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Rural Mental Health Providers Concerned About Managed Care

The capitol building in Jefferson City
j. stephenconn
The capitol building in Jefferson City

Some mental health providers in rural Missouri are raising concerns about a provision passed by the Missouri Senate that would shift about 200,000 Medicaid recipients onto privatized managed care programs.

Loretta Fuge is a psychologist based in Mansfield, Mo. Currently, Fuge is reimbursed for seeing Medicaid patients through the state’s fee-for-service model. She has some experience with managed care and, she says, she isn’t a fan.

A recent failure to get fully reimbursed through managed care has made her cautious about the viability of managed care in small communities.

“I actually not only lost the time that I spent and the cost of the protocols, which are quite expensive,” Fuge said, “but also the administrative time.”

“So for a small business out here in a rural area, we couldn’t survive. There’s no way we could financially be able to do that, we would have to close the door,” she added.

James Skinner, a counselor based in Lebanon, Mo., worries those administrative costs could force providers like him to leave rural areas with higher Medicaid enrollment.

“From a practice perspective, our goal is to support the community. It’s the only reason we do this work,” he said.

But, he added, “from a business perspective it is extremely difficult to own and operate a small business under these conditions.”

About half of Missouri Medicaid recipients are already enrolled in managed care plans. A comparison of the two funding models by the Missouri Department of Social Services found managed care plans had a lower overall cost than fee-for-service, though they also appeared to have lower clinical quality measures.

As part of the state budget, the proposal now goes back to the Missouri House.

A curious Columbia, Mo. native, Bram Sable-Smith has documented mbira musicians in Zimbabwe, mining protests in Chile, and the St. Louis airport's tumultuous relationship with the Chinese cargo business. His reporting from Ferguson, Mo. was part of a KBIA documentary honored by the Missouri Broadcasters Association and winner of a national Edward R. Murrow Award. He comes to KBIA most recently from the Salt Institute for Documentary Studies in Portland, Maine.
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