Major changes need to be made in the way mental health issues are addressed in the United States, U.S. Rep. John Delaney said in Clarinda Tuesday, May 21.
“There’s just such a lack of parity for mental health and how it’s treated versus physical health,” said Delaney, a Congressman from Maryland who is seeking the Democratic nomination for president. “With all the stigmas and biases that exist in society, payers basically use those to effectively deny care, because it doesn’t have the advocacy. It’s not something identified like physical health is.”
He made the remarks during a visit to Waubonsie Mental Health Center, which provides a range of services to residents in Page County and nearby areas in Southwest Iowa.
“A large number of people with mental illness don’t believe they have it, and don’t seek treatment for it,” he said. “That just perpetuates the bias and stigmatization, as opposed to what it is, which is a health care issue, just like a broken leg.”
Delaney toured the Waubonsie facility, talking with staff members about the operation of the center.
One subject Delaney asked about was how much reimbursement is received from Medicaid per individual served. At present, the daily amount is $360, said Jessica Coburn, a therapist and also executive director of Turning Pointe, a Waubonsie affiliate. That is less than the $400 rate that was in effect in 2004.
The reimbursement covers an initial assessment, daily individual therapy, two daily group therapy sessions, and all transportation.
Delaney said he favors increasing Medicaid reimbursement rates to help create more provider networks and expand access to mental health professionals for low income populations.
Medicaid funding is now administered by managed care organizations (MCOs) as the result of former Iowa Gov. Terry Branstad’s decision to privatize the program.
“We used to be able to do cost reporting here in in Iowa,” Coburn said, “but we no longer are offered that. And it’s because of the managed care.”
But she added: “We have a very supportive mental health region that covers additional operational costs.”
Delaney asked if payments from the MCOs were slower than the timetable that existed when the state was in charge of the Medicaid program. “It depends on the service and the company,” said Waubonsie staff member Coreen Dow.
Along with the need to boost reimbursement rates, the center could benefit from receiving “a lot more support from the community,” Coburn said, noting that referrals might not be made because individuals and agencies are not aware of the services offered.
A positive development is a new state law going into effect that will allow Waubonsie to become a full access center for mental health.
“We are going to become a ‘no eject, no reject’ facility,” Coburn said. “Anybody can be dropped off here. We will assess them, and then get them to the level of care they need.”
A challenge will be to find proper placement for individuals requiring acute care -- the fallout from Branstad’s action closing the Clarinda Mental Health Institute in 2015.
“In our area, to get into proper in-patient care can be anywhere from six to 12 weeks,” Coburn said.
The requirement for pre-authorizations from the MCOs before treatment is approved for individuals is another obstacle that Waubonsie faces.
Delaney said the pre-authorizations reflect a strategy on the part of the MCOs to not pay for specific services. “Statistically speaking, mental health pre-authorizations are four times more likely to be denied,” he said.
It can often be difficult convincing people who have mental health issues that they need help. And if they do realize that treatment could be beneficial, they might agree initially “then tomorrow may not want to,” he said. “Waiting for that pre-authorization is a real problem.”
Along with supporting measures to require mental health parity within the nation’s health care system, Delaney favors the expansion of access to mental health resources for at-risk populations.
Proposals include increasing the number of mental health professionals in schools to provide services to students, emphasizing early detection of potential problems and implementing appropriate intervention; and making more mental health professional available to individuals incarcerated in correctional facilities.
Delaney’s visit to Waubonsie was part of a three-day western Iowa tour that included 11 events in 11 counties.