Some mental health and addiction services providers say they are missing out on federal coronavirus aid due to confusing requirements and miscommunication from the Trump administration.
Congress appropriated $175 billion three months ago to help health providers weather the COVID-19 crisis, but little of that funding has made its way to addiction and mental health clinics that primarily treat low-income Medicaid patients. Providers are now struggling to keep their doors open.
Community behavioral health providers have lost money throughout the pandemic as they comply with social distancing orders and see fewer patients, leading to cuts in services and staff at a time when they anticipate a crush in demand for mental health and addiction care as more states reopen.
“We’ve had to substantially reduce our services because we could not support those expenses with this lost revenue,” said Heather Gates, president and CEO of Community Health Resources, a mental health and addiction services organization based in Connecticut.
Some staff have been furloughed, and outpatient therapy and medication management services for the seriously mentally ill and people with opioid dependence have been scaled back at Community Health Resources. Having to make those decisions is especially frustrating for Gates because she knows help is available.
“We know the money is there. Congress appropriated the money very clearly to help providers like us and yet we are not able to access that funding because — we don’t know why, in all honestly,” Gates said.
The Department of Health and Human Services (HHS) is responsible for disbursing that funding to health providers but it has struggled to find a way to get the money to groups that say they need it the most.
Beginning in April, HHS distributed billions of dollars in several batches to providers, including hospitals and nursing homes, but Medicaid providers largely missed out.
Since Medicaid is a state-run program, HHS didn’t have the payment information for those providers, while information in the federally run Medicare program was more readily available.
After collecting the necessary data, HHS announced in June that it would send $15 billion to Medicaid providers, a huge boost to clinics that had been waiting several weeks for government assistance.
But then they learned that providers like Community Health Resources would be ineligible because they had received funding from earlier COVID-19 disbursements, no matter how small the amount.
Since the earlier distribution was based on a provider’s Medicare revenues, some behavioral health clinics that mainly rely on Medicaid payments received very little funding.
Under the formula, a substance use and mental health treatment organization like Recovery Resources in Cleveland received $322 from the Provider Relief Fund, making it ineligible for any portion of the $15 billion.
Adding to the frustration for behavioral health providers is the fact that wealthy hospital systems with large endowments have received billions of dollars under the funding formula.
“By and large, most community-based behavioral health organizations don’t have endowments. A really good financial year is if they have 1 percent [profit] margins,” said Chuck Ingoglia, head of the National Council for Behavioral Health (NCBH), which represents 3,326 organizations serving people with mental illness and addictions.
A survey of 664 of NCBH’s members conducted in June found that 71 percent have had to cancel, reschedule or turn away patients over the past three months; 44 percent said they could last six months or less in the current financial environment; 31 percent had not received any relief funding, and among those that did, 39 percent got less than $50,000.
“We see there’s reports of increased overdoses, and we see anecdotally, members starting to see more people who want to receive care, and it’s going to be a capacity issue. We’re laying off staff. How do we take on more people?” Ingoglia said.
After realizing that the first batch of funding disadvantaged providers who don’t see many Medicare patients, HHS said providers could enter their financial information into a portal to receive more funding, equal to up to 2 percent of their patient revenues from the most recent tax year. That portal closed June 3.
Ingoglia said that change wasn’t made clear and some providers didn’t submit their information before the deadline.
Many providers who count Medicaid as their main source of revenue thought they would be getting funding through the upcoming Medicaid batch HHS had been promising, so they waited for more information on that.
The first batch of funding, based on Medicare revenues, was sent out automatically, so providers may not have noticed they received it because the amount was so small. They also may not have known they had to take action to get some of the aid disbursed in the second batch.
Now they’re both locked out of that portal and ineligible for funding under the Medicaid batch.
“To say this has not been clear would be an understatement,” Ingoglia said. “For the average person, how are they supposed to make sense of all of this?”
An HHS spokesperson on Tuesday defended the agency’s actions.
“All providers who received any funding from the first $30 billion distribution had the opportunity to apply for additional funding from the $20B funding pool. This information was available to providers on the Provider Relief Fund [PRF] website where they were directed to learn more about their payment, as well as on the HHS website,” the spokesperson said. “It is unclear why some providers did not take advantage of that opportunity or why they would have rejected funding from the PRF.”
Providers have been told there is no dispute or appeals process, and that HHS is not taking direct questions from them.
Ingoglia’s group is now asking for HHS to at least reopen the first portal so providers can claim the additional funding.
Gates’s group received $34,000 from the first disbursement of funds, and when she applied for more funding through the Medicaid batch, she received a denial email.
If HHS reopened the portal, Gates’s organization would be eligible for more than $1 million in aid money, according to the agency’s formula.
“It’s been terribly confusing and very unclear whether we’re going to get any additional reimbursement or not,” she said. “I think it’s safe to say this has been an issue across the country for all providers.”
The Provider Relief Fund has been plagued with issues from the start, frustrating both Democratic and Republican lawmakers and health care providers.
HHS was tasked with sending $175 billion to hundreds of thousands of health care providers, including Medicaid providers, but the agency doesn’t have banking information for any of them.
“It’s worth acknowledging that getting $175 billion appropriated and needing to get it out the door expeditiously and as accurately as possible is a pretty immense undertaking,” said Jack Rollins, director of federal policy for the National Association of Medicaid Directors.
He added that HHS is aware of the issue, and he is hopeful it will be addressed soon. One of the most straightforward ways to fix it, he said, would be to reopen the first portal.
“This is hard work, mistakes are bound to be made along the way,” Rollins said. “I think the intent of everybody is good, and we want to ensure that Medicaid providers, all providers, are able to weather this crisis.”