Paula Hartman-Stein, Ph.D.,
Clinical Geropsychologist, Past President of APA,
12/2, Clinical Geropsychology

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New York psychologists notch win in Medicare/Medicaid debate

By Paula Hartman-Stein, Ph.D.

New York psychologists and ambulance service providers were the only groups to salvage threatened cross-over payments for Medicare beneficiaries eligible for Medicaid this year, thanks to grass-root efforts and effective lobbying by the state's psychological association.

Gayle Everitt, executive director of the New York State Psychological Association (NYSPA), said psychologists will continue to receive the full Medicare rate, while other providers, including psychiatrists, were restored to only 20 percent of their original payment levels.

"Physicians were shocked," Everitt said, "that we received something from the legislators that they did not."

In February, New York Gov. George Pataki, citing budget constraints, proposed elimination of all Medicaid cross-over payments, the portion of the fee for mental health services for Medicare beneficiaries paid for by state Medicaid money.

Eric Garfinkel, Ph.D., of New York City, chair of NYSPA's Insurance Committee, said the governor's budget proposed drastic cuts in virtually every area.
"But in the end, the legislature allowed about half the cuts to go through. The governor vetoed the budget bill, and in an unprecedented move, the legislature overturned the governor's veto," Garfinkel said.

Herb Gingold, Ph.D., NYSPA division representative for Adult Development and Aging and president of Independent Practitioners in Geropsychology in New York City, mobilized the grassroots effort to protest the proposed Medicaid cuts.
The two groups conducted both a call-in and write-in campaign to eight leading New York legislators, sending 4,000 letters from psychologists and mental health consumers who would be directly impacted by the proposed cuts.

The groups sent between 4,800 and 6,400 signatures to the legislators from nursing home staff, neighbors, clients, friends and family members.
"Another important factor in this victory was the effort of the teacher's union lobbyist," Gingold said. "The union's clout was a necessary if not sufficient force in the success."

NYSPA, with a membership of 3,300, affiliated with the 440,000-member New York State United Teachers (NYSUT) in 2000. That union is part of the American Federation of Teachers, AFL-CIO.

While New York psychologists are not union members, the affiliation provides NYSPA with lobbying benefits and support services.

Garfinkel said, "When NYSUT adopts psychology's issues as its own, and prioritizes them as strongly as they done for us, we are operating at a very different level than we did before."

Garfinkel, one of the 2003 Karl F. Heiser Presidential Award winners for many years of successful advocacy efforts, testified at hearings held by the State Senate Finance Committee and Assembly Ways and Means Committee within one week of the proposed budget cuts.

He pointed out the "devastating and disproportionate effect the proposed cuts would have on low-income elderly and disabled persons in need of psychological services."

Medicare pays 50 percent of the cost of mental health treatment and 80 percent of the fee for other services.

Garfinkel said that in states proposing the elimination of cross-over payments for Medicare-Medicaid patients, a 50 percent cut in funding for psychotherapy services would destroy a well-developed system of service delivery to low-income older adults.

"We need to keep our focus on this problem and to know that working together it is possible to make a difference," Garfinkel said.

The National Psychologist, Vol. 12, No. 5, p. 10

Paula Hartman-Stein, Ph.D., current president of the American Psychological Association's section of Clinical Geropsychology, is a consultant in Kent, Ohio. She can be reached through email,, or you can learn more about her work by visiting her Web site,


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