State Leadership Conference

With budget shortfalls expected to hit $35.6 billion for the 2005 fiscal year, state governments are looking to cut expenditures, and their shears will likely aim toward Medicaid optional services, including mental health coverage, said experts at the State Leadership Conference. Those who would preserve Medicaid-funded mental health services have difficult fights ahead of them, added Michael Sullivan, PhD, assistant executive director for the APA Practice Directorate's state advocacy program.

And the stakes are high, he said: If Medicaid funding is eroded, it could leave many--including children--without mental health care.

"Legislators should know that 50 percent or more of public mental health treatment is funded by Medicaid," Sullivan said.

A panel of five psychologists with Medicaid advocacy experience, including APA President-elect Ronald Levant, EdD, who fought in Florida for favorable state regulatory changes regarding Medicaid reimbursement, offered the following advice to psychologists working to protect Medicaid funding:

  • Initiate community-based grassroots campaigns. When Georgia Gov. Sonny Perdue proposed scrapping all Medicaid mental health reimbursements for children, Nancy McGarrah, PhD, a psychologist with an independent practice, and the Georgia Psychological Association (GPA) legislative committee chair for children's issues, helped galvanize her members to write letters to their representatives.

The support of rural psychologists and the resulting media attention were especially helpful in fighting the proposed cuts, said McGarrah.

For example, The Times newspaper in Gainesville, Ga., carried several articles and letters about the proposed Medicaid cuts and their potential impact on children and families. The coverage included quotes from local psychologists and GPA spokespersons.

In addition, McGarrah requested the help of juvenile court judges who argued that children soon end up in the court system when they do not receive necessary mental health services.

"Every judge I spoke with agreed to write a letter," noted McGarrah.

The influx of mail alerted the governor and lawmakers to the deleterious results of the proposed Medicaid cuts, and they restored all funding to cover approximately 24 visits with a psychologist, said McGarrah.

  • Build coalitions for lobbying. In a state as populous as New York, getting the attention of state legislators is not easy, said Eric Garfinkel, PhD, a clinical psychologist and New York State Psychological Association (NYSPA) insurance chair. So NYSPA worked with the New York State United Teachers (NYSUT)--an influential labor union with a membership of about 500,000, as compared with NYSPA's 3,000--to fight proposed cuts in Medicaid reimbursement for mental health services provided to individuals who are dually eligible for Medicare and Medicaid, including elderly residents of nursing homes.

The teachers' union, which includes many retired teachers who are eligible for Medicare, has a long history of fighting Medicaid cuts.

Thanks to this partnership, and the thousands of letters it generated, New York psychologists not only made their case before a Joint Finance Committee and rallied enough legislative support to pass a law reimbursing psychologist Medicaid providers for 100 percent of their fees, but also overturned the governor's veto.

"When NYSUT, with more than a half million members, adopts psychology's issues as its own and prioritizes them as strongly as they did the elimination of the Medicaid-Medicare crossover payment issue, our voice is made that much stronger," said Garfinkel.

  • Take legal action. Despite a provision in the state licensing law that prohibits state government agencies, including Medicaid, from discriminating between psychologists and physicians, Missouri historically only reimbursed psychologists for working with children, leaving many low-income adults without mental health services, said John Hogg, PhD, a psychologist in independent practice in St. Louis, and past-president of the Missouri Psychological Association (MOPA).

After consulting with independent attorneys as well as APA's Psychology Defense Fund, the association, under the direction of Hogg and other MOPA board members, took legal action against the state and requested a summary judgment. The psychologists prevailed in 2002--the judge ruled that Missouri could not exclude psychologists from providing Medicaid services to adults.

APA Executive Director for Professional Practice Russ Newman, PhD, JD, while not part of the panel, notes that preserving Medicaid psychological services is an important part of the APA Practice Organization's agenda.

"This will definitely be a tough battle in the current economic climate, but we need to find ways, whether at the federal or state levels, to ensure that psychological services remain a key element of Medicaid," he adds.