MS. T'S STORY
Medicare Found Her a Therapist Who Didn't Take Medicaid
Dual-eligible special needs plans (D-SNPs) are supposed to improve coordination between Medicare and Medicaid. Because of loose federal requirements, they sometimes fall short of that promise for patients like Ms. T.
She enrolled in a D-SNP to close the gaps in coverage she experienced with Original Medicare and Medicaid. But the coordination-only plan—the lowest standard of integration—led her to a therapist out of Medicaid’s network, which created affordability challenges and billing issues that led to the physician dropping Ms. T as a patient.
Integrated plans must be accountable for creating adequate provider networks for mental healthcare that meet people’s needs and goals.
