Profession organizes for action: Mobilizing to overcome
managed care resistance to social work services
by Gerald Beallor, Co-Chair, Health Care Policy and Practice Network
(November/December 1997)

The New York City Chapter will devote significant resources during the coming months to ensure that professional social work services will be more available in health and mental health care. With more than three million NewYorkers, including tens of thousand of children, about to receive comprehensive health and mental health care through Medicaid, the need for psycho-social services is expected to increase enormously. In the current political climate those very services are threatened and losses have already occurred.

The profession has the responsibility to call attention to the gaps in service and to develop strategies to move social policy to include needed social services. Three requirements must be met to carry through that responsibility: Social work services must be mandated and deprofessionalization stopped; Standards for the provision of social services must include appropriate education and training; and Adequate field work opportunities must continue to be available. These requirements are currently under attack as managed care companies and other health care systems seek to reduce costs by cutting services. The planning for changes to implement Medicaid managed care is now underway and provides an opportunity to influence the system as it emerges.

We have seen the role of social work in health care clinics and in mental health care reduced as part of the policies of managed care companies and an overall lack of appreciation of the role by health care managers. However, there is opportunity in the Federal Health Care Finance Agency (HCFA) approval of New York State's mandated Medicaid managed care plan, which followed more than two years of negotiations with State officials and advocacy groups including NASW. One of the most potentially valuable provisions in the HCFA/NYS agreement, "The Community Health Care Conversion Demonstration Project," calls for a fund of hundreds of millions of dollars to be made available to New York hospitals according to the size of their Medicaid populations, so that initiatives between the hospitals and community clinics and essential providers may be undertaken to strengthen and integrate health care services. The social work profession needs to act to ensure that the Health Department requires social work services as part of its approval of plans for ambulatory care development.

Many behavioral managed care plans bar social work students and some less experienced social workers. The agencies, hospitals and clinics which provide the health and mental health placements for graduate social work students are being forced to gradually reduce the number of placements as they enter into contracts with managed care companies who refuse to have their patient enrollees seen by providers they will not credential. (Some companies even bar all social workers because they are unlicensed in New York State). That problem will increase significantly in 1998 as Medicaid patients fall under those contracts. Action is needed to convince the largest purchasers of managed care contracts to insist that professional social workers and student can be credentialed to provide services. For Medicaid, the purchaser is the State of New York through the Health Department and the Office of Mental Health. For others, the largest purchasers are the City of New York and many unions.

Following Governor Pataki's establishment of a new regulatory mechanism, The Governor's Office of Regulatory Reform, many important patient care regulations were abolished in hospitals and nursing homes. The effort to remove the requirement for social work departments was left uncertain as our concerted actions resulted in support from the Commissioner of Health for new language, which was then barred by Bob King, the Executive Director of the Governor's Office of Regulatory Reform. Theoretically, the old regulation stands, but many, if not most, hospitals have changed the status of social work, from abolition of the department, to severe downsizing, to changes in the role of the social worker. Two actions are now pending. Following hearings and NASW testimony last month, NY State Assemblyman Richard Gottfried, Chairman of the Assembly Health Committee, has asked NASW to provide him with a report, on a hospital by hospital basis, of the changes that have resulted in de facto deregulation of social work services. Meanwhile, the suit brought by 10 organizations, including NASW, against the Governor for having promulgated an unconstitutional Executive Order (#20, creating the Governor's Office of Regulatory Reform), is in its final stages in the Appellate Division.

The actions necessary to forward the goals of the profession will be developed and coordinated by a coalition of social work, social work education, unions and other organizations. While the Chapter will continue to participate in existing coalitions that have been successful in bringing us to this point, it is necessary to launch a new coalition. This new organization will be led by the New York City and State Chapters of NASW and will seek to obtain the necessary regulatory and legislative changes required to meet the psycho social needs of client groups through professional social work.

The Chapter's effort is led by the Health Care Policy and Practice Network under the leadership of Gerald Beallor and Terry Mizrahi, co-chairs. Meeting dates and times of the Network are listed in Currents.