Behavioral Healthcare Redesign Is Here

After six years of study, policy making and training, the redesign of Medicaid behavioral health services in Ohio is finally here.

PLACES has been preparing many months for Behavioral Healthcare Redesign, which was implemented in January. The staff has been training on new billing procedures and documentation methods, preparing for certification to bill Medicaid in the next few months. At that time, PLACES will have an opportunity to offer more services to its residents, since some individual case management activities can be billed to Medicaid if properly documented. More change is coming later this year, as behavioral health benefits will be fully integrated into Medicaid managed care plans. The chart below provides a synopsis of the progress made so far and what is still to come.

How Will the Success of Behavioral Health Redesign be Measured?

Continuity of care for consumers is a main goal of Ohio’s behavioral health redesign initiative, along with access to services, appropriate utilization, getting providers to participate, and paying them promptly and accurately. With so much change happening, how do state legislators plan to measure the success of this initiative?
» Number, type and location of behavioral healthcare providers
» Number, type and cost of behavioral health services provided to Medicaid consumers
» Number, location and array of Medicaid consumers who receive behavioral health services

It’s All in the Family

It might seem unusual for a mother and daughter to share the same employer. But it’s familiar territory for Betty and Stacey Coleman.

Betty and Stacey Coleman have dedicated their lives to helping others through a variety of social service roles, from court advocate and probation officer to outreach ministry. Stacey joined PLACES in 2013 as manager of Imperial Court, the newest Permanent Supportive Housing facility to be opened by PLACES to that point. A year later, her mother, Betty, joined the PLACES team as a case manager in the Supportive Living Program. Today, Stacey is manager of PLACES’ North Main adult care facility.

“When Stacey told me about PLACES, I knew it was where I wanted to work,” said Betty. “At the time it sounded like a good fit for me. Four years later, I still believe it’s a good fit. I’m proud to be part of an agency that is committed to helping and empowering people to improve their daily living.” This was the second time the pair has shared the same employer. They both worked at Eastway Behavioral Healthcare a few years before, Stacey as a community support specialist after moving back home from South Carolina in 2010 and Betty as a nurse in a teenage residential facility.

“Not a Sit-Down Agency”

Stacey relishes her role as an advocate for people who need a voice. “It’s increasingly hard to navigate resources to find services for a client,” she said. “You used to be able to make a phone call to get them help, but now it’s harder. If one agency can’t help you, you have to ask if they know anyone who does.”

Betty Coleman agrees. “PLACES is not a sit-down agency,” she explained. “We’re always striving for better ways, seeking out other resources to accomplish our mission.” Betty, who is a case manager in the Supportive Living Program, has been a nurse for more than 50 years and worked as a health nutrition specialist for Head Start.

Betty, the third of 10 children, spent her adolescent years in the Ohio Soldiers’ and Sailors’ Orphans’ Home in Xenia after her mother passed away. “It was not a David Copperfield kind of experience,” said Betty, who speaks fondly of the home as a “city within a city,” with its own trades, gardens and training classes. Betty’s father chose the home as a way to keep his large family together so they could see each other, rather than splitting them up among relatives.

Growing Demand, Increased Red Tape

Over the years, Betty has seen the need for social assistance keep growing. “In the 1980s the City of Dayton did a study on the issue of homelessness, and they didn’t find anybody on the streets. Today, the Apple Street Shelter is packed and the Men’s Gateway at Gettysburg has 200 or more,” Betty said. Stacey echoed her mother, saying that years ago “you could call up Nova House and have someone come in for an assessment right away. Now people may have to wait 30 days to get an open bed.”

Both women express dismay at the heavy toll the opioid epidemic has taken on our community. “This has hit people hard,” Stacey said. “It’s not just a matter of linking people to substance abuse services. It’s everything that pertains to human survival. Children’s Services has been faced with a lack of foster parent homes. They’re having to place children as far away as Cleveland.”

Betty talked about the increased demand for services she has seen over her decades in the profession: “Each year the population gets wider and wider. The greatest need is for people who have a heart for serving others.”

The Next Generation

One thing both ladies take pride in is seeing their children excel. “When I grew up, people could go into a factory, but times have changed,” Betty said. “I’m proud of the fact that all of my children went to college and are successful in their careers.”

Stacey shares that pride in her own children: a son who is majoring in business management and minoring in music at Kentucky State University and a daughter who is majoring in film production at Wright State and sings in an acapella group. “I always say, be sure to remember your mother when you get that Grammy!”

New Manager of Supportive Living Program

Nanci McGuire, seasoned PSH manager, promoted to lead SLP

Nanci McGuire has been promoted to lead PLACES’ Supportive Living Program. Formerly the manager of two Permanent Supportive Housing sites, Nanci supervises a team of case managers who provide ongoing supportive services and life skills training to clients in the community.

SLP clients live at scattered sites owned by other agencies or private landlords. In general, they are chronically homeless and may be coming out of shelters, so need help setting up their new home.

“You’re a little anxious when you get a new place and don’t have a bed!” said Nanci. “PLACES provides start-up funds for furniture and household items. When they go shopping, clients ask for help with budgeting because it’s not a lot of money, so they want to make sure they spend it on what they really need.”

SLP case managers help clients with their other needs, as well. Some lack the education needed to find employment and want to get their GED, then a job. Others may need medical attention. One client hadn’t seen a doctor in 17 years, Nanci said.

Whether dealing with site-based tenants in the PSH program or clients in the SLP, Nanci finds their struggles and needs are much the same. “In our PSH program, every day would bring something new,” she said. “A tenant may be in a bad mood and cuss you out, but later that same day they’d come to ask for help in getting a birth certificate and Social Security card for a new job. You had to be prepared for anything, especially when you see them try so hard and actually succeed. But then they might ‘celebrate’ and fall back on their addiction. It can be frustrating, so you need to be able to accept the small successes.”

Nanci has been doing this for a long time, so she braces herself for the pushback. “I’ve developed a thick skin,” she said. “I tell them, ‘You’re not going to run me off. I’m still going to be there for you.’ The one thing clients need to know is that no matter how bad their behavior is, you’re going to be there for them. It’s kind of like being a parent. You don’t stop caring or doing what needs to be done; you still want the best for them.”

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