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Medica, Prairie Care are in a pissing match over kids' mental health

Hundreds of Minnesota kids could lose access to their mental health services provider, says Prairie Care consultant Tom Lehman.

Hundreds of Minnesota kids could lose access to their mental health services provider, says Prairie Care consultant Tom Lehman.

"Allie," the vortex of last week's feature story, The Broken Little Girl, had to be transported to an out-of-state residential facility hundreds of miles away to treat her mental illness because her mom couldn't find a bed closer to home. Per usual, demand exceeded supply for kids in the Land of 10,000 Lakes suffering from the likes of depression and bipolar disorder.

"There wasn't a place anywhere in Minnesota that had space," the child's mother told City Pages. "That added another layer to what was already, and had been for some time, quite frankly, a crisis."

Allie's crisis could be multiplied by hundreds of Minnesota families come October. It's the result of a good old fashioned piss fight — as masquerade of ethics that's really about money. 

Squared off are nonprofit insurer Medica and Prairie Care, a mental health treatment provider with five Minnesota locations and two more in the works. Between the two parties is Optum, the wildly profitable arm of UnitedHealth Group that's contracted by Medica to make mental health treatment decisions for kids.

If a child whose parent has Medica insurance is admitted into a Prairie Care facility after a suicide attempt, for example, Optum determines what treatment Medica will cover. But Prairie Care claims Medica and Optum make it impossible to do business.

According to Tom Lehman, a Prairie Care lobbyist, Medica has been operating as "an outlier relative to other Minnesota plans for several years."

He accuses the insurer of pressuring for the discharge of patients long before staff psychiatrists believe they're ready to go home. He also claims Medica "routinely" threatens to stop paying for treatment after only one week at a facility, and that patients' cases are reviewed by a regular psychiatrist, not one specializing in children's mental health.  

Mentally ill children are different than adults, the result of ever-changing brain chemistry during development. Lehman points to the American Psychiatric Association, which recognizes child and adolescent psychiatry as a separate discipline that requires two extra years of training.  

"Medica, by virtue of Optum, making decisions about vulnerable children in terms of dollars and cents versus what they need is just one symptom of how dysfunctional our health care system has become," Lehman says.

Optum spokesman Brad Lotterman could not be reached for comment yesterday.

Medica's Glen Andis calls the for-profit Prairie Care "already the outlier versus other nonprofit mental health services providers when you consider their proposed rate increases to us are anywhere between 200 and 250 percent." 

As a result of the impasse, a menacing autumn horizon looms. Prairie Care has given formal notice that it will leave Medica's network come October 20. Families insured through the nonprofit will be notified as early as next week.

"Say your child is suicidal or is having a major breakdown and you have Medica," Lehman says. "Your child's name will go on a list for another provider and will wait and wait and wait."

If a child is admitted into a Prairie Care center and is receiving treatment, he adds, "Once that child is stabilized and we find out they're a Medica enrollee, our only option at that point is to turn to the parents for payment."  

Caught between the punching is state Rep. Nick Zerwas (R-Elk River). He's been attempting to broker a compromise for at least six months. 

"Basically what this will mean is if you have a child in a mental health crisis and you have Medica, you're shit out of luck," Zerwas says. 

Zerwas is at a loss. If Prairie Care's rates are too high, why not whittle them down closer to other providers'? he wonders. If Medica is discharging patients too soon, why not hire a doctor trained in kids' brains and bring the standards back in line with other nonprofit insurers? 

Lehman and Andis were both unable to provide specifics of what would achieve middle ground.

"We already don't have enough spaces in residential treatment in this state," Zerwas says. "This is only going to hurt those kids who need help. I'm not going to point the finger one way or another. I would like to think both sides could still sit down and reach a compromise. That's what we owe the state's kids."