The number of children seeking intensive, in-home mental-health services in Virginia more than doubled in June, just before new state requirements took effect to better screen who really needs the help.
The rush for state approval of the services — double the figure for the same month last year and 2½ times the figure for other intensive mental-health services — preceded a new state initiative to better control use of a Medicaid-funded program that has been vulnerable to fraud and misuse.
On July 18, Virginia launched a system under which 40 community services boards independently assess a child's need for intensive mental-health services in the home, which is the last step before removing them from home for treatment.
Previously, "the safeguards were not in place," said Margaret Nimmo Crowe, senior policy analyst at Voices for Virginia's Children. The June surge in requests for state authorization of services for children — intensive in-home care, day treatment and mental-health support — caught the attention of state officials, legislators and advocates at a briefing Monday.
"How does this happen that this doubles before the changeover?" asked Del. John M. O'Bannon, R-Henrico. While the answer wasn't clear, the implication is obvious. "There might be concern about the new changes," said Secretary of Health and Human Resources Bill Hazel, who briefed the House Appropriations Committee.
The situation may be clearer in December, when children approved for the services in June would have to be reauthorized to continue. "They'll be picked up as the previous authorization ends," said Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards.
The community services boards were chosen by the General Assembly this year to provide independent clinical assessments of children seeking intensive in-home services under Medicaid. The move aims to ensure that scarce dollars for mental-health treatment benefit those who need it most, rather than children who might need something less or none at all.
Last year, a Chesterfield County woman was convicted of health-care fraud and sentenced to 55 months in prison for submitting more than $600,000 in false claims for Medicaid reimbursements under the program.
The state also has tried to rein in runaway costs by reducing rates to service providers and ratcheting up requirements for professional credentials needed to provide the services.
Children continue to be referred to the program from a variety of sources, and given the level of service they really need, Hazel said, "the path hasn't changed. We just put a speed bump in it."