Gov. Paul LePage’s biennial budget plan, which he hopes to pass on July 1 of this year, contains a section that would no longer allow people with Medicare and MaineCare to receive services from Licensed Clinical Professional Counselors (LCPCs) in the state of Maine. If this change passes, the bulk of the responsibility for psychotherapy services will be shifted to Licensed Clinical Social Workers (LCSWs). This is an effort to save money because if these people go to LCSWs, the rate of reimbursement is reduced.
Our clients who have Medicare and MaineCare generally have that insurance combination either because they’re over the age of 65 or because they have psychiatric symptoms of such severity that they receive disability benefits. Common diagnoses involved include bipolar disorder, post-traumatic stress disorder, schizophrenia, schizoaffective disorder, Asperger’s and developmental disabilities. According to reports published in the Journal of the American Medical Association, roughly 50 percent of people with severe mental disorders are affected also by substance abuse. These are the people in Maine who will be denied access to professional counselors.
The numbers don’t add up. According to the Office of Professional and Occupational Regulation, there are 921 LCPCs in Maine and 2,658 LCSWs. At my agency, we get new referrals for Medicare and MaineCare clients regularly. I currently see 22 people with this insurance. If we assume the average number of dually insured clients is 15-25 clients per counselor, that adds up to around 14,000 to 23,000 clients who will suddenly have to be referred to a percentage of the 2,658 LCSWs. I say “a percentage” because not all LCSWs provide outpatient therapy services.
We must also consider that many of the LCSWs who provide this service have caseloads that are already full or close to full. The demands for necessary support would vastly exceed the availability of services. Meanwhile, we would have almost 1,000 licensed counselors who could help to meet the need but would no longer be allowed to do it.
Therapists are also not uniformly interchangeable. We refer to one another, among both licenses, based on our specializations. Other therapists sometimes refer their clients to me who have been severely traumatized because I’m trained in effective treatments for PTSD. On the other hand, when I get new clients who tell me they have sexual urges toward children, for example, that’s a problem that falls outside of my scope of training and experience. I then make a referral to someone who has training to address that problem.
It is not realistic for LePage’s proposal to suggest that we’ll take this large number of people away from one set of providers and give them to another set simply according to their difference in licenses. We’d be denying this population access to specialized and necessary services that would otherwise be available, especially when there are no other specialists of that kind in their area.
We must also consider the effects on businesses and social workers. When a social worker works with someone with Medicare or MaineCare, they receive the lowest compensation rate of any insurance plan in the industry. In the last month, the clinical director of a mental health and substance abuse treatment agency in Maine told me that if his business was comprised of primarily social workers seeing these dually insured clients, his agency would soon need to close its doors because they wouldn’t be able to meet their operating costs.
There are mental health professionals, like others in health care, who limit or refuse to accept MaineCare and Medicare because of these sorts of problems. This proposed change of suddenly flooding social workers with people with this insurance combination, as opposed to the more balanced distribution that we now have, would dramatically exacerbate the problem.
These changes will be a disaster if they are passed. They will deny our most vulnerable population access to necessary services and supports. They will deny our licensed counselors access to the people and situations that they’ve been trained to serve. They will cause a devastating domino effect that will profoundly affect businesses and jobs in Maine.
Expectations are that the outcomes would be what normally occurs when outpatient supports are limited or denied: an increase in hospitalizations and related expenses, an increase in consequences and costs from addiction and the unnecessary increase of suffering and isolation for these affected people and their families.
To anyone who will listen, I encourage you to contact your senators and representatives and ask them to do everything in their power to stop this change from happening.
Keith Young is a licensed clinical professional counselor at the Full Circle Wellness Center in Bangor.