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Proposed mental health cut would affect some children getting therapy through SoonerCare

Tulsa World (OK) - 2/10/2016

Mental health professionals are feeling just how painful upcoming budget cuts could get.

The Oklahoma Department of Mental Health and Substance Abuse has proposed eliminating Medicaid reimbursements to individual therapists serving children on SoonerCare.

The move is expected to save the state about $1.2 million the rest of this fiscal year and as much as $17 million the next; however, that amount would most likely be about $8.5 million.

The Oklahoma Health Care Authority is set to vote on the proposal at a meeting Thursday.

"I don't think our society can afford this," said Michelle Burke, a clinical therapist who operates Hope Rising Therapeutic Services in Bartlesville.

"If the children with mental illness don't get treated, they grow up to be adults that require inpatient treatment or incarceration. Both of those cost much more than private therapy, annually."

The state has contracts with 750 master's-level practitioners to bill SoonerCare. Of those, 512 have billed the state since October and 300 of those billed less than $10,000 in the past year, said Terri White, commissioner for the Oklahoma Department of Mental Health and Substance Abuse Services.

About 8,000 children statewide receive their SoonerCare-funded treatment from independent master's-level therapists.

"None of these kids will lose services if they go to an agency and it's deemed medically necessary," White said.

In 2010, the state began allowing private practices to serve children with mental disorders who are on SoonerCare in an effort to provide more availability to those children in rural areas; however, the bulk of therapists billing the SoonerCare program are in the Tulsa and Oklahoma City areas.

When children are assessed for mental issues, they are ranked within a four-tier category. The majority of children with the most severe mental health problems are already receiving treatment at state-supported agencies, White said, and those children who need mental health care will receive it even with the proposed change.

Burke said that those agencies have limited resources to serve the children in the lesser two tiers and that's where the private practitioners fill a need.

"The large agencies are really not able to take patients as they come in. They have three-to-four-month waiting lists right now," Burke said. "Those of us who get overflow, we can get them in in a week or two and get them started on services."

She added that if this proposal is passed, the cuts would mean longer waits for children to get services, or the possibility that they may never get help at all.

"We worry that if those people are taken away from our caseload and placed on waiting lists they'll just be sitting out there waiting and perhaps falling through the cracks," Burke said.

Gail Lapidus, CEO of Family & Children's Services, said she doesn't support the decision but does support White in making that decision.

"This is a drastic measure by the Department of Mental Health because we're potentially facing drastic cuts.

"When you look at it from an economic standpoint from all equally bad solutions, it was the one you could argue makes sense between all the other bad solutions because there's no good solution when you're already one of the lowest-funded (sectors) in the community," Lapidus said.

She said the real battle is the inadequate dollars available to fund mental health services.

"This isn't a problem from the oil and gas crisis. This is a problem that has gone on for decades," Lapidus said. "In 1937 it was already pointed out that we didn't have the will to fund adequate care."

It was recently reported in The Oklahoman that even 80 years ago the state ranked in the bottom of mental health funding and at the top for its high number of people suffering with mental issues.

The state continues to rank among the highest for those with mental illness and the lowest in funding.

"Many people with mental illness wind up being poor or low-income because their illness is often somewhat debilitating, at least for a period of time," Lapidus said. "Now, the population of people with mental health disorders is going to again suffer disproportionately to other persons in other states because of the limited resources that have been allocated."

Burke said she and her colleagues have discussed other options the state could take to save money. Those ideas include reducing the reimbursement rate for SoonerCare across the board, cutting rehabilitation services provided by bachelor's-level clinicians and cutting the amount SoonerCare pays for clinicians under supervision compared to fully licensed clinicians.

"I know there have to be cuts. We're in a health care crisis. There's going to be cuts, and they're going to hurt," Burke said. "I think there are better ways to go about it than by cutting out one specific group of people."