Friday, January 23, 2009

Magellan Won't Pay

One and a half years before Robert Hawkins' mass murder and suicide at Von Maur, a counselor recommended sending the troubled teen to a locked psychiatric treatment center.

But the state's Medicaid administrator refused to authorize the treatment.

Hawkins never went.

That denial shows how hard it can be to get children mental health treatment through the state's Medicaid managed-care program, created to contain taxpayer costs.

Some troubled children worsen as they wait for treatment or get less intensive, less expensive treatment than recommended by mental health professionals who evaluate them.

The public would be alarmed if children with physical ailments were treated this way, said Douglas County Juvenile Court Judge Vernon Daniels.

Daniels: "Look at this as a cancer that is growing, and you're not administering treatment that could slow the growth or stop the growth. That's what's happening here."

The Nebraska Department of Health and Human Services pays a for-profit company, Magellan Behavioral Health, to authorize mental health services for more than 25,000 state wards, low-income or disabled children. Some middle-class children become wards to get services their insurance won't cover.

Magellan spokeswoman Tami Schmidt: "Our role is to help people to get access to services, despite that people think in some cases we're a barrier."

Magellan serves as an HMO, deciding which medical services to give patients.

The reason?
Magellan denied 14 percent of requests for all long-term residential programs in 2007, or 199 months of treatment.

It saved more than $1 million.

A guardian who has dealt with Magellan summarized the balance the company tries to strike: "They are hired to police our tax money, so they're penny pinchers. At the same time, the children who fall through the cracks are not receiving adequate care because Magellan won't pay for it."

Full Article and Source:
Nebraska system leaves many frustrated in search for mental health treatment

4 comments:

  1. I don't think the public has any awareness of the failure of the mental health system in this country. It is expensive, still retains a stigma, has inherent rights issues and generally fails in the long term.

    Mental health has not progressed along with other medicine. It is the "red headed middle child" of medicine subject to subject to changing views as failures continue.

    While the majority of mentally disturbed have no legal disability and are not wards, ( no $$$$$$$$$ to plunder), those who have recognized issues often lose all decision making powers including treatment.

    Guardianship issues in this nation needs to address RIGHTS of the mentally ill.

    Inpatient mental health care is very expensive and each state approaches the need for care differently. The states I am familiar with usually require a parent to work with social services and lose some parental rights. It is not a good situation.

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  2. The greatest commonality we share is ethical misconduct of the middle/core bureaucracy. Public comments include ‘ethical misconduct is costing this country more than 9/11’. More likely this unethical behavior is a principal reason the “Taliban” & “Al-Qaida” denounce western society.

    State agencies acting as oversight allow the corporate abuse. To quote:” it’s nothing out of the ordinary”. An uncaring and unjust judicial system has helped convert law to what is damaging to the general public.

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  3. this is too sorrowful a story for me to write about

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  4. Yes, Helen, you're right. Mental health treatment has remained stagnant except for one thing - I don't think they lock people up as easily as they used to. And, it used to be if you were a black sheep of the family, you might find yourself locked away for life.

    Now, they've got the guardianship tool.

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