\u201cThis is how we keep the lights on; this is how we pay utilities. This is how we pay our taxes. This is how we function,\u201d Lord said.<\/p>\n
Also, something didn\u2019t sit right with Lord about the letter\u2019s explanation of mirroring Vermont Medicaid rates for mental health: The state\u2019s program for lower-income Vermonters has paid the same rate for all of Eden Valley\u2019s practitioners, licensed or not.<\/p>\n
\u201cThe insinuation that we have been overpaid all of these years is quite scary,\u201d Lord added.\u00a0<\/p>\n
In the days that followed, mental health providers in and around Burlington quickly rallied against that Blue Cross Blue Shield of VT proposal. They circulated a protest form letter among patients<\/a> and other clinicians<\/a> and on the popular Burlington Facebook group Sensi-Babeington. The letters said that the reduction would result in fewer therapists entering training and even further reducing the number of therapists and social workers in a state where they are already scarce, particularly those who take insurance.<\/p>\n This week Blue Cross Blue Shield of VT informed mental health providers that it would pause implementation of the policy to gather more information.\u00a0<\/p>\n \u201cWe\u2019ve received feedback from some of our network providers who disagree with the change, and we take that feedback seriously,\u201d company Vice President Andrew Garland said in an emailed statement to VTDigger.<\/p>\n \u201cWe think we have this right, but we are going to postpone the policy start date so we have more time to discuss the policy change with our network providers and community leaders,\u201d he wrote.<\/p>\n (Mis)alignment with Medicaid<\/p>\n The licensure process is an important part of consumer protection, said Lynn Currier, a licensed inpatient clinical social worker and the executive director of the Vermont and New Hampshire chapters of the National Association of Social Workers.\u00a0<\/p>\n The process ensures that practitioners have passed their qualifying exam and that they are participating in the continuing education required to maintain a license, she said.<\/p>\n \u201cWhen I look at Blue Cross Blue Shield\u2019s reasoning, (and) that they\u2019re seeing people who never get out of the trainee status, they\u2019re not wrong,\u201d Currier said. \u201cThere are clinicians who\u2019ve been working decades without a license, because they can work under the license of somebody else, and that\u2019s a problem.\u201d\u00a0<\/p>\n But ensuring that insurers and regulators have the tools to assess a provider\u2019s licensure status is complicated.\u00a0<\/p>\n One issue is that many types of mental health professionals can practice in the state of Vermont without a license, explained Lauren Hibbert, deputy secretary of state. To practice this way, a provider is required to enroll in what her office calls the roster of non-licensed, non-certified clinicians, giving the state a way outside of licensure to monitor who is providing mental health care in Vermont.\u00a0<\/p>\n Some of the mental health professionals on the roster have degrees in psychology, social work or counseling and are working toward full licensure. To achieve that, a trainee must log around two years of practice, meeting with clients and providing clinical care under the supervision of an already-licensed clinician.\u00a0<\/p>\n Another group of therapists on the roster may be career-long unlicensed practitioners, who might offer different kinds of mental health therapy, may not be able to pass the licensure exam, or may have not completed their education. There are many mental health care professionals who may never intend to pursue licensure, Hibbert said.<\/p>\n The distinction between the two tracks \u2014 those who are working toward licensure and those who stay in this unlicensed, rostered status for long periods \u2014 can easily become muddled.\u00a0<\/p>\n Blue Cross Blue Shield\u2019s Weigel wrote that the reduction in reimbursements for pre-licensed clinicians \u201caligns with Medicaid to create consistency, reduce incentives for trainees to remain unlicensed, and focus resources on high-quality, well-supervised care that benefits members.\u201d<\/p>\n But, in fact, it did not align with Medicaid\u2019s rates for unlicensed therapists.<\/p>\n Vermont Medicaid does indeed reimburse many trainees at 76% of the program\u2019s set fee schedule, which does seem to parallel what BCBS VT initially proposed. But, the state program also reimburses many fully licensed therapists the same percentage.<\/p>\n Medicaid distinguishes its billing rates based on the provider\u2019s education status, not their licensure status, explained Alex McCracken, a spokesperson for the Department of Vermont Health Access, which administers Medicaid.\u00a0<\/p>\n A psychiatric physician or nurse practitioner receives 100% of the Medicaid set rate for a clinical mental health service<\/a>. A psychologist with a PhD receives 93% of that full fee; a psychologist with a master\u2019s level degree receives 76% of that allowed amount. This is true regardless of whether they have achieved their license yet.\u00a0<\/p>\n This has been the case since the inception of this supervised billing structure, nearly a decade ago, in 2016, McCracken said. DVHA has no plans to change that, she added.<\/p>\n \u2018We need to get this right\u2019<\/p>\n Still, the concerns of long-rostered, unlicensed clinicians that Blue Cross Blue Shield initially set out to address remain.<\/p>\n Both DVHA and the state\u2019s Office of Professional Regulation are trying to make it easier to tell who is working toward their license and for how long, officials there said.\u00a0<\/p>\n![\"A](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/Savannah-Lord-1200x960.jpeg\")
Savannah Lord. Courtesy photo<\/p>\n