Texas Psychologists win ‘crossover’ payments for seniors

By Paula Hartman-Stein, Ph.D.

Reprinted from the National Psychologist, September/October 2005, Vol. 14, No. 5 p. 23

Despite an atmosphere of fiscal and political conservatism in Texas, two years worth of intense lobbying efforts by the Texas Psychological Association (TPA) has paid off.  In late June, Republican Gov. Rick Perry signed a bill that reinstated mental health “crossover” payments for indigent older adults that qualify for both Medicare and Medicaid benefits.

 “This new bill was a political football,” said Dean Paret, Ph.D. of Burleson, Texas), chair of the Third Party Payment committee of the TPA. He explained that it was against all odds that a law that resulted in savings of 30 million dollars of Medicaid costs could be repealed at a time that Texas had a $10 billion shortfall in state funding.

 In order to be successful at lobbying for mental health services with Texas politicians, where both the House and Senate are Republican-controlled, Paret explained, “We had to learn how to speak Republican. They’re not unkind, uncaring. They just think differently. I am Republican.”

 Shortly after the new law went into effect, Paret and other geropsychologists pushed for a “repealer” bill by emphasizing the unintended consequences of eliminating payment of optional services such as mental health, optometry, and podiatry for the indigent frail older adult population, many of whom live in long term care facilities.

 “We told the legislators that if you eliminate optional services the Medicaid beneficiary will have access only to psychiatric services. As a result, the indigent will be given psychotropic medications and you’re going to see an increase in hospitalizations and possibly an increase in violence from the chronically mentally ill.”

Former state representative Arlene Wohlgemuth had introduced the 2003 legislation that eliminated crossover payments and massively reorganized state health and human service agencies in Texas. In an unusual twist, Wohlgemuth later relinquished her state position to run for a congressional seat, lost the election and subsequently became a lobbyist for the Texas optometry group that worked to repeal the law she had originally authored.

Grassroots efforts involving time and money by many psychologists influenced the passage of the repealer bill. Two companies that provide psychological services in nursing homes in Texas, Vericare and Senior Connections, where Paret is Executive Vice President, hired separate lobbyists.

The TPA combined efforts with several state associations including the Texas Healthcare Association, the Hospital Association and the statewide medical association. On another front, the TPA lobbied  to keep mental health benefits for all Medicaid beneficiaries by forming coalitions with other mental health groups including marriage and family therapists, licensed professional counselors, and the Mental Health Association of Texas.

This separate effort succeeded as well. Paret said that the bill repealed the section of the law that would have allowed the state to adjust the Medicare/Medicaid co-payments to reimbursement levels that reduced payment for mental health services by 30%. At the same time in a separate bill, the legislators reinstated the optional services for the Medicaid beneficiary.

After more than two years of successful lobbying experience, Paret advises psychologists to stay politically active. “It doesn’t take much to contribute to a legislator’s re-election. Twenty-five dollars and you get on the list. And they see your name. You send most of them $25 and all of a sudden they see your name multiple times. Now they remember.”

Paula Hartman-Stein is a clinical psychologist and consultant at the Center for Healthy Aging in Kent, Ohio. She is immediate past president of APA’s section of Clinical Geropsychology. She can be reached through her website, www.centerforhealthyaging.com.