Medicaid’s expansion under the Patient Protection and Affordable Care Act represents a huge opportunity for health-care providers. But
will psychologists be able to take full advantage of that
opportunity? Not until certain barriers are removed, said
speakers at the 2012 State Leadership Conference.
Health-care reform is expected to bring 16 million more
Americans into the Medicaid system, said Carrie Valiant, JD, a
partner at Epstein Becker Green in Washington, D.C. Medicaid
is already the country’s single biggest payer for mental health
“But just because mental health services will expand
doesn’t necessarily mean that psychologist services will be
covered,” warned Valiant, whose research on behalf of APA’s
Practice Directorate has uncovered several impediments to
One barrier is the fact that most states don’t cover health
and behavior codes, which focus on behavioral aspects
of medical conditions. Of the five states Valiant reviewed,
only Maryland covers such codes. In addition, states don’t
uniformly reimburse psychologists for psychotherapy services.
States also aren’t required to cover telehealth, which could
help fill the gap between already-overloaded programs and
an expanded Medicaid population. And while reimbursement
rates in some states aren’t as low as some believe, low rates can
keep psychologists from participating in Medicaid.
Despite these barriers, Medicaid’s expansion also brings
plenty of opportunities. Fifteen states have received funding
New research focuses
on removing barriers to
psychological services in
to create demonstration projects designed to improve
coordination of care for so-called “dual-eligibles” who
have both Medicare and Medicaid coverage. “There’s a big
opportunity for psychologists to shape what the future of
that may look like,” said Valiant. Another opportunity lies in a
demonstration project designed to provide health homes for
people with heart disease, diabetes, mental health conditions,
obesity and other chronic disorders, some of which will be
based in mental health rather than primary care. Health-care
reform also includes provisions aimed at increasing the supply
of mental health professionals.
Maryland already has such generous Medicaid coverage for
psychological services that the state could serve as a template
for others, suggested Paul Berman, PhD, professional affairs
officer of the Maryland Psychological Association. And
thanks to health-care reform, he said, the number of people
in the state’s medical assistance program and state insurance
exchange will more than double. The exchange will cover
individuals who make up to 400 percent of the poverty level.
For a family of three, that means coverage for those making up
to $76,000; the median income in Maryland is $70,000.