Over the past 50 years, Medicaid coverage has jumped from 4 million to nearly 70 million Americans. Medicaid is the largest single payer for mental health services in the United States, and expansion of the program under the Affordable Care Act has made Medicaid the new coverage pathway for millions of uninsured adults. As of this summer, 30 states and the District of Columbia had adopted Medicaid expansion under the Affordable Care Act. One state was still debating expansion, and 19 states elected not to expand Medicaid.
Because Medicaid is administered on a state-by-state basis, Medicaid reimbursement rules vary greatly regarding full recognition of licensed psychologists (including the use of health and behavior codes) and reimbursement for services provided by supervised interns and postdoctoral students.
The APA Practice and Education Directorates and the American Psychological Association of Graduate Students are working together with state psychology association leaders to make sure that licensed psychologists can participate fully as independent providers in Medicaid, and to help correct the internship imbalance that psychology is facing by allowing services provided by appropriately supervised doctoral psychology interns to be reimbursed by Medicaid.
Since Medicaid is a state-based program, Practice has supported several state association-led initiatives. APA's Practice and Education Directorates provided support to the Arkansas Psychological Association in achieving reimbursement by Medicaid for the services provided by doctoral psychology interns.
As part of the overall Practice advocacy initiative to address barriers to psychological services in Medicaid, Practice is working with six more states to ensure reimbursement for services provided by doctoral psychology interns and full participation of psychologists as independent providers. We engaged Epstein, Becker & Green — a law firm with expertise in Medicaid and health-care law — to analyze and prepare a sampling of challenges to psychological services delivery, as well as opportunities for overcoming those challenges in all 50 states. This information has been helpful as we develop plans for breaking barriers in the different states.
Additionally, APA's Education Directorate recently hired a policy and advocacy fellow to work specifically on the Psychology Internship Reimbursement Project with the Practice Directorate. The Internship Reimbursement Project will work with individuals and with state, provincial and territorial psychological associations (SPTAs) on strategies to increase the sustainability of internship programs by advocating for Medicaid reimbursement for psychological services provided by doctoral psychology interns supervised by licensed psychologists. The fellow will also explore avenues to allow independent psychologists to bill Medicaid using health and behavior codes.
As part of the project, the fellow is helping to organize a task force in each focus state composed of such stakeholders as training directors, SPTA executive directors and directors of public affairs, the psychology licensing board, staff from the Medicaid office/regulators, and Practice Legal and Regulatory Affairs staff. This task force will be able to assess the regulatory and legislative situation in each state and determine the best course of action to remove impediments to intern reimbursement by Medicaid.
Only 11 states specifically allow reimbursement for the services provided by doctoral psychology interns. Many internships are in areas comprising underserved populations with significant health disparities. Expanding intern coverage would improve access to services in these areas, and provide another revenue source for hospitals, mental health clinics and other facilities to maintain the economic viability of internship slots. It will also help address the workforce shortage. Interns who begin working in Medicaid early in their careers will understand the special needs of the Medicaid population and be more likely to continue working as Medicaid providers.
The work we've done so far is an example of what can be accomplished with collaboration between national and state organizations. Much of the hard work will take place at the state level. We encourage you to contact your state psychological association to get involved and keep this issue moving forward.
