Do you know why licensed social workers can bill for Medicaid, but licensed counselors cannot?

Medicaid has an exhaustive list of things and practitioners they will cover and what and who they won’t cover. Apparently LPCs are not considered to provide appropriate care, or useful care. Only social workers will do, says Medicaid.

This list is huge and it contains all kinds of rules, and changing the rules is very difficult. So they may even know the LPCs are out there, and that their care is fine, but be unable to change the rules. But it is almost certainly Medicaid rules that remain, justifiably or not, because of the slowness of the bureacracy.

@wundayatta It’s really silly because the work I do is paid for by medicaid…I just can’t fill out the paperwork to bill for it (which prevents me from being a supervisor). If they thought LPC could not provide appropriate care, then they shouldn’t hire LPCs for the jobs. There is no logic in the way things are set up right now.

Are you talking about MSW – - Masters Social Work. That is an educational requirement.

LCSW (licensed clinical social workers) are most similar to LPC’s (licensed private counselors). Both require a Master’s degrees and a test as well as supervised direct contact hours in order to obtain licensure. (I think LPCs actually have more hours in which they are supervised before being licensed) Both work in the same jobs (I am in a job now with some social workers, doing the same work…but my ceiling for advancement in this particular job is lower due to medicaid billing restricitions.) Why can one bill and the other can’t? They are clinically similar. I just don’t get it- why the discrepancy? Technically, one of my social worker co-workers could bill for the hours that I work.

If I were to get a job as a supervisor in my current job, The agency would have to hire a social worker in order to bill medicaid…..

Only the Medicare rule makers know the answer to that. It is most likely a bureaucratic blooper.

I believe our LPC’s billed medicaid when I worked mental health and I even billed medicaid as a “social services representative” when I worked hospice. A different name for a person doing social work without a social work license. This was all about the time they began to require a license for social workers.

I don’t know what states you all live in, but in Ohio a licensed independent social worker with a supervisor endorsement cannot directly bill Medicaid for services rendered. We had to file for something called an I/O (Individual Options) waiver. In this program, persons with developmental disabilities can use state money given to counties for clients who qualify. We have clients on Medicaid who are not disabled and they can come to see us if they have other insurance which is working with medicaid, like Buckeye Health or CareSource, or Medicare, (which is billable by u s), OR, they must be supervised by an MD, or PhD psychologist, and they must monitor our charts for those patients. That is NOT a free service generally. So if anyone out there knows how we can bill Medicaid directly for non-challenged patients, contact me, I would like to know how. Besides Medicaid pays very little for services, as does Medicare, so what’s the rush?