Youths' counseling provider unclear Local agencies worry HMO plan may neglect Medicaid children

November 10, 1996|By Jackie Powder | Jackie Powder,SUN STAFF

A statewide plan to move Medicaid recipients into managed health care organizations has local agencies worried that poor children may not continue receiving appropriate mental health counseling.

The state Mental Hygiene Administration is working out details of the plan, scheduled to go into effect Jan. 1, but it's unclear how mental health services will be delivered to children receiving assistance through the federal- and state-funded insurance program for low-income families.

Of major concern to Carroll County providers is whether their agencies may continue counseling once a health maintenance organization assumes responsibility for overseeing mental health services.

Based on past experience, they are not optimistic.

Two of the Carroll nonprofit agencies that have long served poor children -- Family and Children's Services and the Youth Services Bureau -- have been rejected by several health maintenance organizations over the years when they have applied for inclusion in their provider networks, said Sandy Rappeport, director of Family and Children's Services.

Local providers say their efforts to get more details from the Mental Hygiene Administration about the delivery of mental health services to children of low-income families have been unsuccessful.

"My fear is that some very powerful HMO is going to set the regulations without input from the providers," Rappeport said.

"Our concern is that this is going to happen in seven weeks. What do we tell our clients?"

Many local children covered by Medicaid who are receiving mental health counseling are victims of sexual abuse and come from broken homes. Sometimes it takes several months before a child can trust a counselor enough to speak truthfully about the traumas he or she has experienced.

"If you tell that child on Jan. 1, 'You can't talk to that therapist anymore,' we could do irreparable damage to the kids we've been able to hook up with," Rappeport said.

Under the state's plan to enroll about 210,000 Medicaid recipients -- mostly mothers and children -- in health maintenance organizations, the mental health services will be "carved out," or handled separately, state officials said. The plan aims to hold down medical costs and give patients better access to preventive care and other health services.

The proposal calls for all publicly funded mental health services to be delivered by a "Specialty Mental Health System," overseen by the Mental Hygiene Administration and local mental health entities, known as Core Service Agencies. Under the plan, a managed health care company -- still to be selected -- will handle matters relating to administration and benefits.

However, Carroll's Core Service Agency -- which may have the authority to select the providers of mental health services for poor children -- is not expected to be in place by Jan. 1.

"Children are going to end up without counseling services, and that's what we're really concerned with," said Lynda Gainor, director of Human Services Programs' Family Center in Westminster.

Jean Smith, a spokeswoman with the state Mental Hygiene Administration, said that at this stage in the Medicaid overhaul, she does not know what providers will deliver mental health services to children on Medicaid.

"There's going to be plenty of providers," Smith said. "The whole system is still being fine-tuned."

Despite this assurance, local service agencies say they are concerned that the providers included as part of a health maintenance organization's network may not be accessible for poor families in Carroll. A state law allows insurance companies to close their provider networks when they determine a particular region is covered.

"The problem is they might consider Carroll and Frederick as a region, and have all their providers in Frederick or Reisterstown," Rappeport said. "It's not always an option to drive to Frederick or Reisterstown."

Pub Date: 11/10/96

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