One Day I'll Be A Medicaid Provider
"I have tried so many times..."
I feel really bad about the fact that I don't take Medicaid. (Here we call it MaineCare.) Providers and facilities not accepting Medicaid has created an artificial shortage of care for Medicaid members. It also creates class-based segregation in care, which is particularly obvious in addiction treatment. I do not want to be part of this problem! So when someone tries to refer me a MaineCare client, I launch into the kind of story no one wants to hear: of a bureaucratic-technological-administrative maze. Or is it a trap? All I know is that I can't get out. Or, I guess, I can't get in.
I have been trying to credential as a MaineCare provider since I opened my solo practice three years ago. (I like to call it "solo" rather than "private" because we don't need any more private resources.) During that time, I've been seeing an undisclosed number of MaineCare members for free because it's illegal for me to charge them anything out of pocket (for reasons I think are valid). If I ever manage to become a MaineCare provider, the state will start paying me for these services and I will be able to work with more low-income and poor clients. Isn't the state supposed to care about that?
A lot of solo therapists don't take any insurance because they don't want the hassle of third-party billing or don't like insurers' reimbursement rates. Among those who do take insurance, many specifically don't take Medicaid due to even lower rates and/or far more required paperwork for each client. And it seems just about everyone who does accept third-party payments hires out the work of credentialing– becoming an in-network provider for each payer– and billing.
I do all my own admin work. And generally, I don't find it that hard. I'm also willing to do all the extra MaineCare paperwork; I'm familiar with it from working in community agencies. The people who use public insurance generally can't outsource their administrative burden, so I feel some solidarity in keeping my own as a provider.
But so far, I estimate that I have submitted my provider enrollment application about ten times, and I still can't get credentialed. The process is far more complicated than with private insurers:
Each of the tabs you see represents multiple forms to complete, and numerous supporting documents are required. As you move through the data fields, you might see your completion percentage inexplicably drop. My best guess is that it auto-deletes answers because every time I have called the enrollment help-line the poor staffer has coached me in artful and counterintuitive techniques for saving my inputs. This is not a system built to work.
Timeline Of Attempts
2023: My practice's first year. The red tape poses a learning curve, and I admit I'm scared off by the MaineCare enrollment process at this stage. I start seeing members for free and figure I'll deal with it later.
2024: I submit a complete application, but it's rejected for unclear reasons. After contacting five different people trying to identify the problem, I find out that I used the wrong combination of business entity and NPI number. (NPI = National Provider Identifier; I have to have both an individual NPI and a "group" NPI since my practice could technically involve other providers.) This data cannot be edited, so my entire application is deleted and I have to resubmit it under the new instructions. Then the revised combination is also rejected and deleted--they want me to resubmit using my original data. I do so, but the specifications change again, resulting in another rejection and deletion. At this point I need a break, but vow to try again.
2025: I submit a complete application but get an email saying I need to remove the space in my license number. The number on my license document includes this space, but the system "can't verify" with the space in it. After a multi-step process in making the data field for my license number editable, I am able to remove the space and resubmit the application.
And...this brings us to the present. Can she do it? Stay tuned!
I appreciate your witness in my tremendous waste of time and effort. But more importantly, patients' obstacles to getting care are our obstacles to providing care. And the process I described here is nothing compared to what many patients go through. I won't go so far as to say that the state wants to make it as hard as possible for providers to enroll with Medicaid, to deter members from actually using their benefits. But the enrollment system is so faulty and under-resourced that this might as well be its purpose.
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