‘Astronomical’ bills prompted McMaster’s review of SC school mental health services
Lexington resident Kathy Maness enrolled her teenage son in school-based mental health counseling in early 2020 on the eve of the COVID-19 pandemic.
His initial counseling sessions were held via Zoom because schools and offices had temporarily been shuttered due to the deadly virus.
“It was extremely helpful to my son,” said Maness, a Lexington town councilwoman who leads South Carolina’s largest teacher advocacy group and recently announced her candidacy for state schools chief. “The services were excellent. He really felt comfortable with this person.”
In the fall, when River Bluff High School reopened its classrooms to students, her son began seeing his counselor in person during the school day.
That’s when she got hit with a surprise bill from the Lexington County Department of Mental Health.
Even though the substance of her son’s counseling had not changed, her insurance would no longer cover it because it was now happening in school. She owed more than $1,000.
“We had the means to pay for it,” said Maness, whose son subsequently ceased in-person counseling and resumed teletherapy. “But I worry about the families who can’t afford it. That’s my concern.”
Maness isn’t the only parent who’s gotten a large unexpected bill for school-based mental health services. In fact, parents who are uninsured, self-insured or have certain private health plans have had to pay out of pocket for school-based counseling for years.
The issue has come to a head recently, however, because more kids are seeking mental health services in the wake of the pandemic. The number of South Carolina students served by the Department of Mental Health peaked in 2020, and remained elevated last year, even as the number of Mental Health clinicians in schools has decreased.
The governor’s office, which Maness and other parents apprised of the confusing billing situation, issued an executive order this month calling for a “comprehensive review and analysis” of the Department of Mental Health’s school mental health services program.
Gov. Henry McMaster even used part of his recent State of the State address to highlight the issue and floated the idea of privatizing the state’s behavioral health services.
“South Carolina’s system of state-run treatment programs and facilities needs a modern-day refreshment, reevaluation and reinvention,” he told a joint session of the General Assembly.
McMaster’s spokesman Brian Symmes said the governor has long been concerned about the need to expand mental health access in schools, especially after two years of near-constant disruptions due to COVID-19, but was moved to act recently by the stories of parents who were billed for school-based counseling.
“In some cases these bills are astronomical,” Symmes said. “It was just another barrier to access in a time when we can’t afford to have barriers to access.”
There’s no reason to believe the Department of Mental Health has mishandled the school counseling program, the spokesman said. The governor simply wants to gain a better understanding of how it operates, according to Symmes.
He said McMaster is committed to ensuring all South Carolina students have access to the mental health services they need and is open to revamping the state’s mental health delivery system, if necessary, to get that done.
The governor wants the state Department of Health and Human Services to take a holistic look at the issue and determine how South Carolina can recruit and retain more mental health counselors and increase youth mental health access, he said.
“We thought our children had access to these services in the school, but when you get this bill on the back end, that’s not true access,” Symmes said. “We’re not saying everything is going to be free, but we need to ensure we’re doing everything we can to mitigate costs to parents so children are afforded the opportunity to take advantage of services.”
DMH open to changes that enhance access
Mark Binkley, the Department of Mental Health’s director of legislative and governmental affairs, downplayed the billing issues, but said he shares the governor’s desire to make affordable mental health services available to all South Carolina students.
He said the agency, which is required by statute to bill for mental health services, has periodically gotten billing complaints from parents. The number of complaints is minimal compared to the number of students served and has not increased markedly since the pandemic, Binkley said.
Parents are supposed to be given information about the potential costs of school-based mental health services upfront, but some families have reported not being aware their private insurance would not cover in-school counseling sessions, Binkley acknowledged.
“We’ve had some complaints about that, that the information given was not clear,” he said. “That’s something we’ve had to make sure our billing staff are being clear about when they do these intakes.”
Children on Medicaid or the state’s health plan pay nothing for school-based mental health services and uninsured children pay on a sliding scale determined by family income. But because many private insurance plans only cover services administered in a mental health center or at home, privately-insured families are often left to pick up the bill when their child sees a counselor at school.
Some parents whose children could benefit from school-based counseling but are cognizant of those costs may pass on services as a result.
The fact that a disproportionate number of children who seek mental health services in school are on Medicaid — which picks up the tab for low-income families — may indicate that privately-insured families are being deterred by the cost, Binkley said.
“If the fact that (the Department of Mental Health) does have to charge for services is creating a disincentive for families that are not on Medicaid … I think that’s worth looking at,” he said.
That said, Binkley believes the larger impediment to mental health access is the alarming number of school-based counselors who are leaving the agency.
The department has lost nearly 20% of its school-based clinicians since 2020, according to data he provided, and the number of public schools with mental health counselors has dropped considerably over the past year-plus as a result.
Low pay — the agency’s master’s-trained therapists earn less than $40,000 to start — is the primary driver of the mass employee exodus, Binkley said. The agency, as part of its budget request, has asked lawmakers for additional money to boost salaries, which aren’t even competitive with other state agencies, he said.
While the recent billing complaints may have driven McMaster to order a review of the agency’s school-based mental health program, Binkley said he thinks the governor’s primary concern is expanding services and stemming the sharp decline in embedded school clinicians.
He welcomed the governor’s review of the program and said the agency was open to making changes if they improved mental health access in the state.
“Whatever is shown to be a good idea to improve services to patients, the Mental Health Commission and the leadership of the Department of Mental Health is going to support it,” Binkley said.
This story was originally published January 30, 2022 at 5:00 AM with the headline "‘Astronomical’ bills prompted McMaster’s review of SC school mental health services."