There are major concerns with the billing process for mental health services. Clinicians report being denied payments by insurance companies for various reasons, often without merit. There are also concerns that insurance companies are making decisions about clinical care, when they are not trained or authorized to do so. Many providers report insurance is a barrier for patients receiving services due to high co-pays or lack of billable diagnosis for young children.

PERSPECTIVES FROM ADMINISTRATORS

“We're required to bill insurance first, and we do. They pay very little. Then we are required to get our Part C money, and we do. But the cost of actually providing the services is not equal to what our agency is receiving. So every year they go into debt to do that. Our agency has other ways of making it up, and I think every agency does. Some is fundraising. Ours is like social enterprise. We make up that difference through those other ways.”

“Insurance companies need to stop pretending to be a medical provider when you're not, and stop trying to make medical providers seem like they're out to game the system in every single moment when they're clearly not. They're looking to provide a service to help their community. And they're looking to be reimbursed fairly based on what the State and the Government says the reimbursement rate is. Not every provider is out here being nefarious and trying to commit fraud. That's where prior authorization requirements come from, because they want to review all the stuff that you're doing to confirm that from their view it's medically necessary. But at the same time their view isn't in the office, in the street, on the ground level with the patient, providing the care, listening in to what the patient is telling you, providing your knowledge and expertise to help that patient navigate that concern, and then getting into a better place. The Insurance Company's sole priority is to pay for the service. That's it. It's their only stake in the life of the patient, the insurer and the provider pay the claims. You don't play doctor.

There was an overall dissatisfaction with private philanthropy. Grant-funded programs are naturally insecure because they are time restricted. Thus, organizations are constantly searching for new grants to keep programs going. Additionally, many people felt philanthropy is not responsive to the needs of the community but rather their own goals and objectives, making organizations jump through hoops to receive funding. This can lead to an environment where organizations are competing against each other for the same funding.

PERSPECTIVES FROM ADMINISTRATORS

 “I think the crux of it is the funding because, you know, they want the program. Officers come, they say, "How much does this program cost? Oh, it costs $120,000? Okay, we're gonna give you $15,000, and also we want you to adjust your goals so that it matches our mission statement." So you're doing more work for $15,000, and it's just on and on. It's just not sustainable for anybody. It felt like an impossible situation.”

“The uncertainty of a grant-funded position inherently makes people feel insecure and also undervalued. There are so many different industries and environments where people don't have to worry. And this one, for some reason it just screams that people are undervalued.”

Providers and administrators reported a tremendous amount of fear about federal and state funding cuts. They feel insecure in the long-term stability of their programs and consequently their jobs.

A DIRECT SERVICE PROVIDER’S PERSPECTIVE

“Fear of financial state level things that would entail layoffs and program cuts is a real concern. That makes my job really difficult right now. And when I feel that time taken from my families and from clients to do the advocacy work than isn't heard by folks who have the power to make changes, that adds to the difficulty and kind of the frustration in the work.”

AN ADMINISTRATOR’S PERSPECTIVE

“For 31 years I've been through two reductions in forces. So two facilities I've worked at have actually closed, and I've had to be relocated. And we have currently just been informed we're going to go through a third round of budget cuts as a state agency. So we're constantly having to worry about job security, when you really think that you get to a certain point where you don't think you should have to worry about it.”

There is recognition that providers working with young children and families get paid significantly less than providers working with older children. This consistently came up when talking about Early Intervention (Part C) services vs Special Education (Part B) services as well as rates of pay for early childhood educators versus K-12 teachers. Behavioral and mental clinicians also reported people leaving community mental health organizations to open private practices, because the rate of pay is higher.

PERSPECTIVES FROM DIRECT SERVICE PROVIDERS

“I've seen a lot of people leave the field, and I have a ton of thoughts on why. Pay equity in early learning is probably number one. It's just not there. I know at the state level we're working on it. The Federal level. Everybody's working on that. It's a difficult issue.”

“There is a big big chunk that have left to work in the school district. Maybe they got their masters in special education, and they were just ready to move up and have a little bit higher-paying job with summers off. There's definitely a difference in pay from early intervention services and the school district, or even a private agency.”

There was recognition that needs of children and families often don't fall into neat funding categories. There was a desire for more flexibility in how funds could be used.

PERSPECTIVES FROM ADMINISTRATORS

“Wouldn't it be cool if there was a pot of money for a family? And you just all work together, and it's like, Oh, well, this department can provide this because, you know, sometimes a family really needs a washer because they've got 3 little kids, and that's a lot of laundry. And my program can't pay for it, but this other one thinks they might be. But since they're not enrolled in their program, they can't, you know? It just would be so cool if there was just money per family, and everybody works together on how to do that.”

“We need sustainable funding for everything. If you're asking for higher pay then who's taking their pay cut? Does that mean less services for families? Or less funding for continuing education? It just feels like people are moving buckets of money from place to place.”