Seattle Times: WA mental health providers say insurance reimbursement isn’t enough

December 21, 2023

In this article, Michelle Baruchman and the Seattle Times Mental Health Project team outline the difficulties behavioral health providers face to sustainably fund mental health services while keeping care accessible. We appreciate the opportunity to participate in the piece, which highlights how Certified Community Behavioral Health Clinics (CCBHCs) will advance community behavioral health and benefit both providers and individuals seeking services.

Issues with insurance

The setup for Medicaid, state-sponsored insurance, is also bleak, providers said. Most Medicaid clients get care through community behavioral health centers, which have long struggled to recruit and retain staff.

Medicaid often doesn’t reimburse for the full components of a patient’s treatment, like care coordination between agencies, which is crucial to creating continuity in treatment, and “other desperately needed services,” said Tom Sebastian, the CEO of Compass Health in Everett.

Instead, these facilities get paid for hours when they serve clients. The problem is Compass experiences about a 30% no-show rate. Clients sometimes miss appointments because they don’t have transportation or they have to attend to child care needs or “their challenges are so significant, they may lose awareness that they even had an appointment,” Sebastian said.

That means, about 30% of the time, “We’re unable to capture any revenue to cover the costs of those staff hours,” said Sebastian, whose organization is a member of Fourfront Contributor, a network of providers in Washington advocating for different payment models. “So long as we’re under this improperly structured system, it is just a big challenge.”

One of the largest worries for mental health practitioners who accept insurance is paperwork. Many therapists say they live in fear of clawbacks, where insurance companies can request thousands of dollars in back pay if they identify billing errors.

Moving forward

Therapists are mostly advocating alone, since contracts between insurers and providers prohibit discussion of reimbursement rates. 

“You are legally not allowed to discuss with other therapists or post on Facebook or tell a reporter how much they are reimbursing you,” Wright said. So mental health clinicians cannot work together to demand higher wages.

“It feels very lonely as an individual practitioner to push back against insurance companies because you know that they can lose any one person. And it’s no skin off their back,” Ballard said.

Benincasa said large companies should leverage their power to bring insurers to the table for the benefit of workers.

“If we want things to change, the people that need to get involved are people at Boeing and Amazon, people that are negotiating the benefits that they provide to their employees,” he said.

Within the public insurance sphere, efforts have been made to improve reimbursement rates for providers who accept Medicaid. The Washington state Legislature approved increases of 7% for community behavioral health facilities that began this year and 15% starting in 2024. It’s a “huge positive,” Sebastian said, but “you can’t rate-increase your way out of the [flawed] structure of the entire system.”

He points to a new funding model called Certified Community Behavioral Health Centers, which would allow facilities to project the full cost of their services, and then request that amount to be reimbursed by the Centers for Medicare & Medicaid Services. Twelve states have adopted the model as part of Medicaid.

The funding model has already been tested in Federally Qualified Health Centers, which serve a similar clientele as community behavioral health centers but for physical needs.

“Mental health and substance use have been treated differently for so long,” said Angela Kimball, the senior vice president for advocacy and public policy at Inseparable, a mental health advocacy organization. “People don’t even recognize the pattern of discrimination that exists in how we treat mental health conditions.”

Washington state will have an opportunity to apply to convert its system to the CCBHC model through the Substance Abuse and Mental Health Services Administration next year.

“We’re trying to unwind a multigenerational underinvestment in behavioral health services. That’s not going to be fixed in any one legislative cycle,” Fullerton said. “It’s going to take a while to unwind all previous policy choices that lead us to where we are.”

Read the full article at the Seattle Times, here.