EUGENE, Ore. — There are new restrictions on behavioral health care services for Oregon Health Plan’s CareOregon members, impacting roughly 15,000 people.
CareOregon, a nonprofit insurance provider that offers free mental health care coverage to its members, said in a bulletin on July 31 that it will no longer pay for outpatient behavioral health care by pre-licensed providers, unless they’re part of a group practice that’s either contracted with CareOregon or has a certificate of approval with CareOregon.
This includes routine outpatient mental health and substance abuse disorder services like individual and family therapy and case management.
Local providers say this reduces the number of behavioral health providers able to accept clients with CareOregon.
Emerald Behavioral Health says it must relocate about five of its behavioral health patients, and the change could put care out of reach for many.
“Even one is too many; honestly. One person having to withdraw from services because their insurance won’t cover it anymore. I’ve worked as a therapist for places that have had waitlists as long as two years because there’s just not providers that can take the insurance,” Maegan Mexicotte, the founder of Emerald Behavioral Health, said. “It’s disheartening, and it’s heartbreaking because I got into this job to help people. They’re making it exponentially more difficult for people to get the help that they need. We tried to get contracted with them, and they said that they have enough providers.”
CareOregon released the following statement about the change:
“During the pandemic, Oregon faced a shortage of behavioral health providers, combined with rising demand for those services. CareOregon responded to that moment by opening its network to work with contracted and non-contracted providers. That allowed us to serve members during difficult times.
Health care in Oregon is still adjusting to the impacts of that crisis with rising costs and growing needs. Services from non-contracted providers cost as much as 40%–95% more than from contracted providers. This policy change will allow CareOregon to continue meeting the needs of our members under new financial constraints, including sweeping federal Medicaid cuts.
This change will affect about 15,000 members, or about 3% of our total membership and 15% of our members who use behavioral health services. We understand it is challenging to change providers, and we will work to minimize any disruption by reaching out directly to impacted members to help them transition smoothly to contracted providers.”
For Medicaid patients, the change is effective Oct. 1.
The change goes into effect Jan. 1 for Medicare Advantage patients.