Counselors lament mental health cuts

A change in the state’s Medicaid program has forced counselors to cut back the amount of time they spend with vulnerable students in Louisa County Public Schools.

The counselors are employed by Region Ten, an agency that provides mental health treatment, but work with students in the schools. The students have behavioral or emotional issues that make it a challenge for them to be in mainstream classrooms without extra help. 

Until this school year, 12 Region Ten staff were in the Louisa schools as part of the Therapeutic Day Treatment program. Now their numbers are down to six, and students who previously had full-time insurance coverage may only see their counselor for a few hours each week.

“We don’t know when or if the service is going to end,” Marcia Becker, a Region Ten senior director, said. “I get calls from parents whose children were denied it. I encourage them to appeal it to the state.”

The Medicaid program is administered by the state Department of Medical Assistance Services (DMAS). In January, the agency contracted with six managed-care insurance companies to handle the therapeutic day program.

“The state went to managed care to cut the amount the state spends on Medicaid,” Becker said. “The way managed care organizations work is to cut services to save money. We did okay last [school] year, but we were warned before the start of this year that they weren’t going to authorize a full day of service.”

As the cuts in Medicaid authorizations have taken root, Region Ten has transferred staff who used to work with children into other roles, she said. There are currently 71 Louisa students who receive therapeutic day services, down from 79 last year.

Jay Rachmel was formerly one of two Region Ten staff at Trevilians Elementary School. Now he is the only one, and the five or six children he works with have fewer authorized hours to see him than they used to. Rachmel doesn’t know from one month to the next whether the students will continue to have the service at all.

“One young lady used up her authorized [time],” he said. “Right now I’m in limbo because until she gets more, I’m not supposed to provide services, which puts me in an awkward position. But if she shows up at my door and is upset and needs to talk, I’m going to let her come in.”

In a statement, DMAS said it wants to reassure families with children who receive therapeutic day treatment that it “remains a covered Medicaid benefit; there are no plans to eliminate this service.” Parents have a right to appeal to their health plans, DMAS said, and if that doesn’t work, they can seek a hearing before the state agency.

Some of the more common issues for children who receive therapeutic day treatment in the schools are anxiety, depression, hyperactivity and lack of age-appropriate anger management or social skills, according to Region Ten. 

With the counselors’ help, most of these students are in the same classes as their peers. Rachmel said some of the kids he sees just need a mental health break once in a while because they have friction with other students or teachers.

“I like seeing the learning that goes on, being a part of that, and to help them through a problem in real time, rather than talk about it afterwards,” he said. 

The students he works with have noticed the reduction in the time they get to see him, Rachmel said. And he’s noticed how it can affect them.

“They’re definitely aware of it, and it’s a hard conversation to have,” he said. “The most glaring example is a student who was denied service this year. We did get an authorization for that student from the insurer in October, after the student made gestures of self-harm on two occasions.”

As Region Ten has had to reduce the time its counselors can work with students, crisis counselors employed by Louisa County Public Schools have tried to fill the gaps where they can. The schools hired two full-time counselors in 2018 in response to recommendations from the school safety task force.

“[We] are definitely disappointed at the changes in the therapeutic program, but we will continue to collaborate to provide mental health and behavioral supports for students,” said Carla Alpern, the schools’ pupil personnel services director.

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