FAMILIES CAN'T AFFORD TO WAIT FOR MENTAL HEALTH SERVICES

L.I. Business News, March 4, 2016 

Access delayed is access denied.

These are words that ring true for thousands of families across Long Island who have been unsuccessful in accessing timely and affordable mental health and addictions care through their health insurer.

How do I know this? From the stories that people tell us at North Shore Child & Family Guidance Center, a 63-year-old children’s mental health agency in Nassau County.

Health insurers are mandated by government to offer panels of providers so that families can find easily accessible, quality care for their loved ones; and not only for physical illnesses. This requirement is known as network adequacy, referring to adequate networks of care.

The problem of access for mental health care, however, is more complex and may begin with a family’s hesitance to ask for help and to reveal that they are living with someone who is suffering from a mental illness. Families coping with mental illness or addiction do not as readily seek help as they might for heart disease, cancer or diabetes. Why? Because of stigma and the shame it generates. When there is a mass shooting for example, and the perpetrator is labeled mentally ill, it casts a shadow on all people with mental illness, despite the fact that mentally ill persons are disproportionately the victims of violence.

In the United States we have chronically failed to treat illnesses above the neck the same as illnesses below the neck. For example, a parent who would not hesitate to reach out for help if their child was in an accident and appeared to have broken an arm, might wait weeks and months, if not longer, to ask for help if it was a mental health or substance abuse problem.

What makes all this so insidious is that once a parent picks up the phone to ask for help, and they are told repeatedly by providers, “I’m sorry I don’t accept that insurance any longer, I only accept cash,” there is a chance they will give up.

When a parent gives up, they risk their child deteriorating further. This is also true for adults with mental illness and increases the odds that they will ultimately need more costly care or confinement; hospitalization or incarceration.

What to do? Gov. Cuomo created the Department of Financial Services, charged with the responsibility to monitor private health insurers to ensure that they have adequate networks of care as a condition of their license. This means they must demonstrate the consistent ability to provide timely access to care for individuals and their families.

Just this week parents who came to the Guidance Center after taking their child to the emergency room, told us that they called no less than 20 different therapists or agencies and were turned down by all of them. Finally they called another hospital that made the referral to us. We turn no one away for inability to pay.

This is an all too familiar story that we hear frequently and that my colleagues from sister agencies tell me as well. You might wonder why this happening.

Private health insurers pay substandard rates of reimbursement for mental health and addictions care, as compared to Medicaid; sometimes 50 percent or less the than the Medicaid rate. Consequently, participating providers bail out because they cannot afford to accept such low rates. The insurers fail to carefully monitor their lists and the state fails to monitor and regulate the insurers.

In the case of delayed care for a child, this represents corporate and state child abuse.

I have reached out repeatedly to the governor, attorney general and numerous state legislators to issue a call to action to demand that DFS do their job. There is sympathy, but no action.

Andrew Malekoff is executive director of North Shore Child & Family Guidance Center in Roslyn Heights.

If you subscribe to Long Island Business News: http://libn.com/2016/03/04/malekoff-li-families-cant-afford-to-wait-for-mental-health-services/

MENTAL HEALTH CENTERS IN DECLINE

Mental Health Centers in Decline

LONG ISLAND WEEKLY - MARCH 11-17, 2015

by Andrew Malekoff

So here's the deal folks. Last week it was announced that Catholic Charities is giving up their Freeport mental health clinic. In January, $250 million, 81-year-old FEGS announced it was closing; before that Peninsula Counseling Center (PCC) in Valley Stream and Pederson-Krag Center (PK) in Huntington gave up their mental health clinics. (Actually it is more insidious than that. PSCH, an NYC-based $100 million operation, took over PK and PCC and then dumped their mental health clinics). Before that, South Shore Child Guidance was taken over by the Epilepsy Foundation. And before that, Family and Children's Association let go of their mental health clinics in Roosevelt and West Hempstead. And, there is more to come.

Now, one might ask, "Well, aren't they being picked up by other organizations?” That may be so; but these mental health clinics were tied to reputable organizations with venerable histories and committed local boards of directors. In other words, they were grounded in community-based cultures.

Culture matters when growing an organization! Change the culture and the values follow. Change the values and time-honored practices change too. Managed care becomes managed cost, and vulnerable children and their families are then shortchanged as a factory mentality prevails.

Why is this happening? Because New York State government leadership is neglectful, misguided and lacking in humane leadership. And, because they can get away with it.

The State has systematically stripped funding from well-established, community-based organizations and, in so doing, has restricted access to care to Medicaid recipients only. Meanwhile, private insurance companies pay substandard rates. Consequently, fewer and fewer providers will contract with them, leaving hundreds of thousands of middle class families in NYS with nowhere to turn for affordable, community-based outpatient mental health care for their children.

Government leaders won't address the fact that insurers do not have adequate networks of providers because providers don't like their substandard rates of pay. Why doesn't the government better regulate them? Because the insurance companies' lobbyists pay elected officials big bucks for their silence. Elected officials can apply pressure or ease pressure depending on what best suits them and their campaign treasuries.

Now, back to those that let go of the mental health clinics and those that picked up their business. The only profitable way for the latter to proceed, with few exceptions, if any, is to restrict access to care to clients with the best insurance rates (that's Medicaid); to see clients for shorter amounts of billable time to pack more revenue into a day; to eliminate salaried employees to save expenses by eliminating fringe benefits; to not respond to time-consuming and labor-intensive crisis situations; to cut parents out of the equation; and to eliminate consistent clinical supervision and team meetings that are essential to quality of care. In other words, build a factory to maximize revenues and minimize quality care.

In the end, what you get are fewer and fewer vulnerable children who are able to access the best care and more and more services that slide from a gold standard of care to a bronze standard or worse. This is because New York State plays us for fools. Do you know what they refer to their "transformation" initiative as? CLINIC REFORM and REGIONAL CENTERS OF EXCELLENCE. They deform clinics and call it reform, and they offer mediocrity and call it excellence. Factories and propaganda.

So why are North Shore Child & Family Guidance Center and a few others still standing and providing universal access to care with diverse (including bilingual), salaried employees? Because their boards of directors won't have it any other way. For now, that is. Whether they can continue to weather the scorched earth policy of New York State remains to be seen. Nevertheless, the public deserves to know what our government and the insurance industry are up to. What are they up to? NO GOOD.

Which kids’ lives are at stake? What kinds of issues are they facing? Depression, anxiety, abuse, neglect, trauma, domestic, violence, isolation, school failure, demoralization, bias, bullying, family unrest, learning problems, posttraumatic stress, loss and grief, gang exposure, rape, incest, poverty, dislocation, suicide, homicide, obesity, eating disorders, alcohol and drug addiction, gambling, cutting and burning oneself, immigration (including unaccompanied minors), adjusting to foster care, loneliness, and more.

These are the children that a community-based mental health center sees every day. Lots of them each week, thousands each year. This is what is at stake. This is what is being neglected and eroded by New York State.

What will come of this? More tragedy for more families and, ultimately, more cost to warehouse vulnerable children and youths who will not be able to access preventive care or more intensive outpatient care early on.

How will tragedy manifest itself? Probably not horrifically, like Sandy Hook where the outcry and ocean of tears changed nothing of significance that anyone sees or feels on the ground. It will happen more insidiously and slowly, in drip, drip, drip fashion. That is, unless there is pushback.

Pushback against speed cameras and slot machines brought about change in Nassau County in the snap of the finger. But children's mental health? Nah, nobody's going to stand up for that. Until it is their child who is suffering and can't get quality care. And then, too often, they fight alone. After all, STIGMA rules. And it crushes.

It is more convenient for the masses to pretend that children's mental health problems are the result of bad upbringing or moral failing. Bad government counts on that. Everyone rallies around kids with cancer. But who rallies around kids with mental illness?

You?

You CAN make a difference.

TAKE ACTION AND BE A VOICE FOR VULNERABLE CHILDREN!

Here’s how to help:

· Share this with your friends and colleagues via Facebook, email and other social media

· Write to your local newspaper

· Contact your local, state and federal legislators (see below for contact information)

To find your congressperson: http://www.house.gov/representatives/find/

To find your senator: http://www.senate.gov/general/contact_information/senators_cfm.cfm

To find your New York State Senator in Albany: http://www.nysenate.gov/senators

To find your New York State Assembly member: http://assembly.state.ny.us/mem/search/

Andrew Malekoff is executive director and CEO of the nonprofit North Shore Child & Family Guidance Center in Roslyn Heights, NY

NEW VAP FUNDING SKIRTS THE ISSUE OF UNIVERSAL ACCESS

New VAP funding skirts the issue of universal access by Andrew Malekoff in the New York Nonprofit News, November, 25, 2014 http://www.nynp.biz/index.php/points-of-view/23292-new-vap-funding-initiative-skirts-issue-of-universal-access

By Andrew Malekoff, Executive Director and CEO, North Shore Child and Family Guidance Center Recently, I participated in a New York State Office of Mental Health Clinic Vital Access Provider (VAP) webinar. The webinar is a first step towards Article 31 mental health clinics applying for funding to preserve long term critical access to community-based mental health services. A total of $60 million in funding, over a three year period, is available. The intention of the VAP funding opportunity is for community-based mental health clinics that are “fiscally challenged” to develop plans that will demonstrate fiscal viability after three years. The funds can be used for such things as incremental costs for staffing and billing software, for example. Each clinic that receives a VAP award will be assigned a “strategic planner,” who would be a financial specialist, to help them to complete their final application, to include measurable outcomes. The ongoing achievement of measurable metrics will be tied to continued payments to agencies that have been awarded funding. The ultimate goal of the project, whether through mergers, improved efficiencies such as centralized scheduling, or agency sharing of back office functions, will be to ensure long term fiscal viability. I thought that the webinar was very informative. Webinar participants were given an opportunity to ask questions by typing them into a chat box function during the presentation. At the end of the almost two hour webinar, the moderator thanked the participants and concluded the session by stating that all questions had been addressed. Not so! Here are three questions that I typed in that the moderator did not acknowledge or respond to: Is the VAP funding initiative biased against middle class and working poor non-Medicaid children and their families who have no other viable access to labor-intensive community-based mental health care? Our specialty children's mental health agency [North Shore Child and Family Guidance Center] works with approximately 68% non-Medicaid and 32% Medicaid and Medicaid Managed Care families? Would a viable VAP proposal look to severely restrict access to care for children in Nassau County who need our outpatient care? It appears that you are supporting mergers. Is there any concern about what has come of the New York City-based PSCH takeovers in Nassau and Suffolk Counties? I felt that I had to ask these questions since, in my attending one webinar after another sponsored by OMH’s Children’s Technical Assistance Center (CTAC), the issue of universal access to children’s outpatient mental health care is routinely skirted. The sole focus of OMH webinars, regarding children in need of mental health care, are Medicaid-eligible children. North Shore Child and Family Guidance Center is a proponent of universal access for children and their families. New York State is not. On the issue of access to care, earlier in the year I asked Governor Cuomo about this and he directed my letter to OMH Commissioner Dr. Ann Marie T. Sullivan, who responded by stating that there is a work group looking into the issue of the non-Medicaid population. One outcome would be to get commercial insurers to increase their rates which, on average, are significantly lower than Medicaid rates. However, the State Department of Financial Services, within which the State Insurance Department is subsumed, does not have the authority to regulate commercial rates. Statute change, which is unlikely, would be required for this to happen. Presently, commercial insurance network adequacy, including for behavioral health care, is monitored every three years by the Department of Financial Services. However, I think it is unlikely that this will lead to significant penalties that would bring about change for entities that do not provide adequate networks of care. After all, the health insurance lobby is well-healed and well-connected in Albany. On the issue of mergers, a few years ago New York City-based PSCH took over Pederson Krag in Suffolk County and Peninsula Counseling Center in Nassau County, both well-established and well-respected community-based mental health agencies on Long Island. When a larger entity takes over a smaller one, the smaller one’s board of directors is dissolved and, at best, becomes an advisory committee, with a few select board members joining the larger entity’s board of directors. This is a step toward diluting the local community’s investment in the organization and its mission. It appears that PSCH has given up on Pederson Krag and its clinics are being dispersed and made available to other interested parties. Will this also be the fate of Peninsula Counseling Center? What are the consequences of decades of dedicated professional and lay leaders building a community-based culture, and then having it demolished by a takeover by a $100 million dollar organization that did not take. And, so, I thought it was a reasonable question to ask the VAP moderator whose agenda would appear to promote mergers and takeovers. What do you think?

$94 Million in Overtime or Universal Access to Mental Health Care?  You Choose

Andrew Malekoff

New York Nonprofit Press - May, 2014

For three decades New York State has been systematically marginalizing middle class and working poor families who have children with serious mental health problems. This is a truth that the public is unaware of unless you have a child who is refusing to go to school, cutting herself, paralyzed by anxiety, deeply depressed or suicidal. Because mental illness is stigmatized, the reality of the State’s neglect has been obscured from view.

We continue to treat illnesses above the neck differently than those below the neck.  People with mental health problems, and their families, often feel a sense of shame and suffer in silence, while people with physical health problems evoke the sympathy, support and comfort of others.

 

In 1991, New York State implemented a plan to use Medicaid dollars to fund outpatient community-based mental health services. That approach, also known as Medicaiding-the-system, is gone.

Medicaiding-the-system was a combination of a base Medicaid rate applied for each outpatient community-based mental health clinic visit for Medicaid recipients only and supplemental dollars paid on top of each base payment to subsidize non-Medicaid consumers (known as Comprehensive Outpatient Funding or COPS). This approach to support community-based agencies was developed to replace local assistance or deficit-financing.

Local assistance was a simple and sensible public-private financing partnership. The partners were the State and County governments (through government funding), mental health consumers (through third party and fee-for-service revenue) and the local community (through fund-raising that was a part of the local assistance government contract). Local assistance funding insured that all stakeholders chipped in their fair share to support an essential community-based service.

In 2009, New York State announced that the Medicaid-bankrolled COPS approach of financing community-based clinics had the inadvertent affect of propping up commercial insurers who were paying substandard rates. Having uncovered that festering wound, OMH got to work on creating a new financing plan that they referred to as clinic restructuring or clinic reform.

The clinic reform plan raised the Medicaid-base rate, added new rates for previously unfunded or underfunded services (known as Ambulatory Patient Groups or APGs), and phased out the supplemental COPS Medicaid rate over a four-year-period that recently came to an end. The Medicaid base-rate and APGs now apply only to those families who have straight Medicaid and Medicaid managed care insurance.

In my discussions with New York State officials about the devastating consequences of the clinic reform plan for middle class and working poor families who do not have Medicaid insurance, I was advised that community-based mental health centers must re-negotiate rates with commercial insurers. That is nothing new. It is common practice. The state officials advised me that if the commercial insurers do not raise their rates to sufficient levels that will help to cover the cost of the services provided, then we should terminate our contracts with them.

Community-based providers routinely re-negotiate rates with the managed-care companies which represent private health insurers. However, they rarely agree to rates that come close to covering the cost of service. As one managed-care representative told me, “C’mon, we’re hurting too.” And, he said it with a straight face, despite record profits. State officials told me that community-based agencies like North Shore Child and Family Guidance Center, a specialty children’s outpatient clinic where I have worked for 37 years, should change their payor-mix. Payor-mix is a euphemism for terminating contracts with private health insurers and, consequently, denying service to thousands of children who need us.

When I pressed him on this, his response was that “the marketplace will take care of it,” referring to private practitioners. But mental health providers know that private child psychiatrists and other private behavioral health practitioners will not accept substandard rates or take on the labor-intensive work required to address the needs of children with serious mental illness (e.g. collateral contacts, crisis intervention, etc.) Nevertheless, commercial health insurers must by license demonstrate “network adequacy.”

Network adequacy refers to a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. The truth is that many health insurers do not have adequate mental health care networks despite the voluminous number of names on their rosters. But tell me, really, what private citizen or community-based nonprofit can be successful in advocating for the revocation of licenses of private health insurers with the millions of lobbying dollars backing them up? Good luck!

The truth is that for many families, when it comes to seeking mental health care for their children, the process of finding help is a shell game aided and abetted by New York State. New York State claims that they cannot provide additional local assistance funding to help to subsidize universal mental health care in community-based clinics, which must also raise funds by contract, to support these vital services. Consequently many clinics are turning away all but Medicaid applicants for their services. But, is it true that New York State cannot offer local assistance support?

In a recent report issued by NYS Comptroller Thomas DiNapoli, it was revealed that the New York State Office of Mental Health runs up annual overtime expenses of $94 million a year. And, this is happening at the same time that the state is footing the bill for nonprofit community-based mental health clinics to enroll in state-sponsored efficiency classes that are a part of the State Office of Mental Health’s Clinical Technical Assistance Center (CTAC) initiative.

The goal of the efficiency classes is to improve the bottom-line by implementing centralized scheduling, open access and collaborative documentation. Fair enough. However, CTAC trainers have joined the state officials’ chorus about marginalizing the middle class and working poor. One CTAC trainer told me, during a recent webinar when I raised the question about the discrepancy in reimbursement rates, “You must change your payor-mix.”

Can you imagine how much savings there would be if OMH took the efficiency classes and were just a little bit more efficient with their use of overtime; and, how much of that savings could go towards supporting universal community-based outpatient mental health care for children?

And, keep in mind that that OMH’s excessive annual overtime expenditures presents New York taxpayers with a pay now and pay later scenario. We pay today for overtime and we will pay later for elevated pension benefits for State employees, a number of whom have left the Office of Mental Health to take on lucrative administrative positions with large conglomerates that state officials encourage smaller clinics to “merge with”; a euphemism for “be taken over by”.

To sum up, the State claims that there is no additional local assistance funding for community-based clinics to provide universal mental health care; clinics are then “encouraged” to take State-funded efficiency classes to reduce their cost of service by dropping underinsured middle class and working poor clients; The New York State Office of Mental Health generates overtime expenses of $94 million per year (plus increased employee pension benefits in perpetuity, at taxpayer expense); private health insurance companies present only the illusion of network adequacy and hide behind lobbying payoffs; community-based mental health clinics are closing or turning away all but Medicaid applicants or are being taken over by conglomerates administered by ex-OMH officials who are collecting overtime-time inflated State pensions on top of lucrative salaries from the takeover institutions; and kids and families who don’t have Medicaid insurance are being turned away from community-based care.

If New York State will not support essential community-based mental health services for the most vulnerable members of our communities – our children – then who will?

 

Andrew Malekoff, executive director and CEO of North Shore Child and Family Guidance Center in Roslyn Heights, NY. amalekoff@northshorechildguidance.org

Our Kids’ Mental Issues Are Shortchanged

Our Kids’ Mental Issues Are Shortchanged

Anton News, Long Island; Opinion – Andrew Malekoff

March 26 – April 1, 2014

The American reality today is 1 out of 10 children has a serious emotional disturbance and more children suffer from psychiatric illness than from autism, leukemia, diabetes and AIDS combined. Yet, we continue to treat illnesses above the neck differently than those below the neck. People with mental health problems, and their families, often feel a sense of shame and suffer in silence; while people with physical health problems evoke the sympathy, support and comfort of others.

 

In the past 25 years, the mental health system has seen many changes.  From a system in New York State that consisted primarily of outpatient clinics, community hospitals, state hospitals, and residential treatment facilities, a continuum has evolved which now also includes a variety of additional services, originally funded with the reinvestment dollars saved from the 1990’s reduction in state hospital beds.  The largest of these programs are Medicaid-driven.

Nevertheless, parents still find that there are major gaps in our service system.  Even with the available community support services, children with mental illness and their families continue to need good, often intensive, outpatient clinical services. The onset of managed care resulted in hospitals discharging children earlier, often before they are sufficiently stabilized to return home.  Mental health outpatient clinics are then left with the task of trying to provide adequate clinical care to these needy and often high-risk youths, but with highly inadequate rates of financial support from insurance companies and government. 

Despite a growing demand for community-based children’s mental health care, right here in Nassau County there are outpatient mental health clinics that have closed their doors, have been taken over by larger corporate entities with no community roots, have transformed their operations into fee-for-service factories with little or no capacity for dealing with inevitable crisis situations, or have decided to turn away anyone who does not have Medicaid.

Commercial insurance companies are expected to demonstrate what is called “network adequacy.” Network adequacy refers to a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. Nevertheless, many insurers do not have adequate mental health care networks despite the many names on their rosters. When it comes to seeking mental health care, for many families, the process of finding help is a shell game.

Only quality community-based children’s mental health organizations are capable of providing the labor-intensive quality of care necessary to address the mental health needs of children with serious emotional disturbances. Yet, these vital organizations are being squeezed out of Nassau County because of substandard insurance reimbursement and government neglect. Furthermore, community-acute care hospitals, because of insurance limitations, are not able to keep kids long enough to stabilize them in many cases. And, so, kids are being discharged to a community with inadequate supports.

The NYS Office of Mental Health has established a multi-year vision for the future of New York State’s mental health care system that they refer to as Regional Centers of Excellence. The vision does not include community-based care for middle class and working poor families with commercial health insurance.

Sounds more like Regional Centers of Mediocrity to me.

Andrew Malekoff, North Shore Child and Family Guidance Center, 480 Old Westbury Road, Roslyn Heights, New York, 11577; E-mail: amalekoff@northshorechildguidance.org

Medicaiding-the-System Redux

Medicaiding-the-System Redux

by Andrew Malekoff©

January, 2010

Executive Director, North Shore Child and Family Guidance Center
Roslyn Heights, New York 11577

BONUS-DOLLAR BLITZ CIRCA 1991

In 1991, New York State implemented a plan to use Medicaid dollars to fund outpatient community-based mental health services. That two-decade-old approach, also known as Medicaiding-the-system, is on its way out.

Medicaiding-the-system was a combination of (1) a base Medicaid rate applied for each outpatient mental health visit for Medicaid recipients only and (2) supplemental or bonus dollars paid on top of each base payment to subsidize non-Medicaid recipients. This approach to support community-based agencies was developed to replace local assistance or deficit-financing.

Local assistance was a simple and sensible public-private financing partnership. The partners were the State and County governments (through government contracts), mental health consumers (through fee-for-service payments) and the local community (through fund-raising).

Local assistance funding insured that all stakeholders chipped in a fair share to support an essential community-based service. However, New York State decided that if Medicaid could cover these costs, that they could systematically reduce and ultimately eliminate the amount that they chipped in through local assistance contracts.

If New York State will not support essential community-based mental health services for the most vulnerable members of our communities, who will?

BONUS-DOLLAR BLITZKREIG CIRCA 2010

In recent years, New York State recognized that the Medicaid bankrolled bonus-dollar approach of financing community-based clinics had the inadvertent affect of propping up commercial insurers that were paying substandard rates and limiting access to essential services. Having uncovered that festering wound, they got to work on creating a new financing plan that they refer to as clinic reform.

The clinic reform plan will raise the Medicaid-base rate and phase out bonus-dollars over a four-year-period. The Medicaid base-rate will apply only to those individuals that have what is known as straight Medicaid insurance; that is, Medicaid that is not managed by a commercial insurance company. There will be no reliable funding stream to replace the lost bonus dollars except for a finite pool of funds, presumably to cover services for indigent consumers.

In discussions with State officials about the devastating consequences of the clinic reform plan for the middle class and working poor, I was told that clinics must re-negotiate rates with commercial insurers. That is nothing new. It is common practice. The State officials advised me that if the commercial insurers do not raise their rates to sufficient levels that will help to cover the cost of services provided, then we should terminate our contracts with them.

Community-based providers routinely re-negotiate rates with the managed-care companies that represent the commercial insurers. However, they rarely agree to rates that will cover the cost of service. As one such managed-care company representative recently told us, “C’mon, we are hurting too.” For more information on public and private insurance markets in New York I refer you to the following website: http://www.uhfnyc.org/publications/880618.

If we drop the commercial insurers, as I was advised to do, it means that middle class and working-poor families are out of luck. They will not be able to afford to pay out of pocket to access community-based outpatient mental health services that are structured to meet their families’ needs. For example, at North Shore Child and Family Guidance Center, almost 30% of all evaluations in 2009 were emergencies that were seen within 24 to 48 hours. Who will take care of these emergencies? Private practitioners?

Clinic reform is nothing more than a downgraded version of Medicaiding-the-system. With clinic reform, the term community-based mental health center becomes a thing of the past as only a small segment of the local community will be able to access needed services.

APRIL FOOL’S DAY 2010

New York State is throwing in the towel at a time when there is unprecedented need for community-based mental health services. As the complex funding history described above is demystified, more and more families are advocating for a freeze on clinic reform. I urge you to call your local New York State legislators and tell them to extend the projected clinic reform start date of April 1, 2010 and to restore local assistance financing.

Don’t accept, “But there is no money!” for an answer. Please listen; the fact is that the cost to place a child or teenager in a psychiatric or juvenile detention center or a young adult in jail is far greater than what it costs to support quality community-based mental health care that will keep them at home.

We all know that familiar refrain, pay now or pay later.

This is an advance proof of Mr. Malekoff’s monthly column PARENTING PLUS, that is scheduled for publication in January, 2010 in the Long Island, New York Anton chain of newspapers.

IT'S NOT REFORM WHEN IT HURTS THE MIDDLE CLASS AND WORKING POOR

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.

"IF YOUR CHILD IS NOT HEALTHY, MY CHILD IS NOT SAFE"

“If your child is not healthy, my child is not safe”

by Andrew Malekoff

Are we going to continue to catch the children that are falling through the cracks or are we going to abandon them?

There is a critical decision that has been made in Albany that will impact negatively on thousands of children and families across Nassau County and that will dramatically increase costs to taxpayers as increasing numbers children will be removed from their homes and institutionalized.

The New York State Office of Mental Health (OMH) has implemented a plan that they call Transforming New York’s Mental Health System (the Plan). The Plan is a blueprint for the destruction of children’s community-based outpatient mental health services in Nassau County.

Here are the facts:

The Plan is dramatically skewed in favor of funding services for individuals with Medicaid-only insurance coverage. At North Shore Child and Family Guidance Center, for example, this represents only 7% of people that use mental health services.

The Plan discriminates against the middle and lower middle class and working poor families that are underinsured or uninsured and live in the suburbs of Nassau County. In fact, the Plan discriminates against all people that pay taxes and are entitled to basic mental health services. Although the Plan refers to something called an “uncompensated care” provision, it does not address the deficit generated when serving a preponderance of middle and lower middle class and working poor families.

Community mental health centers are the last bastion in addressing the needs of children and teens with serious emotional disturbances and their families. Private psychotherapists and counselors, with rare exception, cannot afford to offer the labor intensive work necessary to properly serve families that are struggling with serious emotional disturbance. If you know one that can, terrific! Competent private practitioners know when they can handle a situation on their own and when they need to refer to a community-based agency that specializes in children’s mental health; the very place that the New York State Office of Mental Health has kicked to the curb.

The consequence of the OMH Plan will be devastating to the children and families in Nassau County. It will lead to the loss of life, children being plucked from their homes and institutionalized, and families being splintered and destroyed.

I ask you to join me in calling on Nassau County and New York State to restore and enhance local assistance funding – a partnership between local and state government, the local community and client-consumer. Local assistance funding will support community-based children’s mental health centers that would otherwise disappear or be rendered ineffective as the result of the dramatic lack of government support to the suburbs that the Plan represents.

Call Tom Suozzi and your local County and State legislators and tell them:

• That the New York State Office of Mental Health’s Plan discriminates against their constituents - the middle and lower middle class and working poor children and families that are uninsured and underinsured.

• The New York State Office of Mental Health is discriminating against children and youth with mental health disorders and their families.

• To restore local assistance funding in New York State or there will be no responsive, community-based children’s mental health services in Nassau County by the year 2012 if not sooner.

I urge you to take just a few moments of your time to join the fight for children’s mental health. Community mental health center’s are there for you and your family in your time of need.

Things may be going great in your family, but we know that even when they are, the unexpected enters and we all need a credible place to turn to.

And, if you are fortunate enough to never need such help, please bear in mind what a local mom once told me about her reason for supporting children’s mental health, “If your child is not healthy, my child is not safe.”


First published in the Anton chain of 18 newspapers in Nassau County, New York in April 2009.

A PLAN TO GUT MENTAL HEALTH

NEWSDAY
April 21, 2009, p. A34
A plan to gut mental health

More middle-class families are in need of mental health services ["More seek help in stressful time," News, April 20]. Yet, the New York State Office of Mental Health has a plan that is a blueprint for the destruction of children's community-based mental health services in the suburbs.

The OMH plan - called Transforming New York's Mental Health System - is dramatically skewed in favor of supporting services for families with Medicaid-only insurance coverage. That means it discriminates against the middle- and lower-middle-class and working-poor families that are underinsured or uninsured.

At the North Shore Child and Family Guidance Center these kinds of families represent almost 75 percent of those seeking our help.

The answer is for Nassau County and New York State to join to restore and enhance local assistance funding - a partnership between local and state government, the local community and the consumer of mental health services.

Andrew Malekoff

Long Beach

Editor's note: The writer is executive director for North Shore Child and Family Guidance Center in Roslyn Heights.