I was concerned and sad to read Jeff Benay’s commentary “Medicaid Insists on ‘talk therapy’ and rejects alternatives.”
I’m a clinical social worker who’s practiced psychotherapy in Vermont for over 30 years, much of that time with children. I agree with Mr. Benay about the importance of diverse therapeutic approaches that are geared to the needs, learning style and culture of the particular child, and the foolishness of privileging talk therapy. In particular, some of the most demonstrably effective trauma therapies involve few, if any, words. And there is a huge literature on the uses of play therapy, EMDR, family therapy and other child therapies in culturally diverse communities.
But as a therapist who has always accepted Medicaid, I would also like to understand better what happened in the situation he describes. Claims submitted to Medicaid don’t ask what the specific therapeutic approaches are that we use with children or adults. The therapist needs to specify whether it was an individual, family or group session, the duration of the session, and the diagnosis of the client. The billing therapist needs to be enrolled with Medicaid or working under the supervision of a therapist who participates with Medicaid.Someone in the mix — the therapist or the supervisor — needs to be a licensed mental health professional.
But the claim form doesn’t ask “What happened in the session?” It doesn’t ask “Did you talk or play or draw or sing or tell stories or work with clay or sand?” I have done all these things at one time or another in my clinical work with kids (and sometimes with adults) — and so has everyone I know who works with kids — and Medicaid pays us for these services. It’s up to the therapist and the client to decide together what tools we will use to be of most help to a given person in a given situation.
So I am curious why the claims weren’t paid. If it is something others can help with, I would be happy to try to help. (I can also point you toward literature on the evidence base for diverse therapies with diverse kids, if that would be helpful.) More directly, the therapist can call their provider representative at Medicaid, who might be able to help sort out the issue. Sometimes Medicaid claims get derailed by obscure issues and a lot of the time those issues can be fixed.
Thank you, Mr. Benay, for standing up for kids’ access to the whole range of therapies, talk and otherwise, that are part of mental health care in Vermont. I am very curious to know what will happen next.
Victoria Rhodin
Montpelier
