Working on healthcare

Posted: May 4th, 2018 | Columnists, Featured, Notes from Toni | No Comments

By Toni G. Atkins | Notes from Toni

Imagine you’ve recently given birth to your first child. You don’t earn a lot of money, so you rely on Medi-Cal, California’s safety-net health-insurance program, and you get your health care at a community health center. The baby won’t stop crying, and the stress and lack of sleep are fraying your last nerve. You’re really struggling.

You see your doctor during a regular health visit, and you tell her about all the difficulties you’re experiencing. She thinks it would help for you to talk with a therapist — today.

You’re eligible to receive California’s safety-net benefits, so the health center can bill Medi-Cal for your regular visit. The problem is, it can’t do the same for a mental-health visit when it happens the same day.

So, the health center has two choices. It can make sure you see a therapist today, meaning it must absorb the additional cost for those services, or it can schedule an appointment for another day, delaying the treatment and risking the possibility that you’ll cancel it because you can’t get the time off work, or for myriad other reasons. But your struggles might worsen without intervention.

Or, imagine you suffer from chronic disease and you’re at the health center for a checkup. You tell your doctor how you feel, and eventually you reveal that you’re depressed, and you think about just ending the pain — both the physical and the emotional — once and for all. There’s no choice here: The health center will try to get you to a therapist right away, but it will have to absorb the cost.

These scenarios are realities for many Californians. They are similar to encounters I had with people back when I worked in community health clinics — I know these situations firsthand.

There’s no reason it has to be like this. If health centers can bill Medi-Cal for a mental-health visit tomorrow, why can’t it bill for a visit today?

California allows health centers to bill for primary care and a dentist appointment on the same day — why not mental health, too? What’s more, the federal Medicare program allows for same-day billing of behavioral health and medical services — Medi-Cal should too, as well.

Working with the Steinberg Institute and CaliforniaHealth+ Advocates, I have introduced Senate Bill 1125 to fill this hole in the system. It will require the state to allow Medi-Cal to reimburse federally qualified health centers for primary-care and mental-health visits that occur on the same day.

There are more than 1,300 community health centers in California that provide comprehensive, high-quality care to 6.5 million people. That’s one in six Californians. The vast majority of the patients served by community health centers lives at or below the poverty line, and a substantial share are uninsured or enrolled in Medi-Cal.

The good news is that we have broken down some of the stigma associated with emotional challenges and mental illness, and people are increasingly open to treatment, meaning there is a growing need. SB 1125 will allow health centers to hire more mental-health professionals to meet this demand.

The bill also works hand-in-hand with AB 1863. Signed by Governor Jerry Brown in 2016, AB 1863 allowed Medi-Cal to be billed for counseling services provided by licensed marriage-and-family therapists, and not just clinical social workers and psychologists, increasing the supply of service providers.

Toni G. Atkins

Health centers must be able to seamlessly provide same-day treatment for both physical and mental health — and be compensated for the full spectrum of care they’re providing. It’s only fair. SB 1125 will accomplish this.

I was pleased when SB 1125 passed the Senate Health Committee in late April and look forward to working with my colleagues in the full Senate, as well as the Assembly and the governor, to ensure that this important measure becomes law.

— Toni G. Atkins represents the 39th District in the California Senate. Follow her on Twitter @SenToniAtkins.

Leave a Comment