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.

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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

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.