Many Missouri Children with Mental Illnesses Fail To Receive Treatment Because of ‘Fragmented’ System, Report Says

Children with mental illness in Missouri are not guaranteed a "steady level of care" because of problems in the state's Medicaid system, "inadequate spending" and a lack of cooperation and coordination among state agencies, according to a report released Sept. 16 by the advocacy group Citizens for Missouri's Children, the St. Louis Post-Dispatch reports. According to the report, titled "Mental Health Care Counts," there is only one "willing" psychiatrist per 3,190 Medicaid-eligible children in St. Louis and six adjoining counties. Part of the problem, the report says, is that the majority of mental health services for beneficiaries are run through HMOs, which subcontract with behavioral health HMOs. As a result, Missouri has "too little control" over benefit levels, and insurers have an "incentive to reduce or deny care," the report says. Joe Squillace, the report's author, said, "Our mental health system to treat children is totally fragmented. Families get bounced around among departments. They have to learn how to navigate the system before they can begin to get help." The report advises Missouri to "enforce better coordination" among the state mental health, health and education departments and contract directly with mental health HMOs to provide mental health services for Medicaid beneficiaries. The group also suggests that the state increase Medicaid reimbursement rates for psychologists and physicians, train health care professionals to identify signs of mental illness, change state law to establish guidelines on when people should receive treatment through HMOs and increase state spending on mental health services through the Department of Mental Health (O'Neil, St. Louis Post-Dispatch, 9/17). The report is available online.