Child Mental Health Services Severely Lacking, Citizens Testify

Feb. 03--BOISE -- Pleas for Medicaid expansion and criticism of Idaho's child mental health services dominated the testimony at a public hearing on health and welfare issues Friday morning.

Several people said their children haven't been getting needed mental health services from Optum, the for-profit company that administers Idaho's outpatient Medicaid behavioral health programs.

When they try to appeal, the parents said, they're ignored.

Several people lamented the cuts in community-based rehabilitation services, a form of counseling in which therapists go into the community to help clients build situational coping skills.

Optum officials told the Times-News in July that they believed CBRS was being overused in cases where it wasn't proven effective.

But Rebekah Casey, of Coeur d'Alene, testified that the services worked for her children, and now they're not getting approved.

"My life is affected," said Casey, who is on the Idaho Council on Developmental Disabilities. "The lives of my children are affected."

Cameron McCown, of Meridian, said the state should break its contract with Optum.

"I want to know the company I'm trusting my family members to are truly doing the best things for them," he said.

McCown cited Idaho's per-capita spending on mental health -- the lowest in the nation -- as evidence of the problem.

"Our state is becoming a state of denial," he said.

Idaho contracted with Optum in September 2013 and will pay it $300 million over three years, 85 percent of which is for claims.

Mental health providers in the Magic Valley and elsewhere have been complaining for more than a year about Optum, saying services have been cut and wait times for approving care have increased.

Friday, Optum officials said they are focused on getting people the right services, providing "evidence-based therapy" -- -- i.e., treatments with independent evidence of effectiveness -- -- even when a provider recommends something different.

"We're not cutting services," Executive Director Rebecca diVittorio said Friday. "Our goal is to get people the care that is known to work for them, based on the national behavioral health and medical community."

Jeffrey Berlant, Optum's chief medical officer, said Optum is bringing "national standards and good clinical practice" to mental health treatment in Idaho.

"We don't agree treatment is being cut," he said. "We believe treatment is being bolstered, enhanced, enriched," and that Optum is "moving away from treatments that are not known to work."

The other recurring topic was Medicaid expansion, which almost everyone testifying supports.

Aaron White, president of Idaho'sAFL-CIO, said the state could save money on other programs by expanding Medicaid to cover people in the "coverage gap." An estimated 78,000 Idahoans are in that category. They don't qualify for Medicaid but also don't make enough income to qualify for tax credits to buy insurance on the state's exchange.

"Many hardworking Idahoans lack access to affordable health care," he said.

Terri Sterling, who works with the nonprofit Idaho Community Action Network, told the committee about a friend's daughter who doesn't qualify for Medicaid and can't afford her kidney medication.

"If you decide to expand Medicaid, that would bring the jobs into the state that she's really looking for" and "the health care she needs," Sterling said.

At a hearing at 9 a.m. Thursday, the House Health and Welfare Committee will hear a presentation on the recommendations of the Medicaid Redesign Workgroup that Gov. C.L. "Butch" Otter appointed in 2012.

The Workgroup has voted three times to recommend expanding Medicaid, most recently in November, when it backed a plan to expand Medicaid to cover everyone below the poverty level and give subsidies to people earning 100 percent to 138 percent of the poverty level to buy insurance on the exchange.

Otter asked for a hearing on those recommendations. Idaho so far has resisted expanding Medicaid, with opponents concerned about future costs to the state. Some legislators have said they doubt the votes are there to do it.

Otter said last month that he likes some of the Workgroup's recommendations. He wouldn't say whether he would back Medicaid expansion should the Legislature recommend it.

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