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