Recently, enrollment of new behavioral health providers in two South Florida counties were suspended from the state’s low-income health program.
The reason: They’re accused of over-billing the state for what it says are “impossible” hours. But that’s just part of the problem with how the state deals with behavioral health.
One missed clinic visit can be the difference between progress and relapse says Duval County mother Lori Perry. Her son’s care has lapsed due to changes in Medicaid authorization. The care he received was helping curb his violent behavior.
“Well I have a 14 year old son that’s diagnosed with severe autism. He has self-injurious behaviors and head-banging and agitation and aggression. He has not received any therapy in three months,” Perry says.
Perry’s son had been working with a therapist to learn ways to relax and release his anger through other means. The kinds of treatment patients receive for behavioral health issues is varied; from one-on-one therapy, to group counseling. One of the places that provide these types of services is the Apalachee Center in Tallahassee.
Steve Litherland provides counseling to patients that struggle with anxiety, depression, and bipolar disorder.
“As a peer specialist I try to help people through my own lived experiences. I live with Bipolar Disorder. The idea is role modeling, and mentoring, and trying to help people through their own recovery process in their own way. I learned some real world coping mechanisms along the way that help me and I try to pass those along,” Litherland says.
But there are far more patients needing help than what clinics like his can offer, and Litherland says a big problem he sees is understaffing.
“Probably about a three to four month wait to see a therapist right now. That’s rough, especially if you need help. I see it all the time, there might be 30 people on the list and you call and 29 of them aren’t taking new patients and the 30th one has got a four month, five month wait. That doesn’t help me today," Litherland says.
Patients with Medicaid must get their time in behavioral health clinics approved by the state. Florida’s Agency for Health Care Administration, or AHCA, manages Medicaid for patients across the state.
Earlier this year, AHCA changed over to a different company for authorization of new providers and patient hours. This change has led to some Medicaid clients needing to have their hours recertified, a process that has been lengthy for people like Perry:
“In my son’s case he had so much documentation on him that there should be nothing to review. The behaviors are documented, the head-banging, the self-injurious behaviors are documented. I had two doctors in town that are willing to write letters to say ‘yes, he needs behavioral therapy. It’s a necessity.’ But here I sit three months later and he has no behavioral therapy coming whatsoever,” Perry says.
One of the reasons AHCA switched companies was to fight fraud. In Miami-Dade and Broward County, some clinics made false claims—like billing the state for 26 hours in one day. Nikki Dickens, the president of the Florida Association for Behavioral Analysis, says she understands AHCA’s decision, but thinks the agency’s initial approach should have been different.
“They really need a system review to see where these things are going wrong. It needs to catch fraudulent individuals who are attempting to practice without being qualified behavioral analysts, but it also needs to have safeguards in place that allow those qualified individuals to treat the families that need it, Dickens says.”
AHCA issued a moratorium for Broward and Miami-Dade, preventing new providers from opening before the certification system could be overhauled. A spokesperson for AHCA says the agency will stop at nothing to prevent waste, fraud, and abuse. After a recent meeting, Dickens says she believes positive changes are on the way.
“I was encouraged by our recent meeting with AHCA Secretary Justin Senior and his staff. It’s clear the agency is working to eliminate the extraordinary delays on both the authorization and the enrollment issues. We still have other concerns and details to work through, but the Secretary was very open to FABA’s input and continuing the dialogue,” Dickens says.
For patients on Medicaid seeking treatment, things seem to be moving in a positive direction. But Perry and her son are still waiting to see a behavioral health specialist.