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Testimony before a new Louisiana legislative panel Tuesday ripped the Band-Aid off the state’s ailing mental health care system. The bulk of the discussion centered on the maze patients in the Medicaid system, which provides care for 39% of Louisiana residents according to the state health department, must navigate for treatment, and how that care is often inadequate, interrupted or not covered by the government-provided insurance.
The managed care organizations, or MCOs, the state contracts with to provide treatment access to Medicaid patients were among the topics of scrutiny. Roughly 25% of the annual state budget — nearly $11 billion in fiscal year 2022 – is allocated to cover Medicaid.
Louisiana now has six MCOs, and one behavioral health plan. Critics say the fickleness of MCOs when it comes to what they will cover interrupts the continuum of care for patients.
Although they are supposed to honor one another’s prior authorizations for treatment, experts who testified said that’s often not the case. For example, a patient who has approval for multiple health care visits typically sees that number reduced if they have to switch MCOs. In addition, Medicaid patients also face long wait lists for mental health providers no matter the organization.
“Medicaid recipients and providers have really paid the cost moving from what we used to what we have now because the care is so fragmented,” Katie Corkern, executive director of the Louisiana Rural Mental Health Alliance, told the subcommittee.
Louisiana moved from a state-managed Medicaid system to one with contracted MCOs in 2012 and has gradually increased the number of organizations involved since then.
A majority of mental health rehabilitation providers that accept Medicaid patients are owed hundreds of thousands of dollars by the state, Corkern added, leading some to leave the programs or close entirely.
Some lawmakers appear inclined to reduce the number of MCOs doing business with Louisiana Medicaid with hopes of streamlining the process for patients to receive the care they need. Rep. Mike Echols, R-Monroe, is one of the more outspoken critics of the state Medicaid program and shortcomings within the Louisiana Department of Health (LDH).
“Would you say looking at this industry and based on what’s happened with LDH and MCOs that the patients truly have a voice in their care?” Echols asked Corkern.
“No,” she responded.
Karen Stubbs, LDH deputy secretary for the Office of Behavioral Health, provided the subcommittee with a discharge analysis of state Medicaid patients 6 and older who were treated for certain mental health diagnoses. It looked at the portion of those patients who had a follow-up visit with a mental health care provider within 30 days of their benchmark.
In 2016, the national 30-day follow-up benchmark was 49% of patients. Only one of Louisiana’s five MCOs at the time reported a rate higher than that. In 2021, the national benchmark increased to 59%. None of Louisiana’s six MCOs reported higher than a 41% rate.
Long wait times for treatment at the state’s long-term mental health care facilities have also placed burdens on acute care centers that are geared toward treating people in crisis. Louisiana’s capacity to handle patients who need extensive aftercare has been severely limited since former Gov. Bobby Jindal chose to close mental health hospitals and clinics across the state. He also opted against a Medicaid expansion under President Barack Obama’s Affordable Care Act in 2015, which further curtailed mental health care services.
Dustin Thiels, CEO of River Place Behavioral Health Hospital in LaPlace, told committee members about having recently released a patient who waited 90 days for a bed at a long-term state facility. The patient’s MCO stopped covering the cost of his care a little after three weeks of his stay at River Place.
“We have to eat the rest of that cost for the care that the patient receives until we can provide a safe discharge into the community,” Theils said.
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Louisiana Managed Medicaid Association represents six of the MCOs in Louisiana that together insure 1.7 million Louisiana residents. Its chief medical officer, Dr. Stewart Gordon, appeared before the subcommittee and shared numbers that show while Louisiana Medicaid is spending more on behavioral health, the share of those dollars out of total health care spending is less.
From 2020 to 2022, the behavioral health portion decreased from 9.6% of the total to 7.8%, despite the COVID-19 pandemic interruption in services two years ago and the subsequent increase in demand for mental health care since then.
Subcommittee members asked Gordon, who was previously chief medical officer for the state’s juvenile justice system, to provide a list of suggestions for improving access to mental health care.
“Please don’t build any more jails or prisons, or fund any of them, as long as y’all have any say-so in the matter,” Gordon said, making clear he was not speaking on behalf of the MCOs. “Put it in housing and everything else in this list in the early childhood system of care.”
Rep. Laurie Schlegel, R-Metairie, who is a professional mental health counselor, created and chairs the House Subcommittee on Mental Health in response to the state’s mental health crisis. Her resolution cited data showing 650,000 adults and 246,000 children in Louisiana are likely to experience a diagnosable mental health disorder in their lifetime. Also, almost 3.4 million people in Louisiana live in communities that lack adequate mental health care providers.
One young woman, who said she was diagnosed as bipolar and suicidal, shared how she was unable to obtain care through Baton Rouge Behavioral Hospital. The facility would not take her calls or respond to messages, she said.
“It shouldn’t be this damn hard for people to get the help that they need,” said Rep. Jason Hughes, D-New Orleans.
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