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.