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Managed Medicaid could reduce in-patient mental health treatment for kids in DHS custody

OKLAHOMA CITY (KFOR) – With Oklahoma moving towards a managed Medicaid system, there are going to be possible changes to mental health services to kids in DHS custody. 

Some are worried it’ll reduce services for those who need it most.

“Just the fact that behavioral health will be reduced is very alarming,” Verna Foust, CEO of Red Rock Behavioral Health Services, said.

The Frontier says there could be up to a 20-percent decrease in mental health services for kids in DHS custody under managed Medicaid.

That’s about 31,000 kids.

A company called Centene would be in charged of the plan.

In a proposal to the state, the company said they’ll reduce in-patient and residential treatment for children with behavioral issues, and rely more preventative and out-patient services.

Both the Oklahoma Health Care Authority and DHS said no one was able to do an on-camera interview Friday.

OCHA released a statement instead saying:

“Our goal is to better health for Oklahomans, which means higher value care and better health outcomes. We believe this will include an increased investment on primary and preventative care along with other factors that reduce utilization of higher cost services. The -20% for behavioral health is not a planned reduction in Medicaid services. It is a single assumption amongst a multitude of assumptions dealing with a specific set of services for specific members. It is used for rate setting purposes only to produce a reasonable and appropriate capitation rate to be paid to MCOs. If a medically necessary and appropriate service is rendered, and a clean claim is filed, the expectation from OHCA is that clams are to be paid.

The fundamental belief for that specific assumption is that with MCO resources, there is a considerable amount of opportunity for increased cost efficiency and effectiveness, including program integrity considerations, within behavioral/mental health services when moving from a FFS reimbursement model to risk-based managed care. There are fewer Medicaid public references when we get into non-physical health services, but some demonstrate this.

The reduced savings factor assumption for the children in the custody of the state merely reflects a belief that utilization impacts on that more vulnerable population may be more limited.”

DHS said in a statement:

“When the state made the decision to move to managed care, OKDHS was contacted for assistance in collaborating with the Oklahoma Health Care Authority (OHCA) to plan for how managed care would serve children in foster care. In consultation with national experts, the decision was made to develop a specialty managed care plan that would focus on serving the unique needs of children and youth in foster care and Office of Juvenile Affairs (OJA) custody, and that would also be available to serve children and youth who have been adopted, those who have aged out of foster care, and, when appropriate, families who are being served through prevention services. OKDHS has been working closely with OHCA, OJA and the selected specialty plan, Oklahoma Complete Health, to implement the plan by the target date of Oct. 1, 2021, as well as to collaborating to improve the health, social and well-being outcomes of children and youth who have encountered the child welfare or juvenile affairs systems.”

The Oklahoma Association of Health Plans adds:

“Managed care will not reduce mental health services for youth in foster care. Instead, it will direct and deploy the latest early intervention and support services, like in-home therapy, that improve outcomes. MCOs exist in more than 40 states and operate with the mission to improve health outcomes with oversight provided by local and federal governments. We welcome the modernization of health care delivery in our state of Oklahoma, which has been stuck in last place for far too long.”

The organization Youth Villages says:

“We’re supporting the implementation of a managed care system in Oklahoma because it offers the possibility that more children and families will be able to receive intensive in-home services that will help kids avoid out-of-home placements. We work in 23 states, including Oklahoma, and are particularly pleased that the state is looking at the Tennessee model. Youth Villages has provided intensive in-home services to children with emotional and behavioral problems and their families through Tennessee’s TennCare system since 2000. The managed care system there has enabled us to provide intensive help to thousands of children and families in their own homes. We think this is best for kids.”

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However, some are still concerned about the prospect of the plan.

“When kids don’t receive the mental health services they need, it’s a tragedy, because not only are they suffering at that time, it can lead to lifelong issues,” Foust said. “Behavioral health issues with kids need to be addressed immediately.”

KFOR has reached out to Centene but have not received a response.