MCOs (GA) Georgia Medicaid insurer denied psychotherapy for thousands



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[MM Curator Summary]: Families are saying Anthem is denying or delaying critical services. DCH and Anthem say that’s not the case.




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Georgia Human Services Commissioner Candice Broce, right, testifies at the Georgia state Capitol in Atlanta. Broce said that the insurer managing care for Georgia’s foster children is denying too many requests for mental health care. (AP file photo/Jeff Amy)

ATLANTA (AP) – A newspaper finds that the insurance company that manages medical care for many Georgia children has denied or partially denied more than 6,500 requests for psychotherapy between 2019 and mid-2022.

The Atlanta Journal-Constitution reports that many of the requests denied by Amerigroup, a unit of insurance giant Elevance Health, were for children in state-run foster care.

Child advocates tell the newspaper that the Department of Community Health, which is supposed to oversee the contract, isn’t holding Amerigroup accountable.

“The state is not doing its duty,” said Joe Sarra of the Georgia Advocacy Office, a federally mandated organization that works for people with disabilities.

In a January report to state lawmakers, the department said fewer than 100 psychotherapy requests were denied in calendar year 2019 and the 2021 and 2022 budget years by the state’s Medicaid managed care contractors, including Amerigroup.

But the newspaper found through documents obtained in open records requests that Amerigroup denied hundreds of authorization requests for psychiatric residential treatment, something the Department of Community Health didn’t include in its report to lawmakers. Amerigroup also denied thousands of requests for evaluations related to mental or behavioral health issues and hundreds of requests for autism-related services.

Melvin Lindsey, who leads Amerigroup in Georgia, has denied wrongdoing, telling lawmakers in a January hearing that children’s needs come before profits.

“I’ve never made a decision about how to treat anyone, particularly a foster care kid, that was related to cost and I never will,” Lindsey said. “We will get people the right services at the right time, all the time.”

But Human Services Commissioner Candice Broce, who also leads her department’s Division of Family & Children Services – the state’s foster care agency – has been sharply critical. She urged changes as the Department of Community Health seeks new bids on the Medicaid managed care contract that covers foster children. Broce wrote in a 2022 letter that children must wait weeks or months for an appointment, are rejected for services based on a narrow definition of “medical necessity” and are deprived of care coordination for their complex needs.

Among children denied entrance to residential treatment: an 11-year-old girl who smeared feces in the bathroom of a foster care home and attempted to jump out of a window hours after being released from a psychiatric unit. Amerigroup approved a residential stay months later after the girl tried to both drown and electrocute herself, according to the state’s foster care agency. At that point, no facility would accept her.

Amerigroup also denied a medical provider’s request for a residential treatment of a 13-year-old foster child who was trying to hurt herself and was aggressive toward others. While the state appealed the company’s decision, she tried to overdose on lithium pills and cut herself with glass.

“This is a problem that far exceeds foster care,” said Melissa Carter, executive director of the Barton Child Law and Policy Center at Emory University. “The fact of the matter is, many of those children who are currently in foster care may not need to be if parents were able to access services to meet their children’s needs in the community.”