What Utah County Medicaid Families Should Know About Service Disparities

It’s easy to assume that, as a supposedly state-administered federal program, Medicaid offers comparable coverage to residents throughout the state. Those who know how the system works, however, will tell you that’s not always the case. The number of hours allotted and getting authorization at all for psych evaluations and autism testing isn’t necessarily the same for Medicaid patients in Utah County vs. Salt Lake County.

Now, there are a number of reasons for this, but the biggest one is the differences in how the Medicaid budgets are managed by their county agencies and intermediaries. In Salt Lake County, the Medicaid budget is managed by Optum, and Optum’s contract with the state allows it to avoid paying the cost for nearly every kind of neuropsychological testing. In these cases, the provider must know how to bill Utah State Medicaid directly, which not all providers know how to do. And, again, when these psych evaluations are authorized, a different battery of tests may be administered in different counties depending on the number of hours authorized.

In all fairness, Optum can point to the fact that there are “carve-out” services that providers can bill to the state Medicaid system. They might also point out that, like all health insurance contracts between providers and carriers, a range of factors and allowances are made for authorizing services. At the end of the day, these are not insignificant differences when it comes to the depth and quality of the psychological evaluation, and parents need to be diligent in asking questions of the provider to make sure their child is receiving an equitable standard of care and intervention services.


Why Parents Should Know About These Mental Health Service Disparities

Within this context, we don’t want to unduly panic Medicaid families who live in Salt Lake County. In the majority of cases, the basic diagnosis and intervention recommendations are the same. However, you might discuss the possibility of additional, follow-up testing with your provider. Medicaid families may not have a lot of options to pay for additional testing out of pocket. Instead, we recommend that families ask about what behavioral signs or development delays might indicate the need for testing in the future. That way, families will know when—and how—to seek authorization for further testing down the road.

In fact, this is a good piece of advice for pretty much anyone who receives a psychological evaluation. Be sure to ask: “Is there anything I/we should be on the lookout for to come back more testing?” This is a question to ask beyond following up with any treatment/intervention recommendations that the mental health professional might also make.

Here is another big, if less common reason, that parents should know about these potential mental health service disparities. When young children begin to show serious signs of autism, it can be a very trying time for the whole family—emotionally, financially, logistically. To better marshal their resources, many families may look to move to Salt Lake Valley to be closer to work, to save money and get additional family support by forming a multi-generational household.

In these circumstances, you might think about getting your child autism testing before changing your residency to Salt Lake County. If you’re in Utah County, currently enrolled in Medicaid, and think your child may need autism testing, you should know that Wasatch Mental Health is the primary network provider to contact for Medicaid patients.


Author: Ellen Richards