Texas’ reimbursement rate for abortion alternatives mentors/counselors greater than for master’s-level professionals
Texas’ Alternatives to Abortion Services Program reimburses nonprofit subcontractors $63 per hour for mentoring/counseling performed by unlicensed volunteers to pregnant women. That’s more than the state, under Medicaid, pays master’s-level professionals to provide counseling or social work in crisis situations, but less than it pays doctorate-holding psychologists to perform psychotherapy.
The state program, whose subcontractors are primarily faith-based organizations that include maternity homes and crisis pregnancy centers, “is an issue of great concern to our association,” said Vicki Hansen, executive director of the National Association of Social Workers – Texas Chapter.
Though she said the Alternatives to Abortion reimbursement rate “does seem high to me,” Hansen was more worried about the potential harm rendered to clients by relatively untrained and unaccountable CPC mentors/counselors, compared to licensed professionals.
In a previous Texas Independent story showing that the Alternatives to Abortion reimbursement rate is higher than the Medicaid rate for nurses to provide family planning services ($31 for a new client to receive a pregnancy test), Vincent Friedewald — who heads up the Alternatives to Abortion primary contractor — said his program’s services could not be accurately compared to those offered by a family planning clinic.
“The rates are modeled after those used in other crisis intervention social services programs, like domestic violence and rape crisis. The rates reflect the unique skill set required to help women who are in crisis from the beginning of their unplanned pregnancy up until the child’s first birthday,” said Friedewald, executive director of Texas Pregnancy Care Network.
“Remember, these women are alone and under pressure by others to end a pregnancy they otherwise wish to keep, but don’t know how. The Alternatives Program is the only program in Texas that specializes in serving this special client, so you may be straining if you are attempting to compare its reimbursement rates to those of a non-emergency health services program. A more appropriate comparison might be between two crisis intervention social services programs. In my view it’s apples and oranges, otherwise,” he said.
“It would be my belief that this type of counseling is of the complex nature that would require a licensed professional, whether that would be a licensed social worker, licensed professional counselor, licensed marriage family therapist or a psychologist,” said Hansen, who is a Licensed Master Social Worker, Advanced Practitioner and a member of the Academy of Certified Social Workers.
She doubted that many licensed professionals would be willing to participate in the Alternatives to Abortion program, because, by design, it forbids mentors/counselors from presenting to clients all possible options — including termination of the pregnancy — regardless of the personal faith or beliefs of the mentor/counselor.
“To counsel with a predetermined outcome is not something very many licensed professionals would be willing to do,” said Hansen, who serves on the Department of State Health Services Preparedness Coordinating Committee to assist the state in providing social services in case of large-scale disasters.
According to a TPCN manual posted online by subcontractor Austin LifeCare, mentors/counselors are not required to have any formal education or professional experience outside of TPCN training, although mentors/counselors can forgo “pregnancy counseling skills orientation training” if they have a four-year degree in nursing or social services. TPCN negotiated its rates with the Texas Health and Human Services Commission in 2005, reimbursing subcontractors $1.05 per minute for mentoring/counselors and referral services, $21 per class (more than one student) and $10.50 per visit for material assistance.
In contrast, the current typical Medicaid rate for a doctorate-holding psychologist to provide a standard, 50-minute therapeutic session for a repeat client is $66.55 (translating to $1.33 per minute), said Rick McGraw, Ph.D., a licensed psychologist practicing in San Angelo. The Medicaid rate for an initial evaluation session with a new client is $113.88, he said.
Meanwhile, master’s degree holders, such as Licensed Professional Counselors and Licensed Master Social Workers, are reimbursed $45.66 for a 50-minute session ($0.91 per minute), said McGraw, who is also an adjunct professor of psychology the Austin Community College campus in Fredericksburg.
According to HHSC, mental health professionals would not be exempt from the Texas House budget’s proposed across-the-board 10-percent reduction in Medicaid reimbursement. That would mean psychologists would be able to bill the state’s Medicaid program $59.90 for a 50-minute therapeutic session for a repeat client, a per-minute rate of $1.20. Master’s-level professionals would be able to bill $41.09 for a 50-minute session ($0.82 per minute).
Hansen provided slightly different Medicaid rate numbers for licensed mental health professionals in general, saying in an email that “It’s currently less than $50 and with the proposed cuts before the legislature will drop to $41.30.”
Because it’s an independent program outside of Medicaid, Alternatives to Abortion program rates would not be affected by budget cuts proposed by the House.
Unlike in the Alternatives to Abortion program, mental health professionals bill Medicaid according to each service performed, rather than time spent providing the service. Also, clients must fall below a certain income threshold level in order to qualify for Medicaid, unlike in the Alternatives to Abortion program, where subcontractors provide services for free and are reimbursed by the state regardless of clients’ ability to pay.
To bill Medicaid at those rates, a Texas psychologist must hold a Ph.D. or equivalent doctoral degree and complete a postdoctoral internship and supervision period, in addition to continuing education and practical experience, and also be accountable to the Texas State Board of Examiners of Psychologists.
Similarly, a Licensed Professional Counselor and Licensed Master Social Worker in Texas must hold a relevant master’s degree, complete supervised practical experience and be accountable to his/her respective state regulating board.
Hansen said licensure requirements exist so that the state can hold professionals accountable to a code of conduct and standard of practice, and so that clients can readily seek redress of grievances — protections not in place for crisis pregnancy center clients.
“There’s far more accountability with a licensed professional,” she said. “It’s interesting to me: The reason profession regulations exist for mental health folks is because the state Legislature determined there is risk to the public by the very nature of the service being provided and the population receiving those services. There’s vulnerability. The Legislature of the State of Texas determined those roles should be licensed — and you kind of have a complete evasion of that concept through the CPCs.”
“Nobody wants to talk about this,” Hansen said. “The bypass the state has done is just, very creative. But very troubling.”
(Image by Matt Mahurin)