Latest / The Mental Health Evolution / Ep 8: Viewing Mental Health Care Through a Family Systems Lens

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Ep 8: Viewing Mental Health Care Through a Family Systems Lens · The Mental Health Evolution

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  (Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast Network.
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  Learn more at listenfrederick.com.
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  Welcome to Mental Health Evolution, a podcast about what's changing in mental
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  health and why it matters.
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  I'm your host, Rachel Harrison, inviting you into honest conversations with
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  people from all perspectives in the field, clinicians, tech founders,
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  investors, insurance companies, and all the folks in between.
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  Let's explore what's working, what's not, and what's next.
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  Hello, everyone.
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  Welcome back to the Mental Health Evolution podcast, where we are talking
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  today about how policy is impacting mental health services, how they're
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  provided, as well as system changes and requirements for different care models.
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  Our guest today, Kathy Gilbert, currently works as a consultant to providers,
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  but she has a history of working in big insurance groups, working
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  with provider network development and operations.
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  She has done a lot of research into different policies that are
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  currently impacting our field, and we are going to dive more into
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  that today.
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  So I'd like to highlight some information to get us started thinking
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  on this.
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  One of the big policies that will impact the conversation today is
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  the Big Beautiful Bill Act.
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  This is known to be making cuts to Medicaid, to SNAP, and
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  to Affordability Care Act, offering lower cost healthcare options to many
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  Americans.
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  And NAMI, the National Alliance for Mental Illness, released this about the
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  bill.
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  Their statement was that they are cutting Medicaid for millions of Americans,
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  and they say they're concerned about the mental health care that will
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  not be afforded to millions of people with this bill and will
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  have a far-reaching impact.
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  But we're going to dig into that a little bit more.
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  And before this bill, there were also some other policies, and we
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  might dig into these as well, that 2026 would dissolve the Substance
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  Abuse and Mental Health Services Administration, also known as SAMHSA, and the
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  Health Resources and Service Administration, or HRSA, consolidating them into a
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  new administration for a healthy America, as well as additional federal actions
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  impacting access to mental health care included reduced funding for LGBTQ+,
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  crisis services through 988 Suicide and Crisis Lifeline, halting the $1 billion
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  in school mental health professional grants by the Department of Education,
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  citing civil rights concerns.
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  And all of this was documented from the APA, which is the
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  American Psychological Association article titled, New and Proposed Policies
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  Affecting Access to Mental Health Care.
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  So that's going to be our focus today, is looking at these
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  policies, looking at how they are going to specifically impact mental health
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  care, and getting some of Kathy's expertise on this.
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  So, Kathy, I just want to say thank you so much for
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  being here.
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  Oh, nice to be here, Rachel.
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  Looking forward to the discussion.
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  Awesome.
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  So let's dig in.
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  First, I just want to say all of these changes seem to
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  be moving really fast.
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  I'm wondering from your perspective, is that just how it feels?
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  Or are things actually moving at a faster pace than they have
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  previously in terms of policy changes for our industry?
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  I think with the big beautiful bill, things are moving really fast.
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  So for example, I'll be dating myself, but I did my master's
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  thesis on national health care in the U.S. in the 90s
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  during the Clinton administration.
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  We finally got it in the 2000 teens under the Obama administration.
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  So nearly 20 years later.
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  So it took 20 years for that change when that discussion started,
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  even before that, really.
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  And it felt like ACA wasn't perfect, but it had a lot
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  of the elements that helped us get to where we needed to
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  be.
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  So yes, and now with some of the changes aren't immediate, but
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  things seem to be moving extremely fast because, especially in behavioral
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  health, change is slow.
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  It takes a long time.
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  So yeah, this does feel a lot faster, and I don't think
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  it's still settled yet on how fast some of these changes are
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  going to happen.
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  So with that, I would love to hear your perspective.
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  How are you looking at these various policies?
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  What do you see as the big things that we need to
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  be looking at and addressing in the mental health industry?
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  Oh, one of it is part of it is more general.
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  I see it as just the number of sheer numbers of people
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  losing health care coverage over the next 10 years based on the
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  bill.
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  That's huge.
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  A lot of those that lose coverage, I think, will be individuals
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  with mental health challenges.
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  So because of the work requirement and when you think about this
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  in perspective, something else that's happening in the administration is the
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  dismantling of the Department of Education, which funds training programs for
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  persons with disabilities who now have a work requirement, but the training
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  programs may not be there any longer.
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  So I think it's even broader than what people are realizing right
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  now.
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  So that's part of what we have to think about.
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  Plus, in the mental health world, for people under ACA coverage or
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  Medicare or Medicaid, all three of those are significantly impacted by this
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  bill.
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  Those are usually our most vulnerable populations, the people that could use
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  the additional supports.
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  So if they're losing coverage, programs are curtailed, not just in mental
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  health, though that population is going to struggle even more.
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  So looking for innovative ways to continue to deliver those services, make
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  sure people have the right supports and keep it and try to
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  keep those support systems, those safety net systems intact.
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  I mean, and that's when you think about the whole perspective.
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  That's my big concern.
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  Well, yeah, but but I think about providers with that, whether it's
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  a nonprofit organization, right, that might also be losing grant funding or
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  whether it's a practice, a medical practice.
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  Those typically aren't people that have the means to pick up the
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  slack here, right?
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  Or provide services for free or low cost, even, I mean, right.
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  Yeah, right.
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  Yeah.
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  Because the other concern is how are states going to be able
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  to manage the cuts in what the federal government portion on the
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  Medicaid dollar?
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  It's a pretty significant portion for most states of what dollars come
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  from the federal versus the state match to fund the Medicaid safety
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  net programs.
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  I'm concerned that there will be rate reductions and how providers are
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  reimbursed, not a total loss, but rate reduction.
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  So will they be able to cover costs in mental health?
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  The other thing I worry about is, you know, mental health in
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  that in the medical world, in the health care world has been
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  one of the lowest reimbursed areas historically.
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  It has not kept up with other specialties.
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  And if those rates are reduced yet again, that's not sustainable.
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  Where do you think the rate reduction is going to come from?
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  I think it's got to be a combination.
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  There's a lot of a combination of public and private dollars, which
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  is, you know, kind of where I see I want a combination
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  of looking at the legislation and being able to understand it.
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  I get really concerned about this.
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  It feels like almost a slash and burn mentality instead of really
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  looking and evaluating programs specifically and looking how to improve those.
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  I mean, honestly, everybody in the health care world has concerns about,
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  you know, broad waste and abuse, which is part of what they
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  were trying to get at with some of the requirements they put
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  in.
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  Yeah.
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  But 99.9% of people that go into behavioral health in
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  the health care world aren't going into it for the money.
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  No, they're going into it because they care.
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  And so when they talk about all the slash and burn because
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  they're going to save because people are abusing the system, I'm like,
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  where are you seeing that?
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  It's so small comparatively.
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  So, yeah, I'm not sure.
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  There's so much that remains to be seen on these on all
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  the pieces of this bill.
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  It's like they cancel, like I said, they canceled, you know, they're
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  cutting this and required work.
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  They're also cutting the training programs.
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  OK, does that work when you have individuals who need support?
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  And that's a large group of the mental health.
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  My husband actually was a vocational rehab counselor.
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  He's since retired and he worked with that population, helping them get
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  jobs.
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  That program that he worked in was funded through the Department of
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  Education.
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  And he worked with individuals with disabilities to help them get jobs,
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  many of them with mental health challenges.
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  Yeah, I hear you that it's going to have a bigger impact
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  than just what we see.
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  Yes, people are using losing medical coverage.
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  And what else does that impact?
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  I even think about, you know, society impact, right?
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  If people are getting support with mental health concerns and able to
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  walk into a clinic or whatnot, that that prevents a lot of
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  maybe maladaptive behaviors or other places where that's going to come out
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  and affect our communities.
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  So I'd like to talk about your consulting work.
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  What types of clients do you work with?
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  And I'm curious what you're seeing with them with this policy.
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  Like what kind of conversations are you having?
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  What are you telling people that they should be thinking about?
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  What does that look like?
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  Well, I work with a lot of clients in the digital health
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  space.
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  So either virtual care or hybrid, which they also may offer in
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  -person care in some markets.
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  So a combination of those and plus a couple more traditional behavioral
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  health settings.
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  Most of my clients are in some way tied to behavioral health.
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  So I have a few that are, you know, more in the
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  allied therapies, though occasionally something different, but for the most
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  part in behavioral health, which is where my career has been is
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  primarily behavioral health.
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  I started out as a social worker.
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  So I had that going all the way back to early career.
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  I didn't know that.
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  Yeah, that's cool.
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  So and what I'm telling them, one of the things there is
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  a piece of the legislation that actually is good for virtual care
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  providers.
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  And it could be good because that may be where some things
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  move so that people can have affordable and health insurance coverage is
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  there was a provision during COVID that waived allowed health plans or
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  employ self-employed employ self-insured employer groups to allow virtual care
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  or telehealth to be covered without having to meet the deductible and
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  or pay the co-insurance co-pay could be waived for telehealth
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  visits.
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  They love to deal with preventative care and they waive that.
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  There is a provision in the Big Bad and Beautiful Bill that
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  does make that permanent that allows benefits to not require deductible to
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  be met to pay for virtual care visits.
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  So in all of that, there's a positive.
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  Yeah.
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  I was trying to find some.
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  So that's good.
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  But there's another issue that's not addressed in that bill or that
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  act now that there's a requirement in mental health and substance use
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  for an in-person visit every six months or a year when
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  implementing telehealth that expires September 30th.
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  Congress has not acted to change that yet.
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  So that come but you need you kind of need both.
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  You kind of do.
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  So we're waiting to hear on that other piece, but it is
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  good, especially for individuals that have those high deductible plans, which a
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  lot of companies have gone to to make at some insurance affordable
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  to members.
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  So that's one piece of maybe good in the legislation.
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  And since I work with a lot of digital providers, that's we're
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  excited about that piece.
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  That's good news because some of those are programs and programmatic where
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  their payment structure is for a program and somebody with a high
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  deductible health plan, those high deductible health plans have deductibles of
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  $2,500 to $5,000.
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  So if you're going for care, it's a lot unless you have
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  something nature.
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  It's a long time to your health plan kicks in.
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  That is a long time.
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  So, yeah, when you think about in perspective, I mean, it's across
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  all health services that you see, but still that's that's a big
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  deductible.
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  And it allows for more services to be paid out of health
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  savings accounts.
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  So without impacting health savings accounts.
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  So seems like a positive for employers and employees with with coverage
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  and having that covered basically from day one.
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  Anything that you think is important for solo and group practice owners
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  to be aware of?
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  Maybe, you know, you're talking about working with a lot of virtual
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  folks, but even folks that are seeing clients day to day, what
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  are your thoughts for them?
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  You know, they need to just be aware of monitoring coverage, especially
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  if they participate with Medicaid and ACA plans that to be aware
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  and maybe support their their patients in that recertification and reminding
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  them and helping them to maintain their coverage.
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  I mean, that's one piece.
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  Also to monitor for watch for changes and how coverage changes, because
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  I think benefit plans are going to change a little bit.
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  So monitoring for what services are covered.
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  I think basic mental health services and the standard codes are going
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  to continue to be covered.
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  But one of the things I noticed is there's a mandate under
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  a number of the ACA plans for a minimum level of copayment
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  elections.
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  I think it was something like thirty five dollars.
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  So copayments may change.
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  There may actually be times when you were used to there being
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  no copayment.
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  Now there's a copayment.
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  So really being aware, continuing your eligibility checks and benefit
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  verifications, most of those are electronic and sometimes it's hard to keep
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  track of.
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  But just keep re verifying that I think is going to be
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  really important.
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  The other thing I noticed, which I think is critical, especially if
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  they participate with some of the Medicaid plans, they used to be
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  that for Medicaid in most states, when people were getting enrolled, they
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  they could retroactive up to three months.
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  Coverage.
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  They've reduced that to one month in that bill.
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  So when you're used to as people are in, you know, getting
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  enrolled in Medicaid, especially if that's a population that you see, you
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  know, if somebody is applied, they would retroactive it and it takes
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  them time to process.
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  So sometimes that three months gave them time to get it processed
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  and they retroactive it back to the application date.
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  Now they're only going to be able to go back a month.
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  Yeah.
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  Which can make a difference, a significant difference.
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  Because I'm concerned about application processing taking longer with the and
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  that would also impact those redeterminations of eligibility every six months.
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  Those get delayed.
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  Somebody could lose coverage.
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  It could take a while.
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  Then they they would only be able to retroactive it back a
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  month to be in state coverage.
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  Yeah.
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  Potentially.
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  What is your recommendation for how often to check for eligibility?
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  And if there are changes?
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  I mean, you should ask the patient at every visit.
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  And I think that's pretty standard.
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  But I would almost check monthly just to, you know, make sure
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  nothing changes.
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  And that's about how often things kind of change on a Medicaid
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  roll.
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  And even if somebody is employed and changes jobs, usually it's covered
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  till the end of the month.
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  Oh, that's true.
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  That's true.
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  So figuring out a way to kind of do some re-verification,
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  you know, on a regular basis.
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  That's good.
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  That's good, concrete advice.
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  I like that.
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  So you're not backpedaling or caught unaware or those kinds of things.
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  Right.
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  Because, you know, those individuals may be individuals that aren't going to
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  be able to pay that bill.
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  Right.
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  So, I mean, that's, you know, that that would be one of
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  the things I would really look at.
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  And, you know, I'm also concerned about from the health plan perspective,
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  them being able to maintain networks because if you're in a month
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  where you can stay with just commercial and private insurance or private
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  pay, it's going to even make access more challenging for those individuals
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  that don't have that available to them.
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  Yeah, I see that too.
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  Definitely makes all of that challenging.
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  We are about out of time for this episode.
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  And I'm wondering if you could highlight one critical piece of information
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  for people to know.
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  What would be your top line policy takeaway that folks should know
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  about?
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  Oh, there's so many points.
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  No, I'm asking a hard question.
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  Yeah, it's really to pay attention to what the changes are.
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  Watch those communications from the health plans you participate with.
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  So because they're going to be telling you how they are implementing
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  the requirements of the changes.
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  So my takeaway from all of it, as things settle out and
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  health plans figure out what's going on and even the state Medicaid
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  associations really watch for those notices.
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  Not just what's in the news, but watching for those direct notices
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  that plans do send out.
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  And I know it's easy to ignore those because you can get
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  bombarded.
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  But I think in this time of fast change, especially for small
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  individual and group practices, really pay attention to those notices as things
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  are settling and they'll tell you what's changes are coming and coverage
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  and how they're because it could change some processes.
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  It could change, could mean rate changes, could mean a whole variety
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  of things.
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  So I think when things are moving this fast, it's really critical
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  to watch for those notices or try to monitor the payer websites
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  because that's where they're going to put stuff.
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  I love that.
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  That would be my...
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  I do.
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  Yeah, because with information, we can make better decisions.
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  So that's great.
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  Right.
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  Because you don't know exactly.
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  It's going to be...
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  Medicaid is going to be slightly different in each state.
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  Each state's impacted differently and health plan changes.
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  Each plan is going to have to figure out how they're going
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  to account for the changes.
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  I mean, Elevance and Centene in the last week have come out
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  with the restatement of earnings.
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  I'm sure it's coming from United.
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  It's going to be coming from all the major players who are
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  involved in ACA, Medicare and Medicaid, which all of the major players
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  are.
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  Yeah.
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  Yeah.
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  Well, Kathy, thank you so much for being here and sharing in
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  this conversation about policy changes for the mental health industry.
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  Your perspective has been awesome.
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  And thanks for the concrete takeaways, too.
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  So we will wrap up this episode and we'll hope to hear
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  you back next time.
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  Thanks for listening to the Mental Health Evolution podcast.
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