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The Honolulu Advertiser
Posted on: Friday, April 30, 2010

Hawaii preparing to turn mental health services over to insurers

By Mary Vorsino
Advertiser Urban Honolulu Writer

The Health Department worked to assure mental health providers yesterday that a plan to shift about 1,700 severely mentally ill adults this summer from programs managed by the state to treatment overseen by their Medicaid providers will be seamless and won't result in cuts to services.

The switchover, set to start July 1, has alarmed some providers and advocates who worry that clients will be lost in the mix or could see services cut.

After a Health Department presentation on the changes yesterday, providers said they still had plenty of questions and concerns. But some were also optimistic the changes will result in less red tape for mental health clients, and could end up getting them more comprehensive health care.

Greg Payton, executive director and chief executive officer of Mental Health Kokua, said the shift in clients sounds like "an interesting experiment."

But Payton said he isn't convinced the transition will be as painless as advertised or that the switch will garner the results the DOH says it will.

"What they're wanting is (a) better, more integrated system," Payton said after the Health Department meeting at The Queen's Medical Center. "There doesn't seem to be a plan" to bring together fragmented services.

Still, Payton said his organization is working with affected clients to educate them on the changes and what they need to do after the switch.

Stacy Kracher, clinical director at Helping Hands Hawai'i, said she's worried about the transition of clients and that some might be lost during the switchover. She added, "I don't this is a bad change. I think it's a change."

And, she said, it might even help clients get better care.

DOH officials say that's the whole point of the change. They stressed that switching the clients won't result in any cost savings, but would streamline services and improve access to medical and mental health care for a group of people who on average die 25 years earlier than the rest of the population.

"The outcome that we hope will be achieved is better services," said Michelle Hill, deputy director of the state Health Department, which provides services to about 15,700 people through its Adult Mental Health Division.

AMHD has traditionally overseen services to its clients, either by contracting them out or providing them directly (as in the case of Hawai'i State Hospital in Kāne'ohe). Under the changes, AMHD dollars for clients on Quest, the state's version of Medicaid, will be funneled to their health insurers, which in turn will contract with mental health providers.

Some services for Quest clients will still be contracted by the state, however, including housing, supportive employment and crisis services.

Among the services the health insurers will take on: intensive case management, psychosocial rehabilitation and therapeutic living supports.

The movement of the Quest clients from AMHD services to treatment provided by their health insurer will leave the division with 14,000 clients a figure that will further diminish in the future when about 2,300 Quest Expanded Access clients are also switched over to their insurers.

AMHD hasn't set a date yet for that switch.

The biggest change for clients, DOH said, might be a switch in which provider they go to for certain services. Providers are working now to set up contracts with health insurers, but it's clear some clients will have to move.

Patti Bazin, Department of Human Services health care services branch administrator, said the key is that though providers might change, services won't.

She also said yesterday that she doesn't foresee clients experiencing reduced services, though she also stressed that health plans will make assessments, like the Health Department does, to make sure services are needed.

"All behavioral health services should be medically necessary," she said.