The setup for Medicaid, state-sponsored insurance, is also bleak, providers said. Most Medicaid clients get care through community behavioral health centers, which have long struggled to recruit and retain staff.
Medicaid often doesn’t reimburse for the full components of a patient’s treatment, like care coordination between agencies, which is crucial to creating continuity in treatment, and “other desperately needed services,” said Tom Sebastian, the CEO of Compass Health in Everett.
Instead, these facilities get paid for hours when they serve clients. The problem is Compass experiences about a 30% no-show rate. Clients sometimes miss appointments because they don’t have transportation or they have to attend to child care needs or “their challenges are so significant, they may lose awareness that they even had an appointment,” Sebastian said.
That means, about 30% of the time, “We’re unable to capture any revenue to cover the costs of those staff hours,” said Sebastian, whose organization is a member of Fourfront Contributor, a network of providers in Washington advocating for different payment models. “So long as we’re under this improperly structured system, it is just a big challenge.”
One of the largest worries for mental health practitioners who accept insurance is paperwork. Many therapists say they live in fear of clawbacks, where insurance companies can request thousands of dollars in back pay if they identify billing errors.
