COLUMBUS, Ohio – The Ohio Department of Medicaid is receiving $100 million to increase payments to mental health and addiction recovery providers, who say they have been financially struggling under changes made during the era of former Gov. John Kasich.
The announcement was made official in an executive order signed this week by Gov. Mike DeWine. The money is coming from the budget bill passed last month — $50 million for this fiscal year and $50 million for next fiscal year. This year’s Ohio Medicaid budget – both in state and federal dollars – is $25.3 billion.
DeWine’s executive order also allows Ohio Medicaid to relax some Kasich-era policies that service providers said prevented them from easily getting to mental health and substance abuse patients.
What is Medicaid? Your questions answered
Ohio Medicaid is a program for the medically and financially needy. About 3 million Ohioans are in it.
During the Kasich administration, Medicaid payments changed for mental health providers. Providers formerly billed the state and were paid directly by the state. The change required them to bill and get paid by managed-care organizations – companies such as CareSource or UnitedHealthcare. The state was paying the managed-care organizations. As part of that change, medical billing codes for mental health were updated and policies about what services could be reimbursed changed.
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“There were many problems with the implementation that were discussed with the legislature,” Ohio Medicaid Director Maureen Corcoran said in an interview Friday. “Upon Gov. DeWine taking office, he had heard quite a bit about this and really since January we’ve been working with all the stakeholders.”
Corcoran and her team devised a number of fixes, which were announced in the executive order.
Under the Kasich changes, the reimbursement rate for group counseling was cut by 60 percent for mental health patients and 30 percent for substance abuse patients, said Teresa Lampl, executive director of the Ohio Council of Behavioral Health and Family Services Providers, which represents 150 private businesses.
The fixes increase the reimbursement rate.
“It’s not a complete restoration, but it gets close,” said Lampl, who praised the fixes his week.
The Kasich changes required nurses to get a doctor’s permission before they could get compensated for many services – such as reviewing with a patient new medicines, talking to them about side effects or telling them to schedule blood work to ensure the medicine will work.
“The nurse would not be able to do those things and the agency the nurse worked for wouldn’t be compensated – unless there’s a doctor order,” Corcoran said. “But a nurse doesn’t need a doctor’s order to do that work. By taking off the overly restrictive requirement, it means the nurse can do everything that her scope of practice under Ohio law allows her or him to do, and be able to be compensated.”
Ohio Medicaid offers an intensive behavioral health service for older children, usually ages 15 to 21 years old. A team of experts – such as a physician, nurse, social worker and counselor – would help a child. Sometimes the team would help the child’s parents with counseling. The former policy required the doctor on the team to meet with the child monthly.
“If the doctor had spent a lot of time with the team or talking with the parents, that wouldn’t count,” Corcoran said.
But now the doctor only has to meet with the child as needed, she said.
DeWine’s executive order – and the new funding — went into effect Thursday.
The changes will ultimately result in more patients getting faster access to help, Lampl said.
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“This executive order provides some much-needed relief to provide access to behavioral health services, and gives providers more flexibility in how they can use their workforce,” she said.