On June 19, the Missouri Psychological Association (MOPA) received a favorable decision on summary judgment in a case in which psychologists claimed that the Missouri Department of Social Services (DMS) blocked psychologists' full participation in the state's adult Medicaid program.

With support from the APA Psychology Defense Fund, MOPA initiated the case in 2000, arguing that DMS, in effect, has ignored psychologists' legal scope of practice by refusing to reimburse psychologists for the same services that psychiatrists are reimbursed for.

The Center for Medicaid and Medicare Services--the government body that administers the federal Medicaid program--and Missouri statutes require DMS to formally create rules that define the qualifications mental health professionals need to provide mental health services under Medicaid. But DMS never created these rules; the department instead issued informal bulletins proclaiming which mental health providers could provide certain services within the state's Medicaid program.

For example, DMS reimbursed psychiatrists but not psychologists for providing individual psychotherapy and diagnostic interviews with adults. Interestingly, DMS has reimbursed psychologists for services provided to children under Medicaid. But if a child received services from a psychologist for years under Medicaid, the child would be cut off from those services when he or she turned 21.

"Under Missouri statutes, the state agencies are not allowed to discriminate against psychologists in this manner," says John Hogg, PhD, MOPA's president and clinical assistant professor at the University of Missouri in Columbia.

Though the Missouri Medicaid law doesn't specify which professionals should be allowed to provide mental health services, the state's licensing law prohibits discrimination against psychologists, specifically in regulations that govern services that may be legally provided by psychologists and physicians. So, MOPA built its case on the argument that the implementation of other general statutes must take into account the nondiscrimination statute.

But the issue is more than just discrimination against psychologists, says Bridget Martin, PsyD, MOPA's president-elect and a staff psychologist in student counseling at Washington University's School of Medicine in St. Louis. It's also about opening up access to psychological services for Missouri residents in the program, some of whom live in areas where there is a shortage of Medicaid providers, she says.

Hogg agrees. "It's been particularly frustrating that those Missourians in the adult Medicaid program who could most benefit from a psychologist's expertise have been summarily blocked from our services," he says.

The summary judgment should change that. "The judgment says that psychologists will be able to participate in all Medicaid programs to the extent that other physicians are able to participate and that psychologists will be treated equally for the services they're licensed to provide," says Martin.

In short, if the services provided are within psychologists' scope of practice, DMS must allow psychologists to provide those services and be reimbursed for them.

That could mean good news for other states, too. The MOPA judgment, although not legally binding on other states, could be used as an example by psychologists fighting similar battles in other states, notes Cherie Jones, director of legal and regulatory affairs in APA's Practice Directorate.

At Monitor press time, Hogg and Martin said the judgment could be appealed; but if not, they'd begin working to implement it immediately.

--J. DAW