New NASW-VT Legislative Committee Forms

NASW-VT is re-forming a legislative committee to monitor Vermont legislation and to speak out on issues of concern to you and to your communities. We welcome more members and will be calling on you to help communicate with YOUR representatives in the legislature. This may sound harder than it is--Vermont's policymakers are very accessible, in person, on the phone, and by email. They welcome constructive opinions from their constituents and appreciate receiving background information on issues.

The Legislative Committee will identify high-priority issues that are of interest to social workers and that are issues of social justice.  On high priority issues, we hope to develop brief talking points reflecting our position and then offer those summaries to you to help you communicate with your legislators.

Most of the work will be conducted by conference call and on-line, using email and the Vermont Legislative website (http:/www.leg.state.vt.us). So your location does not have to preclude participation!

If you are aware of specific bills that have been or will be introduced or of issues we should look for, please communicate by email to us through: naswvt@naswvt.org.

Volunteers for the Committee (to date) are:  Sarah Kunz Robinson (Winooski - Board member), Julia Markiesian (Windsor), Kathleen Lehn (Burlington), Sam Conant (Colchester), and Rilla Murray (Montpelier).  Members of the Committee attended a one-day Lobbying and Commuications Bootcamp on November 15 at the State House in Montpelier. The workshop was offered by CommonGood VT to non-profit organizations in the state.

Medicaid Provider Tax Under Study for Vermont

As part of the "health care reform" legislation enacted in the 2010-2011 legislative session, the State of Vermont (DVHA) has contracted with Pacific Health Group (PHG) to undertake a broad-based study of the financial feasibility of assessing taxes on all the categories of Medicaid providers permitted by the federal government. This includes Licensed Clinical Social Workers and other licensed groups that provide "psychological services" to Medicaid enrollees (LMHCs, LMFTs, Lic. Psy. MA, Lic. Psy. Doctorate, Psychiatrists).

The study focuses solely on what is permissible under federal law and how much income additional taxes would yield as a basis for Medicaid match.  The idea is to estimate the amount and provide a defensible methodology for a fair approach to this taxation so that the State of Vermont could draw down additional federal dollars in Medicaid match (state tax must come from tax revenues). Changes in taxes of any kind must be authorized by the legislature and must begin in the House of Representatives. The study does not include policy implications or political feasibility.

While such a tax must be assessed on all providers in a licensing class (a federal requirement), some of this tax (but not all) could be used to increase reimbursements to licensees who accept Medicaid clients. However, increased reimbursement would be an administrative, not a legislative, decision.

NASW-VT's Executive Director, Rilla Murray, was consulted by PHG in this regard both for the purposes of informing us and inquiring as to reliable sources of data on which to base the methodology for taxation. We have been in conversation with all the other mental health professional associations, who have also discussed the study with PHG. The study report is due to the legislature by January 15, 2012.

There are a number of questions and concerns we voiced with regard to taxes on LICSW license-holders.  First, not all persons holding n LICSW are doing fee-for-service clinical work.  A fair number are employed on a salaried basis by the state, hospitals, health centers, mental health centers, etc. Others hold the license but are employed in administrative positions or are retired. Thus the federal requirement that the tax be levied in a manner which is fair raises numerous questions about taxing this class of providers.

There might also be a concern that a tax would be levied by one branch of government and the expected/promised increase in reimbursement might not be carried out by another branch of government.

More importantly, access to mental health services in Vermont is already inadequate, as witnessed by long waiting periods at mental health centers, anecdotal reports of full schedules, the state hospital crisis, and annual reports of the Act 129 Task Force. The private sector already provides over one-half the out-patient mental health care in the state.  If the idea is to attract more private providers to Medicaid, the increase in reimbursement may have to be substantial to attract those who do not now accept Medicaid. In our view, we should be asking legislators how provider taxes will expand access to MH care, which is the intent of a universal health care system.

We also  a workforce problem.  And as many as 40% of the LICSWs  in Vermont (largest group of licensed MH providers) expects to retire in less than five years.  We are not replacing these clinicians. Our graduate social work program produces generalists who take years to become skilled clinicians.  People in other states won't move here unless reimbursements and salaries are higher.

The NASW-VT Legislative Committee, under Sarah Robinson, will be tracking this issue and report to members during the session.

What you can do:

Contact your representative and tell him/her about your experiences as an LICSW and your position on this issue.

Watch your mail from NASW-VT for times when it would be most advantageous to speak out or come to Montpelier to testify, should there be a recommendation to tax LICSWs.