state.
In an attempt to balance the agency’s budget, the state Department of Mental Health and Substance Abuse Services has proposed tightening the criteria for which adults and children can receive psychotherapy rehabilitation services, a type of mental health service that the agency’s leaders argue isn’t evidence-based for all patients.
The Oklahoma Health Care Authority’s medical advisory committee members discussed the proposed rule change at its Wednesday meeting, among more than 200 people in the audience, many of whom voiced their concerns for and against the proposal during the public comment segment of the meeting.
Under the proposed rule change, children and adults would only qualify for psychosocial rehabilitation if they met one of the following criteria:
has been hospitalized at a psychiatric inpatient facility;
has been admitted to a crisis center;
has been determined disabled by the Social Security Administration for mental health reasons;
(child-specific) has been identified as having emotional disturbances and has an education plan, such as an individualized education program plan, for those mental health needs.
Adults may also qualify if they live in a residential care facility.
After more than an hour of public comments and debate among board members, the board voted 18-6 to recommend that the Oklahoma Health Care Authority allow the mental health agency’s changes.
Mary Brinkley, a board member representing the Oklahoma Long Term Care Association, said every person who attended the meeting should contact their lawmakers because they developed the mental health department’s budget, not the board members.
“The passion that was shared today was huge, but we are reactive at this point because the budget has already been set,” Brinkley said.
The Oklahoma Department of Mental Health and Substance Abuse Services proposed limiting mental health psychosocial rehabilitation services to a specific eligibility criteria as part of a proposal to save an estimated $24 million in state money.
This proposal is a response to the Legislature allocating the department a similar budget to last year's amount, even though leaders argue they needed more to supplement about $21 million in federal funding the department won’t receive in the coming fiscal year.
In January, Terri White, the state’s mental health commissioner, told a room full of lawmakers during her budget proposal at the Capitol that more than 7,000 Oklahomans could lose mental health services if the Legislature didn’t allocate an additional $21 million for her agency’s budget.
Jeff Dismukes, the spokesman at the Oklahoma Department of Mental Health and Substance Abuse Services, said there were no good decisions when it came to cutting services, but when weighing all options, the proposed rule change concerning mental health psychosocial rehabilitation services was the best of many very difficult choices.
“Unfortunately, the services we provide are for the sickest of the sick, and for those with critical illness,” Dismukes said. “You try to make sure you preserve the services that are most critical for all Oklahomans.”
A cut in the rate that the state pays mental health professionals for the services they provide Medicaid patients was not an option any board member would discuss.
Mental health providers are paid between 70 percent and 75 percent of what Medicare pays, less than physicians who are paid about 96 percent of Medicare.
Melissa Williams, a therapist at DaySpring Community Services in Tulsa, said she was worried that the rule change would disproportionately affect black children.
Williams said many black families that she works with are hesitant to take their children to inpatient mental health services because of their distrust of government systems.
“In the black community, growing up, we’ve always been taught, what happens at home stays at home,” Williams said. “And when it comes to the system, there’s a mistrust there, and it goes back for generations. Most minorities think, ‘OK, if I send my child to inpatient, DHS is going to think I’m a bad parent.’”
The Oklahoma Health Care Authority board will discuss the proposal at a meeting 1 p.m. June 26.
Unfortunately, the services we provide are for the sickest of the sick, and for those with critical illness.”