space traveling warriors tier list : Psychiatric facilities prioritize out-of-state children for profit

Children in South Carolina who need immediate, around-the-clock psychiatric care are at risk of being stranded for days – even weeks – waiting for help, only to be sent hundreds of miles away from home for treatment.

When no residential psychiatric treatment beds are open in South Carolina, some children must travel southeast to facilities in Florida, Georgia, North Carolina, Virginia, Tennessee, Alabama or Kentucky — anywhere a bed might be available.

The problem in South Carolina is not a lack of residential psychiatric beds, say state agency leaders, but that many of the state’s 518 licensed beds for children are filled by patients from other states. At last count, according to the state Department of Health and Human Services, about half of the children assigned to a residential psychiatric treatment bed in South Carolina were not from South Carolina.

The reason comes down to the bottom line of facilities, which are driven by states’ reimbursement rates, as Medicaid usually covers the care of these patients. South Carolina’s rate has been about $330 a day, one of the lowest for such services in the country, said Deborah McKelvey, executive director of Windwood Family Services in rural Charleston. North Carolina’s Medicaid fee is closer to $500 a day, she said, and other states pay up to $800.

“It’s like any business,” said McKelvey, whose residential psychiatric treatment facility is a nonprofit with a mission to specifically care for patients in South Carolina. Your facility operates at a loss and in part fills the gap through fundraising.

The state’s other seven residential psychiatric treatment facilities for children operate as for-profit businesses. Three are owned by Broadstep, a portfolio company of private equity firm Bain Capital. Some health researchers have said that such ownership arrangements can prioritize profits about patient care.

“More than any other part of the healthcare industry, private equity is pouring money into behavioral health,” said Eileen O’Grady, a researcher at the watchdog group. Private Equity Stakeholder Project. “We don’t really have a clear window on how much money they’re making. They are not obligated to release basically anything to the public.”

The group published a report in February called “The Kids Are Not Alright,” which outlines some measures that behavioral health facilities owned by private equity firms have taken to increase their profit margins in recent years, including reducing staffing and postponing building maintenance.

“Despite the horrific conditions at some youth behavioral health companies, their private equity owners have in some cases made huge profits,” O’Grady wrote.

Bain Capital and Broadstep officials did not agree to speak officially and did not respond to written questions.

The influx of such investments helped create something of an arms race. South Carolina’s Medicaid increased its reimbursement rate on April 1 to $500 per child per day in a bid to entice for-profit facilities to admit more children in the state. The adjustment is expected to cost Medicaid an additional $14 million a year, on top of the $20 million it already spends on residential psychiatric treatment for children. The money should free up some bed space, said SC health and human services director Robbie Kerr. But it may not be enough in the long run.

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“We already know that our neighboring states are ready to raise their rates as soon as I do,” Kerr told a panel of lawmakers in January. “It will be an inflationary spiral.”

It is not uncommon for American children who need intensive psychiatric care to travel to another state for treatment. KHN recently reported that about 90 Medicaid-covered Montana children are spread out in psychiatric facilities in 10 states. Similar trends occurred in Arizona, Minnesotaand Oregon. Many states have a shortage of psychiatric beds.

However, many psychologists and child welfare experts suggest that children who receive such care closer to home will be more likely to succeed. This is primarily because patients can more easily maintain contact with their parents, caregivers, and communities during stays that can last several weeks or months.

Medicaid documents show that some of the South Carolina companies have admitted children from as far away as Alaska and Vermont. Meanwhile, South Carolina ranks 50th among all states and DC — with only North Carolina ranking the lowest — for the proportion of children who have major depression and do not receive treatment for it, according to the report. . Mental Health America advocacy group.

Some children, untreated, become violent and suicidal and eventually need care in a psychiatric hospital or residential treatment center. They may be experiencing anxiety, depression or post-traumatic stress disorder, or have a substance use disorder. In many cases, the pandemic has worsened their mental illness. It also made space in the psychiatric bed more scarce.

At New Hope Carolinas, a for-profit facility for patients ages 12 to 21 in Rock Hill, South Carolina, 133 of 150 psychiatric beds were filled with patients covered by Medicaid plans from out-of-state last summer, according to with a report submitted by the facility to the South Carolina Department of Health and Human Services. At Springbrook Behavioral Health in Greenville, a residential psychiatric facility specializing in children with severe autism, only one of 40 Medicaid patients was from South Carolina. At a Simpsonville facility called Excalibur-Venice, 41 Medicaid patients came from North Carolina and just 10 from South Carolina.

Excalibur-Venice is one of three facilities in South Carolina that fall under Broadstep, a Raleigh, North Carolina-based company backed by private equity firm Bain Capital’s Double Impact Fund. Broadstep’s presence spans dozens of similar psychiatric facilities in seven states, according to its website, and Bain Capital is far from the only private equity firm that makes investments in behavioral health.

In 2022 “Global Private Equity and Healthcare M&A Report”, Bain & Company – a consultancy separate from the private equity firm but founded by the same entrepreneur – reported that the pandemic presented opportunities to invest in behavioral health.

“With reduced stigma for mental health services, combined with greater employer and payer commitments,” the report noted, “the addressable mental health market looks set to expand in the coming years.”

Yet in the Carolinas, the need for psychiatric beds remains particularly acute. In mid-March, Bailey Pennington, a spokeswoman for the North Carolina Department of Health and Human Services, confirmed that 21 children from that state were being held, waiting for a bed to become available at a facility in North Carolina or another state. . Nearly 250 North Carolina children covered by Medicaid were sent to an out-of-state psychiatric facility between mid-2019 and mid-2021, she said. And North Carolina, despite having twice as many residents and a much higher number of Medicaid enrollments, has fewer psychiatric treatment beds for children than South Carolina.

“I probably have five to ten young people right now who could benefit from this level of care that are jumping from placement to placement,” said Michael Leach, director of the South Carolina Department of Social Services.

In some cases, parents have abandoned their children because they can no longer cope with their mental health needs, he said. Sometimes law enforcement gets involved, but parents refuse to get their children back. Children sleep in city offices or hospital emergency departments, he said, when psychiatric beds are unavailable.

Often, beds in South Carolina are technically available, but psychiatric facilities cannot retain staff to handle more patients. That’s when kids can be sent out of state, Leach said. Nineteen South Carolina children in state custody were receiving psychiatric treatment out of state, Leach said in mid-March.

“I need more [beds] now than I have access to,” Leach said. “It’s a real thing.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Research, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.

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