Point of View

A step back from mental health

June 4, 2009 

— Job loss and financial strain have become common topics of discussion, and budget cuts dominate our news. However, little attention has been given to the recession's far reaching impact on the mental health of our citizens and, particularly, on diminished access to mental health providers.

What if you suddenly had no job, no money, no insurance and no hope -- and needed the help of a mental health professional? And what if there were not enough providers out there to help?

As more and more people lose their jobs, they also lose their health insurance coverage. For those who had mental health benefits, they also lose this coverage, just when they are most likely to need it.

Individuals and families may need to access public assistance programs such as Health Choice and Medicaid who have never had to utilize public assistance before. Such programs already fund mental health coverage for the disabled and low-income. How will everyone be served in the face of the budget cuts we hear so much about?

And who is going to be able to provide these mental health services? In North Carolina, that's an even more important question.

Licensed clinical social workers are the professionals most often providing these public services in our communities, in even larger numbers than other disciplines such as licensed psychologists or counselors.

However, by June 30, access to some of these professionals will no longer be an option for those citizens covered by Medicaid.

Upon completion of a master's degree and eligibility for examination, clinical social workers are provisionally licensed with stringent supervision and continuing education requirements. Such professionals are employed by many agencies providing these vital mental health services. Yet agencies are having to terminate employment of provisionally licensed clinical social workers because in the very near future they will be unable to bill Medicaid for the services these professionals provide.

Why? Because Medicaid is eliminating the billing codes that are used by these professionals.

Provisionally licensed clinical social workers are restricted from using specific billing codes for licensed mental health professionals (and yet are licensed) and no alternative billing codes have been proposed. As of June 30, these professionals have no way to seek reimbursement and are, therefore, a liability to the agencies in which they work.

The impact is both short-term and long-term. Those who are in desperate need of or are receiving mental health services now may not get the care they need. And, because provisional licensure is the vehicle by which new professionals enter the field and continue their training and practice, access to care in the future is even bleaker.

Billing and reimbursement is a necessary evil in providing health care. This administrative obstacle impacting the ability of clinical social workers to provide vital mental health services can and should be addressed and remedied by Medicaid. I am hopeful that we can and will meet the mental health needs of our community.

Michelle Reese, a licensed clinical social worker, is a board member and treasurer-elect of the National Association of Social Workers-N.C. Chapter.

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