UNDERSTANDING THE BARRIERS FACED BY AFRICAN AMERICAN LICENSED CLINICAL SOCIAL WORKERS TO MEDICAID NETWORK PROVIDER PARTICIPATION Cassandra D. Smith, MSW, LCSW-BACS Committee: Sara S. Bachman, PhD and Tamara Cadet, PhD LICSW MPH Purpose: African Americans’ mental illness is more untreated than that of white Americans (Snowden, 2012). Studies also show that African Americans are more likely than white Americans to develop chronic mental illness (Snowden, 2012) and compared to their white counterparts, African Americans are more likely to be misdiagnosed (Office of the Surgeon General et al., 2001). Results from studies show that African Americans prefer African American providers, have more positive perceptions of African American providers, and that racial congruence does positively impact treatment outcomes for this population (Cabral & Smith, 2011). Ensuring a racially and ethnically diverse Medicaid provider network can impact those treatment outcomes for Medicaid consumers. This study aims to identify and understand the barriers faced by African American (AA) Licensed Clinical Social Workers (LCSW) to Medicaid Network Provider Participation.

Methods: Data collected via an online survey was analyzed using descriptive statistics. Means, standard deviations, and range of scores were calculated for all continuous variables including age and number of years as an LCSW in Louisiana. Frequencies were summarized for all categorical variables including race; work status; practice setting; Medicaid provider (yes/no); reasons for not accepting Medicaid; MCO credentialing agencies; reasons for non-accreditation; level of satisfaction with Medicaid payment rates; level of satisfaction with the contracting and credentialing process; level of satisfaction with regulations, oversight and administrative burden associated with being a Medicaid provider; most impactful consideration in decision to become a Medicaid provider; level of difficulty in obtaining a $50,000 line of credit for credentialing; and level of difficulty in obtaining National Accreditation. Each variable was also separated by race (Black or AA and White) to provide context using cross tabulation tables. 5 Semi structured interviews were conducted as a qualitative pilot with original coding in categories aligned with the quantitative variables.

Results: A total of N=128 social workers participated in the study. The sample as a whole ranged in their experience as Licensed Clinical Social Workers (LCSW) from 0-54 years, with an average of 19 years (SD=14). Overall, respondents ranged in age from 22-87, with an average age of 52 (SD=14). 60% of AA respondents reported that they do provide Behavioral Health services to Medicaid clients. AA respondents largest reported reason for this outside of not working for an agency that provided Medicaid service was “I do not have the capacity or resources to do so (time, finances, knowledge, etc.)” at 23%. The second largest reported reason amongst this demographic at 15% was “Medicaid reimbursement was too low”. Other reasons reported were non system related responses related to work setting or position. 83% of AA respondents reported being “Dissatisfied to Very Dissatisfied’ with Medicaid Reimbursement rates, 55% of AA respondents reported being “Dissatisfied to Very Dissatisfied” with the Contracting and Credentialing Process and 72% of AA respondents reported being “Dissatisfied to Very Dissatisfied” with the Regulations, Oversight, and Administrative Burden, etc.) Solutions for barriers identified through the literature and through pilot qualitative interviews included amendment of regulation to remove the requirement for additional licensure, alternative payment methods, identification of alternatives to National Accreditation; MCOs providing provider grants, as well as administrative support through technology and centralized billing platforms, and the creation of an ombudsman to address ongoing provider issues are other possible solutions. Additional solutions offered were streamlining of the billing and authorization processes to create uniformity across MCOs in the state. African American LCSWs also believe that additional local staff should be hired by MCOs to address provider concerns. Lastly, of course, raising reimbursement rates for Medicaid Behavioral health services was a central theme in the data.

Conclusions: This study’s data on barriers AA LCSWs have to Medicaid Provider Network participation provides valuable information to guide regulatory policy and to develop strategies for implementing interventions to build the capacity of AA social workers. Improving Medicaid reimbursement rates, addressing concerns with contracting and credentialing, as well as concerns with regulatory requirements can help to increase the number of AA LCSWs in the Medicaid Provider Network. Recommended areas for further study include examining the potential disproportional impact these barriers may have on AA providers and implementation study of the effectiveness of capacity building interventions targeting AA LCSWs who desire to provide Medicaid services. Additionally, future research examining the possible connection between AA LCSWs access to capital and their ability to meet quality standards should also be considered. Lastly, comparing AA LCSW experiences in the workforce and in Medicaid networks across states could provide valuable knowledge.