It's not reform when it hurts the poor
By ANDREW MALEKOFF
First published in print: Monday, July 27, 2009, Albany Times Union
More low- and middle-income families than ever are in need of low-cost, high-quality community-based mental health care. Yet, the state Office of Mental Health, along with the state Health Department, is aggressively pursuing a "reform" plan that will assure continued access to care only to children and families with Medicaid fee-for-service insurance coverage. This will leave a significant number of children and adults in the lurch.
This clinic reform plan sets up a mental health service delivery system that will no longer assure access to care for children, regardless of their parents' ability to pay.
This represents a dramatic departure from New York's statutory responsibility to make sure our most vulnerable citizens -- our children -- get care, regardless of their family's economic status.
Clinic reform signals movement away from a universal model of care to one that will discriminate against underinsured middle-class and working-poor families. Because of the lack of parity between higher rates paid by government and those paid by commercial insurers, many children with what seems like adequate health insurance coverage will no longer receive behavioral health care services from community clinics.
Community clinics are the last bastion in addressing the needs of children and adolescents with serious emotional disturbances. Private psychotherapists, with rare exception, will not provide the labor-intensive work necessary to properly serve children and families struggling with serious emotional disturbances.
One step forward would be for the Health Department to pressure commercial Medicaid managed-care carriers to increase their rates to match Medicaid rates. A second step would be to do the same with commercial insurers.
As community-based clinics void contracts with underpaying commercial insurers, as they are sure to do, families will be denied service if they are unable to pay the full cost. Commercial carriers that cannot demonstrate an "adequacy of network" can and should have their licenses revoked.
Consumers must be educated about these issues so that they can join the fight now and later, when denied services because their carrier cannot offer them an adequate network of care.
Last but not least, the Office of Mental Health must restore and enhance local assistance funding, also known as deficit financing -- a partnership between local and state government, the local community and client-consumer -- for specialty children's outpatient mental health clinics that serve a significant proportion of non-Medicaid fee for service clients. If implemented in its current design, the clinic restructuring plan will guarantee only narrowly-defined treatment for those with Medicaid fee-for-service eligibility. Clinic reform is certain to increase the marginalized role of middle-class and working-poor families in society.
Action must to be taken now to modify the course of clinic reform, before it is too late.
Andrew Malekoff is executive director of the North Shore Child and Family Guidance Center in Roslyn Heights and a member of the state Office of Mental Health group developing the New York State Children's Plan.
Wednesday, July 29, 2009
Saturday, July 4, 2009
MIND OVER MATTER
MIND OVER MATTER
by Andrew Malekoff
More low income and middle-class families than ever are in need of low cost, high quality community-based mental health care. Yet, as I reported in my April 2009 column, the New York State Office of Mental Health (OMH) in conjunction with the New York State Department of Health is aggressively pursuing a “reform” plan (clinic reform) for these critical services that will result in a system of community care where only those children and families with Medicaid “fee for service” insurance coverage will be assured continued access to care. This will leave a significant number of children and adults living on Long Island in the lurch.
For more than a half a century North Shore Child and Family Guidance Center has been a proud provider of community-based mental health services here on the Island. We are in receipt of the recently released New York State Office of Mental Health Outpatient Clinic Reform Implementation Paper (March 11, 2009) that describes a “soup to nuts” reform of our services. Not only does the reform plan threaten the viability of our agency, but it sets up a mental health service delivery system that will no longer assure access to mental health care for children regardless of their parents’ ability to pay.
This policy shift represents a dramatic departure from what we see as a statutory responsibility on the part of New York State to make sure our most vulnerable citizens – our children - get care, regardless of their families’ economic status. New York State government is moving away from a universal model to a residual model of care where Medicaid coverage is the ticket of admission for community-based mental health.
I have been wondering if the individuals that helped to craft this plan experienced any conflict related to the inconsistency between their beliefs and actions. In my conversations with clinic reform workgroup members, my impression is that they believe strongly in quality community-based mental health care for all children and families. Yet they support a plan that cuts a large segment of the population out of the equation.
To their credit, OMH leadership is committed to the development of an “uncompensated care pool,” consisting of funding to address the uninsured. However, that still leaves the underinsured middle class, lower middle class and working poor on the sidelines.
Three further steps are needed. First, the New York State Department of Health must put pressure on Medicaid managed care insurance carriers to increase their rates to match the government rate. Second, the New York State Department of Insurance needs to do the same with private insurers. Insurance carriers that cannot demonstrate an “adequacy of network” can have their licenses revoked. Third, consumers must be educated about these issues so that they can effectively fight back when denied community-based services because their carrier’s rates are too low to offer them an adequate network of care.
CNN anchor Lou Dobbs, who wrote about the war on the middle class said, “I believe our middle class has suffered in silence for far too long, and simply cannot afford to suffer or be silent much longer. Hardworking Americans have not spoken out about their increasing marginalized role in this society, and as a consequence they’ve all but lost their voice.”
I believe that the clinic reform plan is further validation of Dobbs’ contention. We cannot afford to be silent. Perhaps for some policy makers and insurance carriers, quality community-based mental health for middle class children and their families all boils down to a question of mind over matter – they don’t mind and we don’t matter.
Please join the fight to save children’s community-based mental health services on Long Island. Our children matter - all of them.
Published in the Long Island Anton chain of newspapers in June 2009,copyright Andrew Malekoff
by Andrew Malekoff
More low income and middle-class families than ever are in need of low cost, high quality community-based mental health care. Yet, as I reported in my April 2009 column, the New York State Office of Mental Health (OMH) in conjunction with the New York State Department of Health is aggressively pursuing a “reform” plan (clinic reform) for these critical services that will result in a system of community care where only those children and families with Medicaid “fee for service” insurance coverage will be assured continued access to care. This will leave a significant number of children and adults living on Long Island in the lurch.
For more than a half a century North Shore Child and Family Guidance Center has been a proud provider of community-based mental health services here on the Island. We are in receipt of the recently released New York State Office of Mental Health Outpatient Clinic Reform Implementation Paper (March 11, 2009) that describes a “soup to nuts” reform of our services. Not only does the reform plan threaten the viability of our agency, but it sets up a mental health service delivery system that will no longer assure access to mental health care for children regardless of their parents’ ability to pay.
This policy shift represents a dramatic departure from what we see as a statutory responsibility on the part of New York State to make sure our most vulnerable citizens – our children - get care, regardless of their families’ economic status. New York State government is moving away from a universal model to a residual model of care where Medicaid coverage is the ticket of admission for community-based mental health.
I have been wondering if the individuals that helped to craft this plan experienced any conflict related to the inconsistency between their beliefs and actions. In my conversations with clinic reform workgroup members, my impression is that they believe strongly in quality community-based mental health care for all children and families. Yet they support a plan that cuts a large segment of the population out of the equation.
To their credit, OMH leadership is committed to the development of an “uncompensated care pool,” consisting of funding to address the uninsured. However, that still leaves the underinsured middle class, lower middle class and working poor on the sidelines.
Three further steps are needed. First, the New York State Department of Health must put pressure on Medicaid managed care insurance carriers to increase their rates to match the government rate. Second, the New York State Department of Insurance needs to do the same with private insurers. Insurance carriers that cannot demonstrate an “adequacy of network” can have their licenses revoked. Third, consumers must be educated about these issues so that they can effectively fight back when denied community-based services because their carrier’s rates are too low to offer them an adequate network of care.
CNN anchor Lou Dobbs, who wrote about the war on the middle class said, “I believe our middle class has suffered in silence for far too long, and simply cannot afford to suffer or be silent much longer. Hardworking Americans have not spoken out about their increasing marginalized role in this society, and as a consequence they’ve all but lost their voice.”
I believe that the clinic reform plan is further validation of Dobbs’ contention. We cannot afford to be silent. Perhaps for some policy makers and insurance carriers, quality community-based mental health for middle class children and their families all boils down to a question of mind over matter – they don’t mind and we don’t matter.
Please join the fight to save children’s community-based mental health services on Long Island. Our children matter - all of them.
Published in the Long Island Anton chain of newspapers in June 2009,copyright Andrew Malekoff
HELLO DALAI
HELLO DALAI
by Andrew Malekoff
“Giving money and power to government is like giving whiskey and car keys to teenage boys.” – P.J. O’Rourke
The Dalai Lama and the New York State Senate
On May 9, 2009 Nobel Peace Prize laureate the Dalai Lama offered an invocation for the New York State Senate, calling for compassion during tough times. The 73-year old spiritual leader of Tibet spoke from the chamber floor about honesty and transparency and told the Senators and spectators about his deep respect for American values. “This house,” he said, “I think demonstrates the American democratic system.” Ya think?
Just one month later, as we are now painfully aware, a failed legislative coup paralyzed the system that the Dalai Lama praised in the house that he sanctified. Since that time the State Senate deconstructed into a child’s game of “Who gets to hold the gavel.”
Teaching our children about conflict resolution
What can we learn from the senate stalemate fiasco that will help our children when they are in conflict with their peers? According to Marjorie Kostelnik, Dean of College of Education & Human Sciences at the University of Nebraska, in our zeal to reach a compromise, a child might be denied their legitimate right to maintain possession of a desired object. When this occurs, she advises, “the focus should shift to helping the child who wants the object to generate appropriate strategies, such as asking, trading or bargaining to achieve their goal.”
Of course, sometimes our first response to the fuss is to say: “OK kids, who started it?’ or ‘How many times have I told you not to quarrel?” Children typically respond by denial or finger pointing. Of course, neither of these responses leads to constructive problem solving.
Kostelnik says, “It is better to approach the conflict saying: ‘You both seem very upset’ or ‘It looks like both of you want the [gavel] at the same time.’ These statements focus on the problem that exists between the children rather than giving sole responsibility to either child.” Boy oh boy, our New York State Senators sure have given us a lot to think about.
Perhaps the most important goal in conflict resolution is not so much the outcome of a situation as the enhanced ability to handle conflicts on a more mature level. In healthy conflict resolution there are some basic rules of conduct that we can teach our children. No name calling, staying with the topic at hand, no dredging up the past, keeping an open mind, and listening to other points of view. This means no filibustering or talking over one another.
These tips are especially important, living in an era of violence –random, sudden, illogical, and lethal – where anything that seems the slightest bit threatening – a put down, a disagreement, a dirty look – demands immediate retaliation. We need to help our children to peaceably resolve conflicts. It is ironic that the Dalai Lama, a man that advocates for peaceful solutions based upon tolerance and mutual respect, spoke before the Senate just weeks before the mess in Albany.
The Dalai Lama and the Beatles
To digress a bit, when I was a freshman in college in 1969, the Beatles were at their pinnacle. A rumor went around that Paul McCartney died. Word spread like wildfire that there were hidden messages about this on their album covers and in the lyrics of their songs. One neat trick, back in the day, was to play their songs backwards for clues. I did this with the song “Revolution Number 9.” I was sure that when I spun the vinyl disc counterclockwise that I heard the words, “turn me on dead man, turn me on dead man.” This was so freaky that it gave me goose bumps. Of course, the whole thing turned out to be nothing but a clever hoax.
For some reason, this episode in my life recently popped to mind and led me to get hold of the audio of the Dalai Lama’s address to the New York State Senate. Something told me to play it backwards. When I did, I could swear that I heard two words repeated over and over again – term limits, term limits, term limits.
Andrew Malekoff (copyright, July 2009)
by Andrew Malekoff
“Giving money and power to government is like giving whiskey and car keys to teenage boys.” – P.J. O’Rourke
The Dalai Lama and the New York State Senate
On May 9, 2009 Nobel Peace Prize laureate the Dalai Lama offered an invocation for the New York State Senate, calling for compassion during tough times. The 73-year old spiritual leader of Tibet spoke from the chamber floor about honesty and transparency and told the Senators and spectators about his deep respect for American values. “This house,” he said, “I think demonstrates the American democratic system.” Ya think?
Just one month later, as we are now painfully aware, a failed legislative coup paralyzed the system that the Dalai Lama praised in the house that he sanctified. Since that time the State Senate deconstructed into a child’s game of “Who gets to hold the gavel.”
Teaching our children about conflict resolution
What can we learn from the senate stalemate fiasco that will help our children when they are in conflict with their peers? According to Marjorie Kostelnik, Dean of College of Education & Human Sciences at the University of Nebraska, in our zeal to reach a compromise, a child might be denied their legitimate right to maintain possession of a desired object. When this occurs, she advises, “the focus should shift to helping the child who wants the object to generate appropriate strategies, such as asking, trading or bargaining to achieve their goal.”
Of course, sometimes our first response to the fuss is to say: “OK kids, who started it?’ or ‘How many times have I told you not to quarrel?” Children typically respond by denial or finger pointing. Of course, neither of these responses leads to constructive problem solving.
Kostelnik says, “It is better to approach the conflict saying: ‘You both seem very upset’ or ‘It looks like both of you want the [gavel] at the same time.’ These statements focus on the problem that exists between the children rather than giving sole responsibility to either child.” Boy oh boy, our New York State Senators sure have given us a lot to think about.
Perhaps the most important goal in conflict resolution is not so much the outcome of a situation as the enhanced ability to handle conflicts on a more mature level. In healthy conflict resolution there are some basic rules of conduct that we can teach our children. No name calling, staying with the topic at hand, no dredging up the past, keeping an open mind, and listening to other points of view. This means no filibustering or talking over one another.
These tips are especially important, living in an era of violence –random, sudden, illogical, and lethal – where anything that seems the slightest bit threatening – a put down, a disagreement, a dirty look – demands immediate retaliation. We need to help our children to peaceably resolve conflicts. It is ironic that the Dalai Lama, a man that advocates for peaceful solutions based upon tolerance and mutual respect, spoke before the Senate just weeks before the mess in Albany.
The Dalai Lama and the Beatles
To digress a bit, when I was a freshman in college in 1969, the Beatles were at their pinnacle. A rumor went around that Paul McCartney died. Word spread like wildfire that there were hidden messages about this on their album covers and in the lyrics of their songs. One neat trick, back in the day, was to play their songs backwards for clues. I did this with the song “Revolution Number 9.” I was sure that when I spun the vinyl disc counterclockwise that I heard the words, “turn me on dead man, turn me on dead man.” This was so freaky that it gave me goose bumps. Of course, the whole thing turned out to be nothing but a clever hoax.
For some reason, this episode in my life recently popped to mind and led me to get hold of the audio of the Dalai Lama’s address to the New York State Senate. Something told me to play it backwards. When I did, I could swear that I heard two words repeated over and over again – term limits, term limits, term limits.
Andrew Malekoff (copyright, July 2009)
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