Feds eye Medicaid mental health reimbursement

By Bobby Harrison/NEMS Daily Journal Jackson Bureau

JACKSON – The fact that the state Division of Medicaid does not provide reimbursement to the 15 community mental health centers that treat Medicaid recipients could be part of a lawsuit filed against Mississippi by the U.S. Department of Justice.
Ed LeGrand, executive director of the state Department of Mental Health, recently told members of the Legislative Budget Committee that DOJ investigators who visited the state “were very interested in the state Medicaid program and how it reimburses certain providers.”
LeGrand went on to explain specifically that DOJ was concerned that the community mental health centers, which include Region 3, based in Tupelo, Communicare, based in Oxford, and Timberhills, based in Corinth, are not reimbursed by the state Division of Medicaid for services provided to Medicaid recipients.
The DOJ announced in May it was joining other advocacy groups in a lawsuit against Mississippi on the grounds of not providing sufficient community-based care – as dictated by U.S. Supreme Court ruling and federal law – for mental health patients. The lawsuit alleges that the state’s mental health system is choosing more costly institutional care for mental health patients at the expense of community-based care.
In announcing an October 2010 settlement with Georgia of a similar lawsuit, DOJ said, “The Supreme Court ordered states to serve individuals with disabilities in the most integrated settings appropriate to their needs.”
The 15 community mental health centers, which are governed locally but licensed by the Department of Mental Health, are the primary providers of community-based care in the state. It has been an issue in the state in recent years that state law prevents the Division of Medicaid from reimbursing the centers for treating Medicaid recipients.
House Public Health Chair Steve Holland, D-Plantersville, and others have bemoaned the fact that a private provider could treat Medicaid recipients, typically a disabled person, the elderly and poor pregnant women and children, and be reimbursed by the Division of Medicaid, but the less expensive community mental health centers could not be reimbursed for treating the same patient.
“I think if (community mental health centers) went to court, a judge would say ‘Medicaid, pay the bill,'” Holland has said.
Now DOJ may be going to court for them.
In recent years, the Department of Mental Health has taken money from its state appropriation to pay roughly half the community mental health centers’ cost of treating Medicaid recipients. The centers have picked up the rest of the cost – a practice that has put some of the centers in a difficult financial situation, various sources have told legislators through the years.
In his recent meeting with the Legislative Budget Committee, LeGrand asked for the Legislature to appropriate the full $20 million cost for the community mental health centers to treat Medicaid recipients. The $20 million would pay the state’s share for Medicaid, a federal-state health care program. The federal government’s share is roughly $60 million.
Overall, LeGrand asked for a general fund budget increase of $58.8 million – to $294.2 million – primarily to respond to concerns that have been raised by the Justice Department. LeGrand said the goal of the Justice Department is to house mental health patients in home-based community settings where three or four patients might live together with adequate staffing.
Similar lawsuits and investigations have been ongoing for more than 10 years by DOJ, LeGrand said. He said the goal of his agency also is to provide community-based care when possible, but said in some instances he believes DOJ pursues that goal when it is not in the best interest of the patient. Still, LeGrand said DOJ has prevailed in other states.
“The feds have made it very clear,” LeGrand said. “… This is not isolated to Mississippi. They have been in 27 other states. All but one have found it a very expensive proposition.”
LeGrand said the budget request is an attempt to fix the problem, “but I don’t think it is overkill.”
He said the states that have gone to court to battle on the issue have not been successful.