Medicaid changes may affect mental health in schools


By Jon Hawley
Staff Writer

Saturday, June 15, 2019

As Medicaid reform unfolds, social services and mental health agencies are trying to get a lot of questions answered, including whether new Medicaid plans will continue covering mental health services provided directly to children at their schools.

A state Medicaid administrator pledged this week that the state is working to get information out and maintain coverage — though she couldn't guarantee every provider of school-based mental health services would be deemed "essential" under state law.

Medicaid reforms that lawmakers and Gov. Roy Cooper agreed to last year will make big changes to who covers services through Medicaid, whether mental health and substance abuse services provided by managed care organizations, such as Trillium Health Resources, or physical health needs that people get through county offices of social services.

As Trillium Northern Regional Director Bland Baker reported to Pasquotank County commissioners last month, the state is transferring most Medicaid patients to “standard plans” that will include services now provided by Trillium and other MCOs across the state. MCOs instead will cover patients with the most serious needs through “tailored plans” that are set to launch in two years.

Trillium is also seeking the Department of Health and Human Services' guarantee that school-based mental health services will continue to be covered, and it asked Pasquotank commissioners to adopt a resolution to that effect earlier this month. Commissioners did so, but have held off on sending it to DHHS, Commissioner Charles Jordan said in a phone call Friday. Trillium and other MCOs continue having conversations with state officials to address concerns and get more information, he explained.

According to the resolution and accompanying documents, providers of school-based mental health services are not considered “essential providers” that insurers must contract with under the state's standard plans.

That could lower access to mental health services for some students, according to Trillium, particularly since low-income families may struggle to transport their children to appointments outside of school. Treatment in schools also improves student achievement and school safety while reducing the stigma of mental health needs, a Trillium document notes.

However, providing services in school also makes them more expensive than “typical clinic-based treatment,” according to Trillium. The agency notes that in school, therapists' work more directly to improve student performance, including collaborating with teachers.

Trillium also said most students now receiving these mental health services will be enrolled in standard plans, not tailored ones.

Though school-based mental health services may provide important care, only a small number of families in Pasquotank receive them. In an email, Elizabeth City-Pasquotank Public Schools spokeswoman Tammy Sawyer reported 33 students districtwide received school-based services, and the district doesn't know how many are covered by private insurance, rather than Medicaid.

Debra Farrington is the Medicaid chief of staff for DHHS. In an interview Monday, she said the state values school-based services and wants to convey that to providers. She also explained state law defines, and limits, how DHHS may designate essential providers. Session Law 2016-121 lists five kinds of entities, such as health departments and free clinics, that must be considered essential.

Other providers may be deemed essential if their services are “not available from any other provider within a reasonable access standard,” or if a provider covers so many people that, without them, other providers couldn't take care of all a region's Medicaid population. In effect, the law appears to allow, but not mandate, a school-based service to be covered.

Farrington explained school-based providers do not fall into a single category, and their services take different forms and help with both mild and severe conditions.

Farrington said the state's intent is for services that are now covered will remain covered, and children might be grandfathered into standard plans to ensure school-based services they already get continue.

Farrington also invited Medicaid beneficiaries to reach out to providers or visit Medicaid's website for more information about how Medicaid reform will affect them. For most of the state, including eastern North Carolina, standard plans will launch in February 2020, and open enrollment will run this fall from mid-October through December. Details are still being worked out on the launch of tailored plans, but it won't start until July 2021, she said.

Jennifer Forlines, who oversees Medicaid in Pasquotank County and is the income maintenance program administrator for Pasquotank DSS, credited the state and insurers with making a good effort to inform and reassure everyone about reform — though there are a lot of questions to answer still, she acknowledged. The state is fortunately phasing in Medicaid reform gradually, she said, giving officials time to inform people and work out issues.

She also expressed cautious optimism about the new plans: state officials and insurers have provided assurances that services will be maintained or enhanced, if possible. One enhancement they're pursuing is bringing more physicians than are currently in Medicaid into the standard plans' provider network. That should help access to care, she said.

A key goal of Medicaid reform is to cap and lower costs for care; insurers are meant to get a set amount per patient, rather than a fee-for-service model. Asked if she had concerns about new plans being under-funded, Forlines said she couldn't speak to that. She noted the state may have auditors go through doctor's offices to find savings, and there's also an emphasis on preventative care, which can lower long-term costs.

Forlines also said Medicaid beneficiaries in Pasquotank should see letters about enrollment in standard plans around August or September, ahead of the enrollment period opening in October. Anyone with questions is welcome to call the Pasquotank DSS office, at 338-2126, or follow the state's website on Medicaid reform. That website is www.ncdhhs.gov/assistance/medicaid-transformation, according to a DHHS spokeswoman.