January 20, 2021
Following five years of partisan opposition, Virginia celebrated Medicaid Expansion that was approved by the Virginia General Assembly in an extended session in 2018. The new benefits that started January 1, 2019, provide essential healthcare for thousands of uninsured low-income Virginians. 490,000 newly enrolled citizens now receive services as of July 26, 2019 -totaling over 1.78 million Medicaid recipients in Virginia as of December 31, 2020. Despite these initiatives and advances, there remains much work to be done to adequately serve Virginia’s Medicaid recipients, specifically, Virginia’s most vulnerable and underserved populations.
Notwithstanding the excitement of the long- awaited and much- needed strides achieved with the final approval of Medicaid Expansion in 2018 toward an equitable system of access to healthcare for all Virginian’s; it is of great concern that in 2019, DMAS, in partnership with Virginia’s six managed care organizations (MCO’s), has chosen to restrict access and freedom of choice to mental health and substance abuse services to Virginia’s Medicaid recipients. We see this as an egregious affront of the intent of the Virginia legislatures underlying premise of Medicaid Expansion-quality and access to healthcare for all Virginians.
To this end, we have inherent policy concerns that Virginia’s state agencies are currently leading:
1) Medicaid consolidation -eliminating private providers without cause. The MCOs should not have the authority to create terminable at will contracts – the authority to create terminable at will contacts moves the MCOs from a vendor to an executing decision maker, which is exactly what 42 CFR 455.410 and case law, K.C. v. Shipman, state is in violation of the law 2) workforce shortage - refusing to put forth initiatives to address workforce shortage. These issues are antithetical to a state seeking to expand mental and behavioral health Medicaid services.
Because of this, we are asking for the following consideration:
Co-Patron BA 313#11s- the “Provider Bill of Rights” - a Senate budget amendment submitted by Senator Lucas to the DMAS portion of the budget.
BA 313#11s-The “Provider Bill of Rights” is:
No provider services agreement can be unilaterally terminated by MCO without “cause” and an opportunity to cure;
Provider networks should reflect the demographic profile of the Medicaid population being serviced;
The end-goal of every MCO-provider relationship should be the “best interests” of the customer. Needless interruption of service should be avoided if possible.
1. Virginia’s 6 MCO’s continue to terminate private community based mental and behavioral health providers in Virginia “without cause” and have no demonstrable evidence of value-based outcomes, but terminating indiscriminately in a time of COVID-19 and Virginians are facing opioid and mental health epidemics, why? As a part of the ACA, the federal Network Standard Adequacy regulation in the 45 Code of Federal Regulations §156:230 describes federal requirements for all qualified health plans to maintain a provider network that is “sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services, to assure that all services will be accessible without unreasonable delay.”
2. Expansion of Medicaid simply in word only, the DMAS is intentionally restricting the supply of providers and QMHPS to limit the demand. DMAS is aware of the shortage of QMHPs and has not taken ample steps to close the gaps of needs for that skillset. In fact, DMAS has raised the service level definition for service provision to eliminate opportunities for low income people to access services
“While Medicaid expansion is creating an opportunity for thousands of people to enroll in healthcare coverage, it’s also creating a demand for more behavioral health specialists, "says Sara Dunnigan, Governor Ralph Northam’s Deputy Chief Workforce Development Advisor.
Says Dunnigan: “Every state is touched by the workforce shortage. Projections show that by 2025 the shortage will be astronomically worse; six vital mental health provider types (psychiatrists; clinical, counseling, and school psychologists; substance abuse and behavioral disorder counselors; mental health and substance abuse social workers; mental health counselors; school counselors) will have shortages of approximately 250,510 FTEs.4 An infusion of qualified behavioral health providers is needed to drive down avoidable hospitalization costs, reduce recidivism with justice-involved clients, address the substance use epidemic and increase access to timely, evidence-based care.”
Medicaid Provider Network Consolidation:
Paradoxically to the mental health professional workforce shortage, and in the midst of Virginia’s Opioid crisis, it is deeply troubling that the will of Virginia’s general assembly, DMAS and Virginia’s MCO’s instigated a consolidation of private community- based behavioral and mental health providers on September 25, 2019. This consolidation resulted in the termination “without cause” of many of Virginia’s licensed private and community based behavioral and mental health providers; all qualified by DMAS and DBHS (the preeminent authority for Medicaid recipient’s behavioral health services in the commonwealth). We strongly question at a time of expansion of services underneath the Medicaid umbrella why INDISCRIMINATELY terminate these qualified providers “without cause” if the ultimate goal is to serve as many needy Virginians as possible? This element simply is not consistent with the need for services and the fundamental intent of the Virginia legislature.
Virginia’s community-based mental health professionals who treat and support individuals living with mental illnesses and substance use are a key segment of the mental health workforce. Primarily funded through Medicaid, these professionals provide treatment and support at home or in the community rather than in a traditional clinic setting. Such settings are preferential for and conducive for a population that is often reluctant to seek treatment due to a combination of mental health challenges, frequent homelessness, unstable housing, and extreme poverty. Since 2011, in part because of Virginia’s restructuring the professional qualifications of its mental health professionals, the mental health professional workforce serving this population has decreased by 23%. Without additional workforce development initiatives specific to qualified licensed mental health providers (QMHP’s), Virginia will continue to fail to deliver adequate access to treatment. As a result, access to treatment will remain elusive for Virginia’s most vulnerable populations because there are simply not enough workers.
Thank you for your continued leadership and strong dedication to mental and behavioral health and substance use disorder parity. We look forward to working with you to ensure the enactment of this important legislation.
Caliber Virginia, was established in 2006 to provide support, resources and information with a united, well-informed and engaged voice among the private community-based behavioral and mental health service providers of the Commonwealth.
Caliber Virginia is the collective voice of private minority community-based behavioral and mental health providers in Virginia. We champion community providers’ causes and represent their interests at the Legislature, with the Administration, state agencies that contract with community providers, the media, and with other related advocacy organizations/associations at the local, state, and national levels.
Caliber Virginia’s respected voice protects private community-based service provider funding, advance new funding initiatives, support strategies for long-term change to the funding system, facilitates training and education programs for providers and advocate for policies that support the community provider system.