Better mental health care predicted for Healthy Families kids with serious needs

December 4, 2012

Children with less serious needs will have to find providers who take Medi-Cal’s lower rates

By Lynn Graebner
California Health Report

Santa Cruz County mental health staff and patient advocates in California predict that many children enrolled in the state’s Healthy Families Program, an insurance program for low-income families that will be phased out in 2013, should actually have better access to mental health services once they start transitioning to Medi-Cal in January.

This summer the state legislature approved Governor Jerry Brown’s plan to cut the Healthy Families Program, saving the state $129 million in the next two years and $71 million annually after that. Healthy Families enrolls families whose incomes are low, but not low enough to qualify for Medi-Cal, as Medicaid is known in California. Many fear that with this transition to Medi-Cal, former Healthy Families enrollees will have difficulty finding health providers, since Medi-Cal pays providers less.

Many county health departments in California, however, welcome the state’s 2011 decision to give their departments responsibility for managing the money that will help them provide the specific mental health services needed locally.

But they are concerned about the state’s recent decision to switch from funding Medi-Cal mental health services with state general funds to giving counties a set amount of sales tax revenues. That funding will be based on estimated mental health care needs, but counties say that funding may not keep pace with the growing need for services.

“Counties certainly want to move forward. We think we can do it, [but] it comes down to the financial support,” said Suzanne Tavano, Director of Mental Health and Substance Abuse Services for the Santa Cruz County Health Services Agency.

The state is estimating counties’ funding needs for mental health services based on historical use plus the expected increased use of county services as Healthy Families enrollees come into the Medi-Cal system.

Based on that estimate the state is depositing a portion of its sales tax revenues into a behavioral health account, which will pay for adult treatment programs as well as youth screenings and services.

“To have counties responsible for providing care for their residents seems to make sense,” said Carmella Gutierrez, president of Californians for Patient Care, a nonprofit patient advocacy organization based in Sacramento. “The concern is with the funding.”

The Healthy Families Program gave parents seeking mental health care for their children more access to physicians in private practice because Healthy Families provider rates are higher than Medi-Cal’s.

After the transition, children suffering from mental health disorders serious enough to require a specialist, such as conduct disorders or early diagnosis of bipolar disorder, will continue to seek treatment from the county. Children with milder needs – for instance, depression resulting from divorce – will need to find therapists who accept Medi-Cal.

The county already has the infrastructure in place to support children with serious mental health care needs, so the transition away from Healthy Families to Medi-Cal should benefit them.

Participants in Healthy Families actually seem to underuse their mental health care services, compared to Medi-Cal participants. No one is sure why that is. “The state has been trying to get to the bottom of that for quite a few years,” said Patricia Ryan, Executive Director of the California Mental Health Director’s Association.

“I don’t think it was due to any problems per se on the part of Healthy Families,” said Dane Cervine, Program Chief of Child and Adolescent Mental Health Services for the Santa Cruz County Health Services Agency. He said it could have been that families just weren’t aware of the services. Medi-Cal has a much longer history of providing mental health services.

That’s one reason why counties are concerned about the current funding estimates – they expect to see an increase in specialty treatment services as Healthy Families enrollees transfer to Medi-Cal.

Only about 1 percent of Healthy Families beneficiaries in Santa Cruz County, for instance, are getting mental health services, Cervine said. In comparison, usually 5 to 10 percent of children with Medi-Cal are getting some sort of treatment. In Santa Cruz County 10.71 percent of children with Medi-Cal received mental health services in 2010, he said.

Ryan estimates that about 43,000 children transferring from Healthy Families may require these higher-level specialty services at the county or through county-contracted providers.

They will be eligible for a wide variety of services with their Medi-Cal coverage, including screening and assessments, therapeutic behavioral services and wrap around services including family teams and in-home visiting.

Paying for this level of services based on state estimates of current use is a concern, Ryan said at an Oct. 16 Senate Budget Committee hearing.

In an interview, Ryan said counties question the state’s funding estimates for serving these additional children.

“We fear they low-balled it,” she said.

If counties come up short, they may need to redirect county funds from other programs for indigent individuals or for child welfare services or adult protective services, Ryan said.

But the state believes the funding is adequate, said Norman Williams, Deputy Director of the Office of Public Affairs at the California Department of Health Care Services.

“The state will monitor expenditures in this funding category to determine if adjustments are needed on a prospective basis,” he said in an e-mail response to questions.

Healthy Families enrollees with less serious needs, such as attention deficit disorder or mild depression, will be able to continue treatment through their primary care providers.

Children with mid-level needs, such as a child suffering from anxiety about a divorce, who may currently be seeing a private psychiatrist, psychologist or an agency contracting with Healthy Families, could continue to see those providers if the providers agree to take Medi-Cal reimbursements and enroll in the state’s fee-for-service Medi-Cal network.

But some providers and families don’t want to make the switch.

Vivian Gratton, president of the Santa Cruz Chapter of the California Association of Marriage & Family Therapists, treats a child with Healthy Families coverage. The family was told they now have to seek services at the county.

They opted not to. They are comfortable with Gratton and her skill set, she said. They pay Gratton on a sliding scale out of pocket, which is a stretch for them.

Sylvia Yee, another marriage and family therapist in Santa Cruz County, has treated children in the Healthy Families Program even though the reimbursement didn’t completely cover her fees. But she said she probably won’t become a Medi-Cal provider.

She’s not alone. California ranks 46th nationally for Medicaid reimbursement levels to providers, according to Williams.

He indicated his agency is working on equipping counties with lists of current Healthy Family mental health providers who could possibly be resources for counties.

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