From the Office of the Insurance Commissioner
Insurance Commissioner Mike Kreidler is directing all health insurers in Washington state to identify any policyholders who had mental health services denied because of a blanket or categorical exclusion since Jan. 1, 2006 and notify them of their right to have their claim re-evaluated.
The Washington State Supreme Court recently ruled that Washington’s Mental Health Parity Act prevents insurers from using blanket exclusions for mental health services that may be medically necessary.
Kreidler sent a letter to the insurers today (PDF, 371KB), outlining his expectations for how to implement the court’s decision and what steps he expects them to take on behalf of consumers.
“The court ruled decisively on behalf of Washington consumers, and I intend to see that insurers doing business in our state follow through on this decision,” Kreidler said. “I expect the insurers to do a thorough review of all policyholders who may have current and past claims that may be impacted by this decision and to start the process immediately.” Continue reading
SEATTLE — Carlos Romero’s apartment is marked with remnants from his former life: a giant television from his days playing World of Warcraft and a pair of jeans the width of an easy chair. The remnants of that time—when he weighed 437 pounds—mark his body too: loose, hanging skin and stretch marks.
“I lift weights and work out and work hard, but there’s lasting damage,” said Romero.
Yet for all the troubles he had dating when he was obese—all those unanswered requests on dating web sites—shedding weight left him uneasy about how much to reveal.
Indeed, the stigma of obesity is so strong that it can remain even after the weight is lost. Holly Fee, a sociologist at Bowling Green State University, has conducted some of the only research on dating attitudes toward the formerly obese. In 2012, Fee published her findings in the journal Sociological Inquiry.
She found that potential suitors said they would hesitate to form a romantic relationship with someone who used to be heavy. “The big dragging factor in why they had this hesitation in forming this romantic relationship was that they believed these formerly obese individuals would regain their weight,” Fee said. Continue reading
Amid national concerns that too many children are being medicated for Attention Deficit Hyperactivity Disorder (ADHD), some state Medicaid programs are stepping up oversight of diagnoses and treatments.
By Christine Vestal
ATLANTA – Attention Deficit Hyperactivity Disorder, or ADHD, affects one in every seven school-aged children in the U.S., and between 2003 and 2011 the number of children diagnosed with the condition rose by more than 40 percent.
Doctors have considerable leeway in deciding the best course of treatment for a child with the condition, no matter who is paying the bill.
But children covered by Medicaid, the joint federal-state health care program for the poor, are at least 50 percent more likely to be diagnosed with the disorder.
Children covered by Medicaid are at least 50 percent more likely to be diagnosed with the disorder.
That is partly because of the toll poverty takes on kids and a lack of resources in poorer schools. But some states believe there are other factors at work.
Several have begun to investigate whether doctors and mental health providers who bill Medicaid for ADHD are rigorously using evidence-based guidelines when diagnosing and treating it.
In Georgia, state Medicaid officials are working with the Centers for Disease Control and Prevention to improve the accuracy of diagnoses and the efficacy of treatments for the ailment.
Missouri and Vermont have also sought the CDC’s help in analyzing Medicaid claims data to determine how best to improve care for what has become the most commonly diagnosed childhood behavioral disorder. Continue reading
By Anna Gorman
KHN / AUGUST 28TH, 2014
LOS ANGELES, Calif. — Hoping to keep more people with mental illness out of jails and emergency rooms, county health officials opened a mental health urgent care center Wednesday in South Los Angeles.
The goal of The Martin Luther King, Jr. Mental Health Urgent Care Center is to stabilize and treat people in immediate crisis while connecting them to ongoing care.
Run by Exodus Recovery, it will be open 24 hours a day, seven days a week and can serve up to 16 adults and six adolescents.
During their stay of up to one day, patients will undergo a psychiatric evaluation, receive on-the-spot care such as counseling and medication and be referred for longer-term treatment. Continue reading
When Yuri Maldonado’s 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California’s Medicaid plan for low-income children was going to be tough.
Medi-Cal, as California’s plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage.
But Maldonado’s son was approved for 30 hours a week of applied behavioral analysis (ABA), a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn’t enough.
So she and her husband, neither of whose jobs offered health insurance, bought an individual private policy for their son, with a $900 monthly price tag, to get him more of the comprehensive therapy.
“I don’t know any family that can really afford that,” says Maldonado. “We made some sacrifices.”
That should be changing soon. In July, the Centers for Medicare & Medicaid Services announced that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans, another federal-state program that provide health coverage to lower-income children. Continue reading
Mental health therapists most often leave issues of faith outside their office doors, even for patients who are religious. But one class of counselors believes a nonsectarian model doesn’t serve everyone equally well.
“On a feeling level, people want a safe, respectful place, to ponder the tons of questions that come begging in hard times,” said Glenn Williams, a pastoral counselor in Kentucky and chair of the Kentucky Association of Pastoral Counselors. “Where is God? Why did this happen? Is it karma, sowing-reaping, happenstance? What purpose does this suffering serve?”
Six states allow these counselors – who include faith and spirituality in their work – to be licensed mental health counselors, which can make it easier for them to get health insurance reimbursements.
Kentucky recently became the sixth state (joining Arkansas, Maine, New Hampshire, North Carolina and Tennessee) to allow pastoral counselors to become licensed mental health counselors. Continue reading
SAN ANTONIO — It’s almost 4 p.m., and Officers Ernest Stevens and Ned Bandoske have been driving around town in their black unmarked SUV since early this morning.
When it first came out, I was very skeptical. I thought, well this is ridiculous.
The officers spot a call for help on their laptop from a group home across town.
“A male individual put a blanket on fire this morning, he’s arguing with them, and is a danger to himself and others, he’s off his medications,” Stevens reads from the blotter.
A few minutes later, the SUV pulls up in front of the group home in a run-down part of the city. A thin 24-year-old sits on a wooden bench in a concrete lot out back, wearing a black hoodie. His bangs hang in damp curls over his forehead.
“You’re Mason?” asks Bandoske. “What happened to your blanket?”
Eight years ago, a person like Mason would have been heading to the emergency room or jail next. Continue reading
Tips for the US Centers for Disease Control and Prevention
Going to college is an exciting time in a young person’s life. It’s the end of one chapter and the beginning of another. College is a great time for new experiences, both inside and outside the classroom. Here are a few pointers for college students on staying safe and healthy. Continue reading
Psychiatric boarding – the practice of detaining patients with mental health problems without treatment because of limited psychiatric beds – is unlawful, according to a unanimous opinion the Washington state Supreme Court issued Wednesday.
By Michael Ollove
By his own admission, for many years Cyrus Napolitano’s mental illness—bipolar disorder—did not make him an ideal employee.
Perhaps the worst moment came when he walked into the Brooklyn McDonald’s he was managing to discover some now-forgotten worker infractions.
“Whatever it was,” he said last week, “it triggered an explosion where I was screaming at the top of my lungs and beating a path of destruction all the way to the back, knocking everything off shelves and kicking the back door with my boot.”
He left the job at McDonald’s, as he did various other jobs over the decades—as a waiter, a bartender, a concierge at a luxury condo building. During one eight-year period in the 2000s, after his third suicide attempt, he could barely work at all.
But that was some time ago. Thanks to his eventual involvement with Fountain House, a community mental health center in Manhattan, Napolitano, now 53, is in his fourth year of steady, part-time employment as the “scanning clerk” at an international law firm, a stress-free job he credits with helping him manage his illness. Continue reading
By Charles Ornstein
ProPublica, July 13, 2014
This story was co-published with The Chicago Tribune.
A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions.
Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.
And then there was this: The sessions were often being performed by obstetrician/gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled.
By Jenny Gold
KHN / JULY 10TH
Most adults with mental illness want to work, and six in 10 can succeed with the right supports, according to the report.
“It isn’t surprising,” says Sita Diehl, director of state policy at NAMI and author of the report. The problem has less to with the workers themselves, she says, and more with the organizations that provide services for people with serious mental illness. Continue reading
Studies show that enrollees with mental illness, who also have chronic physical conditions, account for a large share of Medicaid spending.