The national Mental Health Association’s 2015 report lists Louisiana as one of the states with the highest prevalence of mental illness and lowest rates of access to care.
In the new report, Louisiana ranks 47th on the survey, which includes 50 states and the District of Columbia. The states ranking below it are Washington, Nevada, Mississippi and Arizona.
The report comes as the Jindal administration launches a new approach to the state’s delivery of behavioral health services through its Medicaid program.
No longer will one private company manage the care of Medicaid patients with drug addiction, schizophrenia, bipolar disorders and other behavioral health problems. Their care will be covered by the five insurance companies the state pays to manage the medical care of about 980,000 out of the state’s 1.4 million Medicaid enrollees. With the expansion, the insurance companies will be overseeing 1.09 million Medicaid lives at a projected cost of $4.33 billion.
“You treat the whole person from the head to the toe,” said Dr. Darrell Montgomery, who has worked on the transition for the state health agency. “It will be in their best interest to have one managed care entity to manage all care.”
There is a better chance of catching someone with behavioral health issues earlier and getting them the treatment they need with the new arrangement, he said.
“It’s the merger of physical and mental health we believe that’s actually going to help our consumers because it’s going to increase their access to care,” said Brittany Howard, director of the Mental Health Association of Louisiana. A kind of one-stop shop, she said.
Gov.-elect John Bel Edwards’ plan to move forward with Medicaid expansion next year will also improve access to a whole new group of people — low-income working adults, Howard said.
The Medicaid changeover — in the works for the last year — went active Tuesday and is the latest development in Gov. Bobby Jindal’s privatization of Medicaid — the government insurance program for the poor. The privatization is supposed to reduce Medicaid spending while providing better health care outcomes.
The federal Centers for Medicare and Medicaid Services is encouraging states to adopt the approach because medical problems can cause behavioral health issues and vice-versa.
Eight other states have embarked on variations of the program but the report cards on their successes and failures aren’t in yet.
The administration abruptly decided last year it would not renew a contract with Magellan of Louisiana to coordinate services for poor residents with mental health as well as drug and alcohol abuse problems.
Magellan had been the subject of scathing legislative audit reports for its failure to meet some contract requirements. The auditor cited problems that led to reduced services and budget problems at five state entities serving behavioral health clients.
Department of Health and Hospitals Secretary Kathy Kliebert said the agency wanted to move toward private insurance companies handling the care. She said the decision was unrelated to the audits’ criticism but rather a decision to move to a more comprehensive health care approach through the insurance companies available through what is called “Bayou Health.”
Magellan will continue to coordinate the care of 2,152 children and youth who need intensive care management and specialized services to keep them out of institutions.
Magellan more than doubled the number of behavioral health service providers from 800 to 1,700 during its three-year contract for care management.
The five insurance companies can build upon that framework, Kliebert said. She said the state will be monitoring each of the insurance plans to see if they have enough psychiatrists, psychologists, social workers and other professionals to cover enrollees.
The companies offering the expanded coverage are Louisiana Healthcare Connections, United Healthcare, Ameri-Health Caritas, AmeriGroup and Aetna.
“Psychiatrists and psychologists are very difficult to find no matter where you are — rural or urban,” Kliebert said. “The ability of these plans to use some of their networks in other states by using telemedicine will help.”
“I believe we are in a much better place, having a better level of provider networks,” she said.
Carmen Weisner, executive director of the National Association of Social Workers — Louisiana, worries that behavioral health providers who once had to deal with Magellan now have five companies to contract with. “I think there will be some transition problems for some of these practices,” Weisner said. But she said the approach is a good one. “That is where health care service delivery is moving,” Weisner said. “They are now training family practice physicians in their residency program to practice with a behavioral health provider,” she said.
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