NC House bill would tie patients to therapists

lbonner@newsobserver.comApril 30, 2013 

Emotional testimony from a mother helped push forward a House bill that lets people with mental health problems on Medicaid continue to see their longtime therapists even if they move.

The bill is needed to remedy a problem created after local government mental health offices were restructured to become managed care organizations.

These organizations, which cover groups of counties, receive a set amount of state and federal money for eligible mentally ill patients in their regions and control which mental health providers are paid to offer treatment. The state legislature passed a law in 2011 spreading managed care for mental health statewide as a way to control spending.

But over the past 18 months as the change was implemented, problems have cropped up all over the state as people moved from one county to another. Once outside the boundaries of their original county’s managed care organization – and where they first received Medicaid – people found that those organizations did not have contracts with mental health providers in their new county.

Parents of foster and adopted children have been most vocal about the problem, and have talked about children with severe problems losing mental health services because they were adopted from distant counties. But the managed care-contract problem has also separated adults from their longtime doctors and has forced adults to leave group homes where they’ve lived for years. The state had not been keeping track of how many people have grappled with this problem.

Under the bill, mental health services paid by Medicaid will be based on where people live, not on the counties where they first received Medicaid.

“Regardless of home county of origin, where you live is where you get the services,” said Rep. Marilyn Avila, a Wake County Republican and the bill’s primary sponsor.

Meg Moss told lawmakers that she and her husband adopted three boys from Cumberland County, a newborn going through cocaine withdrawal and 1- and 2-year-olds who were abandoned in a trailer.

The two younger boys have been getting intensive mental health treatment for nearly six years for a variety of disorders, including ADHD, oppositional defiant disorder and sensory processing disorder, Moss said. The mental heath services ended two days ago because the Mosses live in Lee County, which is outside the insurance zone that covers Cumberland.

“We are desperate,” Moss said. “We cannot start all over again.”

It takes months for one of her sons to adjust to new people because of his anxiety disorder, Moss said. Forcing him to see a new therapist would be a significant set-back.

The bill was approved in a House committee without opposition, though Rep. Verla Insko, a Chapel Hill Democrat, asked whether Medicaid patients switching counties may be in danger of having their treatment downgraded because mental health services are not uniform across the state.

Bonner: 919-829-4821

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