Testimony of Eric Garfinkel on the Proposed 2005-06 Executive Budget for Health, Medicaid & Aging. Jan. 31, 2005. New York State United Teachers.

Testimony of Eric Garfinkel on the Proposed 2005-06 Executive Budget for Health, Medicaid & Aging

January 31, 2005.

RELATED RESOURCES

Testimony of Eric Garfinkel, Ph. D., Chair of the Insurance Committee New York State Psychological Association, to the Senate Finance Committee, Owen H. Johnson, Chair, and Assembly Ways and Means Committee, Herman D. Farrell, Jr., Chair, on the Proposed 2005-2006 Executive Budget for Health, Medicaid & Aging

Senator Johnson, Assemblyman Farrell, honorable members of the Legislature and distinguished staff, I am Eric Garfinkel, a licensed psychologist and Chair of the Insurance Committee of the New York State Psychological Association (NYSPA). The New York State Psychological Association (NYSPA), is a statewide organization which represents over 3,000 licensed psychologists and psychology students, and works cooperatively with more than a dozen regional organizations of psychologists throughout New York. NYSPA is affiliated with New York State United Teachers (NYSUT), representing over 508,000 educators and healthcare professionals in New York, the American Federation of Teachers, representing over 1.3 million educators and healthcare professionals nationally and with the American Psychological Association, representing over 140,000 psychologists across the United States. NYSPA is also working as part of the Medicaid Matters coalition of over 100 consumer oriented advocacy groups concerned about quality healthcare for the poor.

The New York State Psychological Association would like to thank both the Senate and the Assembly for your action last year in rejecting the Executive Budget proposal to eliminate Medicaid coverage for "optional" services including psychology, dentistry, audiology, podiatry and private duty nursing care.

We thank this joint legislative committee for convening these public hearings and for allowing NYSPA testify today. Unfortunately, again this year the Executive Budget proposes to eliminate private psychologist services from the Medicaid program. We need your help to insure that we can continue to do our part to contribute to society by delivering high quality, and low cost behavioral healthcare to our neediest and most vulnerable populations.

The Executive Budget proposal to severely restrict Medicaid coverage for psychological services would deprive tens of thousands of New Yorkers treatment with a psychologist, disrupting current treatment, and creating barriers to access for others in need.

For background information, let me tell you that the fees that Medicaid pays psychologists for treating Medicaid patients are an absurdly low $36 hour. If these patients are able to access services in a Mental Health Clinic setting, Medicaid would pay an average of $120 for the same service, usually with a lesser trained professional. If enacted, the Executive Budget proposal will not save money, but instead would cost the State millions of dollars as patients are shunted into much more expensive and less effective models of service delivery, or allowed to go without the treatment that they need to function adaptively and contribute to society.

Untreated mental illness is epidemic, and profoundly costly in both human and economic terms. According to World Health Organization data, mental illness accounts for 25% of all disability across major industrialized nations. Mental illness, substance abuse, and Alzheimer's disease and dementias rank first, second and third among all causes of disability; accounting for more loss of function than musculoskeletal diseases, respiratory diseases, cardiovascular diseases, sense organ diseases, injuries, communicable diseases, cancers, diabetes and all other diseases combined. (WHO, 2001) In the US, the economy's loss of productivity from mental illness amounts to $63 billion annually. (DHHS, 1999)

In the Department of Health and Human Services groundbreaking publication, Mental Health, a Report of the Surgeon General, it is reported that:

One-in-five Americans suffer from mental illness in any given year.
A range of effective treatment exists for virtually all mental illnesses.
Only about one-in-three Americans with mental illness receive the treatment that they need
Stigma and lack of access to services are the main reasons why people do not seek or receive the treatment when they need it (DHHS, 1999)

Untreated mental illness:

causes significant distress and dysfunction
interrupts developing lives and education
disrupts families and other relationships, deprives individuals of their human potential to live, work and contribute to society
has been implicated in increased and/or inappropriate utilization of medical/surgical services and inpatient emergency psychiatric care
drains social welfare programs and unemployment compensation funds
increases the risk of societal strains (e.g., accidents, violence and crime) (DHHS, 1999)

This Executive Budget proposal would prevent access to needed care by excluding all providers of optional services.

Our clinics settings alone are not capable of meeting the need. According to DHHS data,

there are significant delays between referral and treatment at clinics. Fifty-nine percent of Medicaid recipients who seek out mental health treatment are unable to obtain an appointment at the time that they need the help. Clinics typically do not have the range of specialty services, such as neuropsychological assessment or behavioral treatment of phobias, that are available from psychologists in the community. Clinics in a given region will not have the coverage available from community psychologists to meet bilingual needs.

President Bush's New Freedom Commission on Mental Health describes the nation's mental health delivery system as in "shambles", due to:

Fragmentation and gaps in services
High unemployment and disability for people with serious mental illness
Older adults who are not receiving care
Mental health and suicide prevention are not yet national priorities

Federal regulation defined psychological services under Medicaid as optional. For New Yorkers, there is nothing optional about people with mental health problems receiving the psychological services that they need.

Psychologists work in long-term care facilities, primary care settings, programs for children and the disabled, in community based organizations and office settings. Psychologists work in many settings in which Medicaid is the only source of payment.

I have worked as a private psychologist with Medicaid patients in an Adult Day Health Care Program in the Bronx, Community Residences for developmentally disabled adults in Brooklyn, an AIDS service organization in Manhattan and at several nursing homes. In the ADHC program, approximately 40 percent of registrants have Medicaid as the sole healthcare coverage. These younger registrants are people with emotional and behavioral problems associated with traumatic brain injury, survivors of serious car accidents and gun shot wounds. They are young people with progressive neurologic disorders like multiple sclerosis, hemmed in by their own bodies. There are people with chronic debilitating physical illnesses, paraplegics, and quadriplegics. It would be virtually impossible, or at least a terrible hardship for these individuals to get to a clinic setting, and it would be highly unlikely that they would find the specialized care there that they may need.

In the AIDS program we were able to successfully integrate psychological services into a community based organization. These were rather low functioning people with AIDS, most of whom were previous or current drug addicts - and some continued putting their own and others lives at risk on a regular basis.

With the mentally developmentally disabled clients we were able to help we were able to help people with a wide range of cognitive and emotional disabilities to avoid and solve problems to the extent that they were able to spend their lives in the supportive setting of the residence and work usually in a sheltered workshop but occaisionally in competitive employment.

In the nursing homes, the need is tremendous for both the elderly, and the increasing population of younger residents in long term care. Here we see:

The active church involved, busy Hispanic grandmother, who falls, breaks her hip and is admitted to s short term rehab unit in a nursing home in Manhattan. There she fails to make progress in rehab because she becomes overwhelmed with pain and panic when the physical therapists try to work with her. She is depressed and anxious, feels that this is the end of the road for her. The rehab staff are on the verge of discontinuing her treatment - since she is no longer making progress, and the facility is planning her transfer into a long term care unit. The psychologist is called in, and works with her to bring her depression and anxiety under control, and to give her coping strategies, motivation and support to tolerate rehab. This woman has now strengthened herself to the point where she is going to be discharges within days to go home to her family.
The chronic schizophrenic who has spent his whole life in Bronx State Psychiatric Center, and as he seemed stable, has recently been moved to a nearby nursing home. In the new setting he becomes combative, deteriorates into paranoia, believing his roommate or nursing are poisoning his food. He will only eat out of sealed containers, which he hoards, he is terribly frightening to the more traditional elderly residents in his environment, and the staff do not know how to manage these types of behaviors. When he becomes paranoid, he mistrusts his roommate and staff, but because the psychologist has expertise in dealing with chronic psychotic patients, she has been able to establish a relationship with him where when he wont talk with anyone else, she could stay in his trust. As a result, she has been able to detect when he starts to get more paranoid, to communicate with the physician who can then increase his medication, calm the patient by helping him to communicate, redirecting him to constructive activities and reducing his aggression. She has worked to teach the staff to recognize signs of escalation and avoid triggering aggression. The psychological service has been highly successful in diverting hospitalization and injury to the patient and others.
Suicidal ideation is very common among nursing home residents, and in fact elderly men have one of the very highest rates of successful suicide. Clinical depression is exceptionally common in nursing home residents, impacting - according to federal data - as many 35 percent of residents. When nursing homes are presented with suicidal or aggressive behavior in residents they call the psychologist in to assess the patient, determine the level of risk and intent, and make an appropriate plan. The vast majority of these patients are able to be maintained with psychological intervention in the nursing home, when otherwise they would have been hospitalized.

Eliminating access to private psychologists will cost New York State more than it could ever save. It will cost more dollars, and it will cost more lives.

Both last year and the year before, the Senate and the Assembly came together to pass legislation assuring Medicaid recipients access to vitally needed private psychological services. We thank you, and we ask you to maintain Medicaid coverage for "optional" services including psychology.