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Changes to WV Mental Healthcare Financing Worry Some

May 27, 2010

CHARLESTON, W.V. - Plans by the West Virginia Department of Health and Human Resources (DHHR) to move Medicaid mental health patients to a managed care system run by for-profit HMO's is meeting with opposition. Many clinics fear the needs of some patients will not be met in the rush to change.

Phyllis Gore, acting CEO of Valley HealthCare System in Morgantown, supports the current system, which she says meets the needs of 30,000 especially vulnerable people. Under the proposed new plan, she believes HMOs would tend to cut services.

"They're going to want to maintain their profit margins. They're assuming all the risk at this point, and they will tend to move that risk to the providers."

Gore believes providers would feel pressure to see fewer patients at a time when many in the state go without the care they need.

However, Nancy Atkins, the state's commissioner for Medicaid, supports the change, saying the objective is to combine the patients' physical and mental health care under the same payer, not to add to the HMO's profits.

"We would move these Medicaid members into a coordinated system of care and coordinate that care around the person, not around the service. I don't think it's going to increase costs."

Gore counters, many of the providers say patients already get coordinated care, arguing facilities such as hers have doctors on staff to do that.

"By having a primary care physician in our agency, it really closes that gap and makes it much more efficient. But, I don't see where this proposed system is really going to facilitate that any more."

Most of the patients in question are in the state's Temporary Aid to Needy Families (TANF) system, or the federal Social Security disability system. DHHR wants those TANF clients in the new system by July 1, which Gore says is rushing the process.

Dan Heyman, Public News Service - WV