By Samantha Slaughter, Psy.D.
This is the second article of six meant as a companion to the Practice Organization’s six-article series on Medicaid. In my first article, I covered why psychologists should become Medicaid, or Apple Health, providers. Now I will review Washington State’s Apple Health program and provide a step-by-step guide for becoming a provider.
As Rebecca Clay writes in the Practice Organization article, Medicaid is a federal program that is implemented at the state level based on a set of guidelines. In Washington, Medicaid is administered by the Healthcare Authority. However, similar to the experience of the psychologist interviewed for Ms. Clay’s article, I also find the HCA website confusing and less than user friendly. Here are the basics about Apple Health in Washington State:
- • Which providers can participate in Apple Health? The WACs list which providers are eligible to participate in Medicaid. Psychologists and other mental health providers are included.
- • What mental health treatment does Apple Health cover? According to the Healthcare Authority site, many mental health services are covered. These include inpatient treatment, outpatient treatment, and treatment for substance dependence. Services are available for adults and children; however, there are differences. For example, it is my understanding that Medicaid covers two hours of psychological assessment per year for adults, but more for children.
- • Are there preauthorization requirements? For most outpatient services, prior authorization is no longer required. However, if you want to use more than two hours of psychological assessment for an adult, you will have to apply for prior authorization. Some Apple Health companies are willing to authorize additional hours.
In my opinion, the current networks of all Apple Health plans have a dearth of private practice psychologists. Looking through the providers listed on their online databases shows what initially looks like a robust network of mental health clinicians. However, a closer look at the details of the databases reveals that a large portion of the listed providers are only available through hospitals and community mental health agencies. We need these facilities to be Apple Health providers, but not all Apple Health subscribers are appropriate clients for such facilities and could do well in a private practice setting. Unfortunately, with so few private practice psychologists on the Apple Health panels, these clients do not have the same access to services as other potential clients. For example, as a psychologist in Seattle, I see clients from as far away as Aberdeen, Yakima, and other areas of the state. Why? Because as far as I know, I am the only doctoral-level provider on all five Apple Health plans who writes letters for services for people who are transgender. These clients must have such letters to receive appropriate healthcare, so they have no choice but to find a way to Seattle for a visit with me.
As of the publication of this article, the panels of all Apple Health plans are open. I provided an overview of the two-step process for becoming an Apple Health provider in my last article, but here is a more detailed outline.
1. You must first complete an application to become a Medicaid provider with the state. This is a lengthy process, but will go faster if you have your professional information accessible and all necessary documents as electronic versions you can upload. Psychologists in group and independent practice are not required to pay for enrollment, so you can ignore that section of the website.
2. After joining the state’s network, you then can join the panel of one or more of the five Apple Health plans. The current plans are Amerigroup, Community Health Plan of Washington, Coordinated Care of Washington (managed by Cenpatico), Molina Healthcare of Washington, and United Healthcare Community Plan (managed by Optum). Applications for all Apple Health plans go through OneHealthPort.
- a) If you do not have a provider/subscriber profile on OneHealthPort, then you will need to create one. It is not difficult to create a profile and application, but it is time consuming. You will first register your organization, which means your practice if you are solo, and then you can complete the provider application. If you are a provider in a group practice, contact the group’s administrator to be assigned a subscriber ID.
- b) Already have an application on OneHealthPort? You will need to make sure it is up-to-date and then contact the Apple Health plan(s) you want to join and ask them to review your application.
3. Once your application is under review by the credentialing department(s), the only thing left to do is wait. The credentialing process, like that of all insurance companies, takes 60 to 90 days to complete. Successful credentialing should lead to the Apple Health plan(s) notifying you of your in-network status. If you do not hear from the plan(s) after 60 days, contact the Provider Relations department(s) for the status of your application.
Should you have problems with the application process, you can use the following information to obtain assistance.
- Provider Enrollment department of the Health Care Authority (HCA): 1-800-562-3022 x16137 – open Monday, Tuesday, Thursday, Friday 7:30 a.m. – 12:00 p.m. and 1:00 p.m. – 4:30 p.m.
- Amerigroup: 1-800-454-3730
- Community Health Plan of Washington: 206-613-8950
- Coordinated Care of Washington: 1-877-644-4613
- Molina Healthcare of Washington: 1-888-858-5414
- United Healthcare Community Plan: 1-877-842-3210
The process to become an Apple Health provider may seem onerous, but I believe it is well worth it. The clients I see with Apple Health plans are some of my hardest working clients, committed to the process of psychotherapy no matter how challenging. They need and deserve the same access to mental health services that is typically taken for granted. I ask you to join me as an Apple Health provider, giving these clients the same access to treatment received by clients with private and employer-sponsored health insurance plans.