Jewish Family Services is now an approved behavioral health provider for Medicare. The social service agency has been accepting Medicare since July 1.
JFS offers counseling for adults and families, offering a wide array of integrative therapies and services. Its staff is comprised of social workers, professional counselors, and psychologists. All of the agency’s staff is licensed and credentialed and are all approved Medicare providers.
“Medicare Part B covers outpatient services including outpatient psychotherapy and that’s the service that we provide at JFS. {mprestriction ids="1,3"}That can be provided in home as well as at the office, and we do both,” said Richard Odiam, LCSW, LSCSW, JFS’ director of clinical services.
Medicare, of course, is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease. The choice to become a Medicare provider, JFS Executive Director & CEO Don Goldman explained, is all about the agency’s bottom line.
Fiscal figures for 2013, the last official figures available (2014 will be available shortly), show that only 6 percent of JFS’ income came from program fees. Clients are asked to pay what they can; donations and grants make up the difference. No one is denied service based on ability to pay.
Becoming a Medicare provider is one way that JFS is accomplishing a strategic priority to find more sustainable revenue.
“While we’ll always rely on individual donations and grants, more and more funders would like us to take as much advantage of all sustainable revenue that we can find,” Goldman said.
JFS has accepted some insurance plans in the past, but recent changes in healthcare laws caused JFS to explore the viability of becoming an approved Medicare provider. Goldman and Odiam explained that payment for mental health services now has become more equal to payment for physical health services.
“It’s 80 percent now, but in prior years it’s been less than that,” Odiam said. “I think that’s part of that effort toward parity with physical health.”
Goldman said one of the reasons JFS has not taken Medicare in the past is because it is not easy to navigate the insurance system in general “and the government insurance system, like Medicare and Medicaid, is not easy either.”
“So it took some effort to do that along with some expertise we didn’t have,” he said.
It has taken about a year for JFS to navigate and implement this change. A grant from the Healthcare Foundation in 2014 allowed JFS to hire a consultant to investigate the feasibility of becoming Medicare approved, help JFS complete the process of becoming certified, and implement the policies and procedures it needs to make it all run smoothly.
One of the things the consultant was able to determine, Odiam said, was that about 20 percent of JFS’ clients qualify for Medicare. Clients who were paying for JFS services and are covered by Medicare will now be able to use Medicare to pay a portion of their services.
“For someone who couldn’t afford to pay, it’s obviously nicer that we can get money from Medicare,” Goldman said.
That helps the agency because it won’t have to turn to funders to pay for the cost of basic services.
“Medicare typically covers 80 percent of the acceptable cost. So the client pays the 20 percent copay if they can afford to pay. If they can’t afford that 20 percent, then we can go to other funders like the Jewish Federation to cover their cost,” Goldman said.
“There is some time and effort behind it, but there’s enough revenue potential that it is worthwhile to do it,” he added. No new staff was needed for this administrative change.
Goldman emphasized that people who can’t afford the fees and don’t qualify for Medicare will still not pay anything for JFS behavioral health services.
“The benefit is that it allows JFS to have more robust and sustainable service and it means that our funders don’t have to carry as heavy a burden for things that we have other sources of revenue for,” he said.
At some point down the road JFS also hopes to start accepting Medicaid as well. Medicaid is a joint federal-state program that provides health care insurance to low-income persons. JFS chose to begin accepting Medicare first because it’s a national service that’s regionally managed. Goldman noted that Medicaid operates differently in Missouri and Kansas and since the agency operates in both states, the Kansas and Missouri offices will likely follow different procedures.
“We also deal with the fact that both states have not expanded Medicaid, so we still have a significant number of our clients that don’t have Medicaid nor can qualify for subsidies on the health care exchange,” Goldman said.
Besides mental health services, some of the services offered by the Older Adult Care Management program may also be eligible for Medicare reimbursements.
“Initially we thought accepting Medicare might be a lot of work and wondered if it would be worth it, but it was clear early on that it would be worth it, especially since some services in care management may qualify as well and with the idea that we could eventually get Medicaid. Maybe the states one day will expand Medicaid and cover even more people,” Goldman said.
For more information about JFS services, contact 913-327-8250 or visit jfskc.org.{/mprestriction}