After several years of advocacy, New Hampshire has changed its Medicaid reimbursement policy to include coverage for psychological services provided by post-graduate residents enrolled in the licensure process and working under the supervision of a licensed practitioner. This policy change is expected to benefit psychology residents, mental health centers, and the patients they serve.
Bethann Clauss, LICSW, executive director of Maps Counseling Services in Keene, New Hampshire, explained that the new Medicaid reimbursement policy will allow private mental health centers like hers to increase capacity to meet client needs.
She pointed out that the state has had a workforce shortage for some time, but private mental health centers have historically been able to hire only licensed clinicians; individuals working to complete requirements for a professional license did not qualify for Medicaid reimbursement.
Having the ability to hire individuals not quite yet licensed will increase access for Medicaid clients, many of whom are children, Clauss said.
Furthermore, while this reimbursement change will enable the facility to grow staff, it also provides an opportunity to train, support and build a sense of community for students working toward licensure.
Previously, some students were not able to pursue jobs in their chosen field; rather, they could be employed as case managers or in some other capacity, but were not building a therapeutic skills base, Clauss noted.
Now, they will be able to provide direct service surrounded by a group of clinicians who are committed to working diligently for clients. She added that being mentored helps student residents grow and get clinical hours in the field as they continue working toward licensure.
Clauss attributes the changes in Medicaid reimbursement in large part to the efforts of retired clinician Gary S. Barnes, Ph.D, who served as executive director of Maps Counseling Services from 2006 to 2020.
He had hoped to offer residencies to post-graduate students but was told that only a mental health center with a medical director, which Maps did not have, could bill Medicaid.
Barnes reported that post-graduate students fell into a Catch-22 situation; these students were eager to enter practice, but very few jobs were available without a license. The inability to
get supervised hours toward licensure prompted students to leave the state to get training or to take jobs in areas outside the parameters of their training.
The growing increase in Medicaid referrals motivated Barnes to contact New Hampshire Senator Jay Kahn (D – Keene, 10th district), an advocate in the mental health arena who had also worked strenuously to reduce barriers to bringing professionals into the state.
“He has been incredibly hands-on and has hosted numerous forums for a variety of agencies and organizations,” Barnes said.
Kahn connected Barnes with a senior policy analyst in the Department of Health and Human Services (DHHS) who, after investigating the nuances in the language, found that a private, non-profit mental health center does not need to have a medical director. Rather, the facility can bill for services if the student is enrolled in the licensure process and is overseen by a supervisor who is licensed to provide Medicaid.
Before implementing the change, the state still had to secure an agreement with the three managed care companies that provide most of New Hampshire’s Medicaid reimbursement. In August 2020, all parties involved reached that agreement.
“My hope is that more and more agencies will become aware and more private agencies will take advantage of it also,” said Barnes. He added that this change in billing will encourage graduate students to look for jobs in New Hampshire.
Barnes anticipates that non-profit agencies can now have a stable of two or three residents in training on an on-going basis.
According to Kahn, New Hampshire has been facing three important issues. “We have a national shortage of mental health clinicians, which is affecting a variety of populations in our society,” he said. “The need is great, but the supply is limited.”
A second issue revolves around clinical hours needed for licensure. Kahn pointed out that a person who has received a degree has already logged some significant experience. For these individuals to assist with casework under a licensed supervisor has greater value than there is risk, he said.
Kahn noted that people who are under-insured or who receive Medicaid, which pays less than commercial insurers, are most likely to be unable to access services. With the expansion of Medicaid reimbursement for post-graduates, these interns can fill a void, he added.
Third year pre-doctoral student Rebecca Moussa noted that Medicaid reimbursement is opening up opportunities for those working toward licensure. She said that because of this reimbursement, mental health centers will be more likely to take on residents, enabling these institutions to serve a wider range of clients.