Transcript: One Year Later! Financial Crisis for Mental Health Providers

“So you're, A, not getting paid for the work that you've been doing, and B, having to take away time from providing care to patients…” 

One year after VNN Oklahoma interviewed two mental health professionals about Oklahoma’s transition to Managed Care Oklahoma (MCO) for its Medicaid program, providers continue to face major challenges, including delayed or insufficient payments, agency closures, and job losses. Lack of communication and solutions from the state is leaving many patients and providers unprepared, disrupting care for vulnerable populations. Despite temporary financial relief efforts, providers say the system remains burdensome and unsustainable, with lasting damage to Oklahoma’s mental health infrastructure.

Click here to catch up: VNN Interviews on Issues - Financial Crisis for Mental Health Providers

Story Snapshot 📷 The financial crisis for Oklahoma mental health providers hasn’t gone away—it’s gotten worse. Leslie Smith of B4ME Counseling and Marjorie Ray of Hope Blooms in Muskogee say Managed Care of Oklahoma companies still aren’t paying at the rates promised by the state. Instead, they’re denying claims, underpaying for sessions, and rejecting services that Medicaid previously covered. Providers are spending hours chasing payments instead of helping clients in crisis. As the mental health needs of Oklahomans rise, small clinics are left fighting to keep their doors open. (Summary generated using AI to provide a quick overview.)

This interview has been lightly edited for clarity and flow.

Brittany Harlow: Hello, everyone. It's VNN's Brittany Harlow. Thanks for joining us today. We're having a one-year anniversary recap. Joining me today is Leslie Smith and Marjorie Ray. We spoke with them a year ago about the financial crisis for mental health providers in Oklahoma. And so it has been one year and we're just checking in. If you guys want to give a brief introduction of your experience and your organizations, starting with you, Leslie?

Leslie Smith: All right. Leslie Smith, I have a private practice called B4ME Counseling Recovery. I bill my Medicaid and the services for those clients through the state of Oklahoma. And we've just, this last year has been a struggle. We're still not being paid the fees and rates that we were promised. We can see a difference between what we bill to Legacy Medicaid that is still being paid by OHCA (Oklahoma Health Care Authority). But what we're seeing with these three contracted insurance companies, the confusion and chaos is just outrageous. And we're not doing well.

Brittany Harlow: And we are going to be linking to that video that we had done one year ago to give people some more background information of exactly what the situation was a year ago. And we'll include a brief summary at the top. But essentially, it is still relating to this SoonerCare transition to Managed Care. And Marjorie, if you want to give just a brief intro about your organization and how you guys came to be partnered up.

Marjorie Ray: Excellent. I am Marjorie Ray. My agency is Hope Blooms LLC in Muskogee, Oklahoma. We have Leslie Smith as an associate with me along with 15 other therapists, 15 case managers, and 15 peer support members. We are struggling financially because the Managed Care of Oklahoma crisis, which began on April 4th of '24, has left us, as well as many other agencies, financially devastated. They are not paying providers the proper amounts. The Managed Care of Oklahoma, which is Oklahoma Aetna, Oklahoma Humana, and Oklahoma Complete Health, have paid at lower percentages than Legacy Medicaid, and they promised to pay us the same as state Medicaid. But since that time, they have not. So we struggle to pay the providers. We see our clients. We bill regularly as we should, but the income is not coming the way they were promised.

Brittany Harlow: And I'm surprised to hear that, honestly, that after a year that these issues are still happening. And not necessarily, I know that we had touched before on, like, just, like, kind of billing errors and, like, oh, just the code's not matching up and, oh, there's going to be, like, a little bit of lag time. But even now, a year later, from my understanding, they are supposed to be paying at the Medicaid rates as before, but they're saying either, like, oh, we're not going to pay at those rates. But as far as, like, the number of visits allowed, like, they're supposed to be doing it at, what, eight a week max, but they're saying they'll only pay out at one?

Leslie Smith: Okay, so just a little bit of clarity there. So yesterday, Marjorie received at Hope Blooms a letter from me from Humana, and basically Humana is saying you cannot bill two individual sessions.

Marjorie Ray: Per week.

Leslie Smith: Per week. Okay, you can't do that. And the state says yes, you can. And then there's modifiers to say whether it's an individual session, a family session, with or without the client. Where the eight comes in is the state uses a method of measuring time in 15-minute increments. So if I'm going to do four units, that's one hour, okay? So in the beginning, and up until recently, it hasn't been that long ago, if I submitted four units to one of the MCOs, they would only pay one unit, which was $19.

Marjorie Ray: For 15 minutes. So basically like a segment of the full session and not the full session.

Leslie Smith: And that was a coding issue. But this other issue that we're looking at now is we have always been able, because the state asked the individual providers to also provide family support. So it's not just, and especially if it's a minor client, okay? So we want to come in and do family. And sometimes a client isn't present so that we can find out what the progress has been on a certain objective, if the families still need some other assistance that maybe we can put case management with and help them with something, some training, that kind of thing, to strengthen skills. And the MCOs are saying, no, we're not going to do that.

Brittany Harlow: And MCO, one more time, what does that stand for?

Marjorie Ray: Managed Care of Oklahoma.

Brittany Harlow: Okay, and so those are one of those three groups.

Marjorie Ray: Right.

Brittany Harlow: Okay, and so when you come back and say, so I understand that you, as an organization, as a company, have these set rules, but you're supposed to be following the rules of Oklahoma, like that was the deal, and these are Oklahoma's rules. What kind of response do you get back to that?

Leslie Smith: This is where I'd like for Marjorie to chime in. She has been on several Zoom calls that are supposed to be (with) a lot of the entities that are involved. Communication is also going to the state saying we're still having this problem. I don't think they've ever been involved, but why don't you just describe what that process is like.

Marjorie Ray: So when I reach out to one of the MCOs regarding billing that they have not paid or paid wrongly, they respond, we will send it up for reconsideration, which they sometimes do, sometimes not. We don't always get a proper response. Or, like last week, we Zoomed about the percentages. Leslie pointed out to Oklahoma Complete Health, you're paying every one of our billing statements at 10% less. And they responded, oh, we'll check into it. So basically, we get no action from what we put out. We ask for help, they say, okay. For instance, on the letter I received yesterday from Humana stating family is not accessible if you've done individual. Two weeks ago, we had that happen, had a discussion with our rep, and she said, well, of course you can bill family and individual. That's what Medicaid pays for. So yes, we'll pay. But a week later, another letter saying we will not pay that.

Brittany Harlow: What's happening? Is it just like nothing happening? It's kind of like that is the end of the line as far as you've been able to get?

Leslie Smith: Sometimes. What one of the companies told us was, and I believe it was Oklahoma Complete Health, that their system is bumping in information that has nothing to do with us or our billing.

Marjorie Ray: It causes denials.

Leslie Smith: It's triggering that. But then, so here's the frustrating part. So yes, I've got this problem with this agency, this one, this one. But until we discover it, until we find it, then when we present it, then we have to present it to all three. But then they say, show us all the claims that this involves. You know how much time that takes. And so we're going through all of our records trying to support that. And then what I wish is that we could make one call to OHCA. This is their contractors. This is their systems that they have put into place, that they are providing a service for the state. Why is all the burden placed on the individual providers, the individual agencies? And a lot of us are not these big, huge nonprofit agencies. We're small.

Brittany Harlow: Small businesses?

Leslie Smith: It is, very much so.

Brittany Harlow: Do you have a financial impact? This is causing us to lose this much, or this is causing this many people to close, or this many people to not receive care. If you were to ballpark the biggest kind of glaring stats there, I want to put you on the spot for that.

Leslie Smith: You remember whenever you were, and it was on this last call with Oklahoma Complete Health, and you said, this is what we've billed, this is what you've paid, what is this gap? Do you remember what those numbers look like?

Marjorie Ray: Often less than half. What I see we've billed and what we receive is often less than half.

Brittany Harlow: So a ballpark, can you ballpark an amount monthly or annually?

Marjorie Ray: I believe on that billing, for instance, we may bill $26,000 to one company, and when I look at what's received, it might be $10,000. It's quite a bit less. So we reach out, they say, we see the errors. We will send them up for reconsideration. But our thing is, if you follow the rules, pay them, there will be no reconsideration because we're following the same rules we always have for Medicaid. My concern is overall with the mental health crisis, it is causing therapists like myself and Leslie to take time away from clients to dig in the paperwork. And so that's been the crisis, is that we still have clients who need us, need us, need us, and we're over here trying to figure out how do we make sure this billing goes through so the lights stay on?

Brittany Harlow: So you're, A, not getting paid for the work that you've been doing, and B, having to take away time from providing care to patients.

Marjorie Ray: Right, and they are also in crisis because the state is the government, the country, you know, people are in crisis in general, and so mental health is even more important, especially in Muskogee, where we're from, so much is going on. Tulsa also, people are stressed.

Brittany Harlow: I was going to touch on that too, because obviously this is a continued issue as far as financial crisis for mental health for over a year, but also just like what other impacts, even as recent as this year, mental health care in Oklahoma seems like it's getting one after another hits that are impeding care to people who need it.

Leslie Smith: I noticed that there was some attention to Tulsa County specifically. I wish I had more information. You know, a lot of times I skim it and go, but I do know that, and I believe it was our Attorney General that had talked with a group of people about the impact that this was having. And so when we begin to see that, and we see it trickle down into the communities, but I just don't know what power is there. And the other thing too is if you think about it, even if there was a legitimate, let's say a lawsuit, class action lawsuit, we're looking at the auditors now that are looking at ODMHSAS. They're looking at a lot of agencies within the government umbrella, and some of those will take years. And so the windfall from that, you know, before we have any answers. This is another complaint that I have, is if I find a problem and I ask one of the MCOs to investigate and complete it, what my desire is, is that they will go back through everybody's claim with that particular code, sweep the whole system and rectify it, instead of taking my individual claim, the few that I caught that I didn't have time to go back in history and blanket fix the problem for everybody.

Brittany Harlow: I know that there have been some funding cuts in general to local health, mental health, and so I don't know, to be honest, if those have been proposed or if those have been actually implemented. Are you familiar?

Leslie Smith: The thing that I would speak on is there's a group of nonprofits that are our big, huge mental health providers.

Brittany Harlow: Like Tulsa Family and Child Services?

Leslie Smith: Yeah, it's Family and Children. And then we've got CREOKS, and then the other one was...

Marjorie Ray: Grand Lake.

Leslie Smith: Grand Lake.

Brittany Harlow: So those funding have been cut.

Leslie Smith: Yeah. Well, no, not yet.

Brittany Harlow: There was maybe like a letter that went out and it was like, oh, that was premature. Like, you know, it wasn't supposed to be sent out, but obviously that letter existed. So is that kind of also adding to like the kind of overall, just like umbrella crisis of mental health?

Leslie Smith: So I talked to a client that has services at Grand. And they went in to see their psychiatrist. And the morning that they went in, this was probably a week and a half, maybe two weeks ago. And the first thing that they were told is we don't, we're not going to do any more what they call DMH services. There's Medicaid and then there's the Department of Mental Health. Okay. If somebody is not eligible for Medicaid, then they can be eligible for this, especially if there's like substance abuse involved. You know, I don't know what all the qualifiers would be. That's what these big companies that we just talked about, they have both contracts for both of those. So this client was told, we're not doing it. We got word this morning that we are no longer accepting any...

Brittany Harlow: Department of Mental Health.

Leslie Smith: Yeah, any DMH clients. Now, this person also had an advantage program through Medicare. And so what they did was they switched that and then they said, but we need a $30 copay.

Marjorie Ray: Oh, goodness.

Leslie Smith: And this person said, I can't do that. So just that, but it seemed that the employees weren't even aware until that morning that there had been a cut, that there was going to be this. Now, it was a proactive cut in case we don't... And in case...

Brittany Harlow: When was that?

Leslie Smith: Was it May?

Marjorie Ray: May 6th was supposed to be the last day of funding.

Leslie Smith: Okay, for those for those entities as well.

Marjorie Ray: Right. So I don't know.

Leslie Smith: Now they're saying they're going to restructure.

Marjorie Ray: Right.

Leslie Smith: But it put everybody in a place. What do you do when you work in fear? What do you do? Employees leave. They try to find other avenues. Some of them, that's all they have done is that type of employee, not contractor work, things like that. It's just chaos. Total chaos.

Brittany Harlow: Now, what are your next steps? Now, today, given this, one year anniversary of bringing attention, like what are you doing?

Marjorie Ray: Well, there's one more topic I want to address which is quite bothersome. If they, when they say we will sit in up for reconsideration, they also have gone back all the way to April of '24 and recouped funds they've paid, which were paid on a smaller percentage anyway. So if they paid a whole therapy unit in '24, they're now going back and saying, for instance, we paid for two, we paid family and individual, we're taking one back. So they're going in the past. So I will get an invoice. I may wake up with a negative 5020 from one of the MCOs saying, oh, we took this back. So not only are we fighting forward...

Brittany Harlow: When did that start?

Marjorie Ray: We're fighting backwards.

Leslie Smith: We've been seeing it the last couple of months for sure.

Marjorie Ray: Probably. Not as far back as January, but I would say February, March, they started digging into April, May, June, going through all of our billing that they've paid and saying, oh, we overpaid. I will get a letter from one of them, a paper letter saying this therapist bill these units, we need you to send back $290.

Brittany Harlow: Do they say why they were paying it correctly before? And why, like what changed? What made them start to suddenly say, like, we're not going to follow that anymore, we're just going to pay what we want to pay?

Leslie Smith: We'll never know.

Marjorie Ray: We don't know.

Leslie Smith: We don't know because there's no transparency. There's no communication. We have not heard the state of Oklahoma one time say, man, it's tough out there. These people are struggling. Instead they go, what a success. And yet we've got money missing. But to piggyback on that too, this is what's very frustrating. When they recoup money, they don't just recoup it from me or these providers. They shut down all the claims that we're sending through, take that recoupment off of people that were not even involved. So now we have a whole group of people that are not getting paid.

Brittany Harlow: So people outside your organization?

Leslie Smith: Well, even within. Let's say this person has only been doing one, which we know it could be two, but one. And so they're not even involved in this discussion.

Brittany Harlow: Oh, wow.

Leslie Smith: But if they've been billing and we've been submitting, then they're saying, no, they don't get paid. They don't get paid. Nobody gets paid until that recoupment comes down to zero.

Marjorie Ray: And we have no control over the recoupment or an understanding of why they're taking the money back that they didn't pay the full amounts on anyway. It's just keeping us like this.

Leslie Smith: So when we get a recoupment, we get a code or a letter or something that represents the meaning of why it was rejected. It's never detailed. It's a very generalized idea. So now we've got to get back on the phone again and find out what happened. And then we have to tell them, present to them. We can't just say, go back to this particular invoice or evidence of payment. They want to say, we want to know the client's name. We want to know the services that were paid, the date that they were paid, when they were billed, who was the NPI provider.

Marjorie Ray: We're doing their work. We're doing their work and it's miserable. It's unfair. And the people who are doing the work are not being paid fully.

Brittany Harlow: My final question for you guys, who can fix it? Who should fix it? Who is that person who needs to be watching this video and understanding what you're going through and start making their own phone calls and doing their own research and their own work?

Leslie Smith: It starts with the ones that contracted these agencies. It's like I said earlier, I did not contract these agencies. I contract with OHCA. That's where my contract is. They contracted with them. They need to find out what are the problems? Where are we seeing these problems? And until that happens, until there's some acknowledgement, but it's basically like the best kept secret in Oklahoma. We can't even get the news media. We are so thankful for the time that you've spent to help us with this.

Marjorie Ray: Absolutely. To get our story out.

Leslie Smith: News media, they don't want to hear it. They go back to the state. The state says, oh, we're doing great. And they go, well, the state says that they're doing great. And so it just kind of ends there. So we're just landlocked. We're not getting any help.

Brittany Harlow: Well, I appreciate your time today and talking about this issue. I hate that we're sitting here another year and the issues have not only not gotten better, they've gotten worse.

Marjorie Ray: They've gotten worse. They're out of control.