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Systems-based disparities for African American Medicaid Recipients in the NY OMH Article 31 Clinic

“WHAT DO YOU MEAN I’VE BEEN DISCHARGED?”

“YOU’VE MISSED TWO SESSIONS. WE TALKED ABOUT ATTENDANCE, AND IN THIS CLINIC, IF YOU MISS TWO CONSECUTIVE SESSIONS, IT WILL RESULT IN YOUR DISARCHARGE”

“DISCHARGE? I’M GOING END UP IN THE HOSPITAL!”

“YOU’RE ALWAYS WELCOME TO REAPPLY FOR TREATMENT WHEN YOU’RE READY TO COMMIT TO YOUR MENTAL HEALTH

Tell me: is your skin crawling? You’ve heard this before. Or maybe you were complict, or even worse, believe it.Above all, if anything is gleamed from the arugment about to unfold, remember commitment to therapy is a two way street, and that being invested in your own care as a patient is not just a reflection of attendence or frequency of psychotherapy sessions. In a system where contact and numbers are driving clinic scheudling, as well as reimbursement for therapy, ‘welcome’ and ‘ready’ are really a reflection of dollars and cents.

The conversation that just transpired is common practice in many outpatient mental health clinics operating on state Medicaid benefits and insurance to pay for treatment. In New York, the Article 31 clinic continues to be the semiotic locus for mental health treatment for impoverished, low-income, and disabled Americans seeking psychotherapy or medication management for psychiatric illness.

Clinic directors are under the clinical gun, “wire,” and mandate to move nonpayers or unreimbursable sessions and the clients that need them off their census to lower deficit and overhead.

This overhead eats into profits, hiring, staff retention, and other clinic operations needing money to keep the doors open. The management issues around Medicaid are numerous, and the system is broken. The fix, or solution by the NYS Office of Mental Health, has not been the loosening of regulations around line items keeping a patient enrolled in treatment.

Instead, the government launched studies and other programs to fix the deficits and cracks within the NY Medicaid system. Programs like HARP, after the silos fell, and the rise of Care Management is now out there evaluating and reevaluating the impact of these cracks on the care and provision of treatment inside Article 31 (Free Standing Clinic Mental Health Clinic).

Initial findings suggest more flexibility. Well, ask any provider already treating African Americans and other oppressed populations which historically have connectivity issues with outpatient free-standing and hospital-based clinics with rigid rules for treatment is a gosh darn no brainer!

I mean, who would have predicted folks without cars, and a few dollars to their name, can make the time to take four busses after work and get to therapy when the pressing need at the moment is putting food on the table. I can tell you one thing if a child went without dinner and CPS (Child Protective Services) got involved, which is more likely if you are an African American family, there is no right path forward. Treatment or dinner? Wait for a second, arent both requirements for survival?

African Americans and low income service recipients are NOT given a VIABLE way ahead in treatment. Certianly not stable enough to reap its benefits.

Instead, all too often, barriers and cracks within the system, which continue to be a problem today, are working at the cross purposes of the people seeking its very care. Ladies and gentlemen, this isn’t inaccessible. It is dangerous to the consumer. We need to loosen regulations in treatment, and we need to do it today. Forget moving the problem patients into the hospital into some psychiatric limbo until a paperwork nightmare and systems snafu is worked out.

We need answers and laws adapted today to resolve the issues programs like HARP and other independent researchers are doing to revise Medicaid. Even revisions as simple as offering more solutions-focused care, which allows consumers to come when they need treatment and not when prescribed for them, would a big jump forward from what has become stalled legislation.

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