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What are consequences for not having plan for our most vulnerable?

  • Published in Letters

To the editor,

The Medicaid Care Management Contracts were made public this week. There is a great deal of verbiage in the document, which spans well over 500 pages and proposes significant changes to the health care of tens of thousands of Granite Staters. What concerns me, however, is what is not in the document.

As the administrator of a community mental health center, I need to raise a question or two about what is not in the contract language with the Managed Care ...

To the editor,

The Medicaid Care Management Contracts were made public this week. There is a great deal of verbiage in the document, which spans well over 500 pages and proposes significant changes to the health care of tens of thousands of Granite Staters. What concerns me, however, is what is not in the document.

As the administrator of a community mental health center, I need to raise a question or two about what is not in the contract language with the Managed Care Organizations (MCO) to better understand how this proposal will affect the care of the patients we serve and the sustainability of Genesis Behavioral Health and the other centers throughout the state. MCOs would be responsible for covered members (Medicaid recipients). They are not responsible for the uninsured. According to current state law, it is the state that is responsible for the poor and uninsured. For years, community mental health centers have been designated to serve those who cannot pay and do not qualify for Medicaid. Community mental health centers also serve those with Medicaid spend-downs (deductibles) who cannot and do not pay, and offer emergency care to all 24/7, 365 days a year. The impact of providing these services has created fiscal instability within the organizations, which has not been recognized by the state.

These issues will not be addressed within the context of managed care. Though managed care is being touted as savings to the state, the issues raised above are the largest contributors to the fiscal instability of the community mental health system, which continues to carry the state’s burden for care. So, who will be responsible?

Last year, the legislature voted to allow community mental health centers to establish a wait list and prioritize services based on need and the level of funding available. As a mental health professional, this is more than troubling for me. People need treatment to get better and recover from their illness. We don’t tell someone with a gushing wound to simply slap a band-aid on it and come back when they can afford a few stitches. Untreated mental illness is a health care crisis. Allowing a delay in treatment for those with serious mental illness is to the detriment of the patient, the community and other resources, such as the emergency departments and the police.

As the person responsible for ensuring the sustainability of our services, we will have to take measures that will be unpopular and misunderstood by our patients and our community. The message is that community mental health centers are not expected to serve the uninsured beyond their emergent needs and an intake appointment (screening). Neither of these equate to treatment, but rather crisis intervention and assessment of need. There is no cure for severe and persistent mental illness — people can and do recover, but they can’t do so without treatment.

What is the plan going forward? Are the consequences of not having a plan for our most vulnerable citizens worth the risk or the cost? Will we be forced to post signs on our buildings turning away the uninsured mentally ill, beyond the intake or emergency care we are mandated to provide? When the person whose thoughts are impacted by their mental illness harms him/herself or others, will we all turn a blind eye and say we never saw it coming? These are the questions we must ask ourselves going forward. I, for one, hope we are able to answer them while remaining responsible to our patients and the communities we serve.

Maggie Pritchard, Executive Director,

Genesis Behavioral Health

Laconia