BLUE ASH, Ohio — A surprise move by CareSource, Ohio’s largest Medicaid managed care provider, is sending shockwaves through the state’s mental health community and raising concerns that care for thousands of patients could be in jeopardy.
CareSource confirmed it will retroactively recoup payments from behavioral health providers in addition to cutting future reimbursements. The reductions — resulting in an 85% reimbursement rate for certain providers, down from the contracted 100% — apply not only to future claims but to payments already made, stretching back to 2024.
In a statement to WCPO, a CareSource spokesperson said the action is part of the organization’s compliance and stewardship responsibilities.
CareSource’s mission is to improve the health and well-being of Ohioans while responsibly managing Medicaid funds to maintain high-quality, affordable care. During a recent review, we identified certain behavioral health claims that were not paid in alignment with the established billing and reimbursement rules. When this occurs, it is our standard practice to work with providers to correct the issue and ensure accuracy.
We are notifying affected providers of reimbursement adjustments going forward, as well as the need to recover overpaid funds, in accordance with our fiduciary responsibility. We understand this may cause concerns for some providers, and we are working with them to review individual circumstances and offer flexible repayment options. Throughout this process, we are working closely with state regulators and remain focused on supporting provider network stability and protecting our members’ access to quality care.
CareSource Spokesperson
CareSource said such adjustments are standard when payment issues are discovered. But many behavioral health providers say the combination of deep rate cuts and retroactive clawbacks is unprecedented and pushes the mental health care system closer to collapse.
WATCH: Ohio mental health providers sound alarm over CareSource Medicaid payment clawbacks
Ohio mental health providers sound alarm over CareSource Medicaid payment clawbacks
In Blue Ash, Alexandria Fields, owner of Inclusive Counseling, said she learned of the change the same way many providers did — through social media therapist groups.
“I kind of woke up to complete chaos,” Fields said. “And at first I’m thinking, I’m sure it’s nothing. We’ll figure it out. And as I go through, I find that actually it’s true.”
Inclusive Counseling has 30 therapists and about 800 active clients. Around 40% are on Medicaid, and CareSource accounts for roughly a quarter of the practice’s claims. Fields said she’s already seen more than 500 recoupment notices just for March through May of 2024.
She said she estimates the clawbacks on those will total close to $100,000 for her business alone.
“To lose 15% all at once, withheld from future payments, is very scary,” Fields said. “It’s a catastrophic amount of money.”
Fields said losing that funding will have ripple effects far beyond her ledger.
“If you’ve ever had a therapist you really connect with, you know how hard it is to replace that. If practices close or drop CareSource, many people will have to start over, and some may never find a new fit,” Fields said. “For people managing trauma, depression, PTSD or anxiety, suddenly losing your provider can set back progress dramatically. This isn’t just inconvenient. For some patients, it can be dangerous.”
Monica Hill, who owns Untangled Thoughts LLC, a solo outpatient psychotherapy practice in Midland, said the retroactive adjustments threaten solo practices just as much as larger ones.
Hill sent the following in an email to WCPO:
“CareSource has issued retroactive reimbursement adjustments and recoupment notices for previously paid claims, citing internal reimbursement or ‘market requirement’ updates. These are not billing errors on my end. The claims in question were submitted correctly, processed, and reimbursed at the contracted rate at the time of service,” Hill said. “Applying recoupments in this manner undermines reimbursement reliability and raises serious concerns about the validity of post-payment reversals without clear, upfront contractual or policy disclosure.”
Hill said the clawbacks create “immediate financial instability” and “force difficult operational decisions that directly affect patient access to care,” particularly in communities with already limited mental health resources.
In response, a formal petition has been launched to the Ohio Department of Medicaid, Gov. Mike DeWine, the Ohio General Assembly and CareSource leadership.
It warns that the clawbacks are “a financial crisis forced upon the providers who serve Ohio’s most vulnerable Medicaid members” and demands:
An immediate suspension of the 15% clawback pending public reviewA ban on retroactive cuts for services already renderedFull public explanation of the rationale and legal authority for the changeLegislative protections against retroactive managed care clawbacksA stakeholder meeting before any rate changes take effectAn equity review of the impact on underserved populations
A social media announcement is urging Ohioans to sign the petition, contact lawmakers and file complaints with the Ohio Department of Medicaid. It warns that the cuts could force closures and reduce statewide access to mental health care for Medicaid recipients.
Fields said she’s committed to keeping her staff paid and continuing services for CareSource patients. Hill said she will keep pressing for clarity but fears the move has already eroded provider trust.
“Some providers in my network are talking about shutting their doors completely. Others are talking about dropping CareSource outright,” Fields said. “We don’t want to do either, because that would hurt the very people we got into this work to help.”
CareSource said the reimbursement adjustments do not apply to every provider in its network and is urging those impacted by the clawbacks to call its provider services hotline at 1-800-488-0134. Providers should then reference the numerical ID on the bottom of the letters they received from CareSource.
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