What Is Happening?
Ohio already has a shortage of behavioral health providers. Families often spend months searching for professionals who provide psychological, autism, ADHD, and learning disability evaluations and who also accept their insurance.
At the same time, many Ohio Medicaid providers are facing significant reimbursement challenges, including payment changes, audits, claim denials, and payment clawbacks. These issues can make it difficult for small practices to continue serving Medicaid patients.
This is not simply a provider issue. When providers can no longer afford to participate in Medicaid, patients lose access to care.
For families seeking answers about autism, ADHD, learning disabilities, and other neurodevelopmental concerns, access to a qualified evaluator is often the first step toward getting appropriate services and support.
The facts.
- 75 OF OHIO'S 88 COUNTIES are designated as mental health professional shortage areas.
- EVALUATION CAN OPEN THE DOOR TO SERVICES. A comprehensive evaluation may be needed to clarify a diagnosis and help individuals and families pursue appropriate treatment, educational supports, workplace accommodations, disability services, or other resources.
- FEWER PROVIDERS MEANS FEWER OPTIONS. When practices stop accepting Medicaid, families may have fewer providers to choose from and may face longer waits, greater travel distances, or the need to pay privately for an evaluation.
- THE IMPACT DOES NOT END WITH THE EVALUATION. Delays in identifying autism, ADHD, learning disabilities, and other neurodevelopmental conditions can also delay access to the services, accommodations, and supports that depend on understanding an individual's needs.
What this has meant for PACE.
PACE Consulting has been committed to providing comprehensive neurodevelopmental evaluations to children and adults, including individuals covered by Medicaid since 2018. We know how difficult it can already be for families to find experienced providers who offer autism, ADHD, learning, and other psychological evaluations.
Over the past year, our small practice has faced increasing financial and administrative pressures related to Medicaid, including claim denials, audits, payment takebacks, and reimbursement challenges.
THE FINANCIAL IMPACT HAS BEEN SIGNIFICANT.
For a small practice, these challenges have reached a point that is not sustainable. Continuing under these conditions would jeopardize our ability to remain open and provide services to the children, adults, and families who depend on our practice.
As a result, we made the difficult decision to temporarily stop accepting new Medicaid patients.
We hope this is temporary. We are working toward conditions that would allow us to sustainably accept Medicaid patients again while continuing to provide the thorough, high-quality evaluations our patients deserve.
We want to return to serving Medicaid patients. We also need to be able to keep our doors open in order to do so.
Help protect access to care.
Your voice as a Medicaid member matters.
If you have experienced long wait lists, difficulty finding an available testing provider, or other barriers to obtaining an evaluation, you have the option to contact your insurance plan and share your experience.
Let your plan know what access to care looks like for you and your family. Tell them if you want experienced local providers, including small independent practices like PACE Consulting, to remain available to Medicaid members.
Our hope is to return to serving new Medicaid patients. We believe Ohio families deserve timely access to high-quality evaluations, regardless of the insurance they carry.
If you need an evaluation now, please visit our Insurance & Payment FAQ to learn about commercial insurance, self-pay options, and current availability.
Thank you for supporting PACE Consulting and access to neurodevelopmental evaluation services in our community.
Ohio Medicaid: What Patients and Families Should Know
To help our patients and community better understand the challenges currently affecting Medicaid providers and access to care in Ohio, we have collected several news articles and resources below. Before you read them, it may be helpful to understand one term you will see frequently: clawback.
What is a “clawback”?
A clawback happens when an insurance company pays a healthcare provider for services that were already provided, then later determines that some or all of that payment should be returned and seeks to recover the money from the provider.
For small practices, significant or unexpected clawbacks can create serious financial strain, particularly when the services were provided months or even years earlier and the practice has already paid the costs associated with providing that care.
ARTICLES. CLICK ANY TITLE TO OPEN THE ARTICLE IN A NEW WINDOW.
These reports cover different parts of Ohio’s access-to-care problem. The clawback stories concern certain behavioral health providers; the autism story illustrates existing delays in evaluation.
They do not describe PACE’s individual claims or establish that the same payment changes applied to every provider.
