Funds should be allocated for more QA/oversight of existing Medicaid-funded behavioral healthcare services.   There isn't enough space in this forum to 1) describe some of the non-justifiable practices being billed as clinical services; or 2) to ponder the mysteries of why no other insurer will cover these services -- only Medicaid, as if only the poorest of the poor have problems for which wraparound supports are necessary.  Perhaps 1 explains 2.  Regardless, this is folly.  Auditors should focus less on how agencies/providers prove they are doing the work (chart audits), and more on conversations with consumers about their experiences.  These conversations inform my belief that widespread incompetence (at best) and outright fraud (at worst) is rampant throughout the Commonwealth.

Since so many Virginia seniors with identified behavioral healthcare support needs are just a few dollars away from being Medicaid-eligible, outpatient counseling is typically their only option.  But the waiting lists are long -- so many providers are (still) only offering telehealth services and many seniors are not comfortable with this, have access issues, and/or cannot afford copays.  Virginia and the rest of the country could easily address the provider shortage/access issue by passing Medicare Reimbursement Legislation (link) permitting Licensed Professional Counselors (LPCs) to be reimbursed by Medicare.  Finally, we cannot go wrong by improving every low-income Virginian's access to technology, so (especially where/when only telehealth options exist) we could provide training and/or tools (including but not limited to devices and internet service) to enable them to access healthcare.