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Naturopaths not signing up to be Medicaid providers

The expansion of Medicaid in Washington state includes a change allowing licensed naturopathic physicians to function as primary-care providers for patients in the state’s Apple Health (Medicaid) program. In Kitsap County, however, naturopaths are passing on the opportunity to enroll as Medicaid providers.

Washington is one of only three states that allow Medicaid patients to choose naturopaths for their care. The inclusion of naturopaths is regarded as one way to help meet the need for more primary-care physicians since many more people now have health insurance under the Affordable Care Act and its expansion of Medicaid, the federal program that covers mainly lower-income people.

Among reasons cited by naturopaths for not signing up to take Medicaid patients are the costs involved in joining the system, and the low reimbursement rates.

“I am not taking Medicaid patients in my practice, despite an overwhelming positive response from those who have Medicaid,” said Dr. Katherine Barkshire of Bremerton. “The problem I am having is the cost of the infrastructure needed. I am a very small practice and have not yet changed over to the systems required by the federal government to process Medicaid patients.

“Naturopaths were not included in the financial assistance provided by the federal government to other health providers to upgrade their infrastructure.”

She views the naturopathic care option for Medicaid patients as a positive step, though.

“Naturopaths are primary care providers in the state of Washington and already fulfilling the provider shortage issues,” Barkshire said. “I view allowing Medicaid patients to see naturopaths a plus for all.” 

A recent Associated Press article reported that “Officials with the state Health Care Authority say that about 200 naturopaths are enrolled in Medicaid either through the state, or through the five Medicaid-managed care plans in the state.” There are more than 800 licensed naturopaths in Washington.

The website of the state Health Care Authority lists no naturopaths in Kitsap County as contracted providers for Washington Apple Health/Medicaid clients.

Dr. Ruth Urand, who operates Sound Naturopathic Clinic in Poulsbo, said her clinic is not currently accepting Medicaid patients, primarily due to the additional overhead costs it would impose.

“I have a very busy practice with one employee and we share the administrative workload, which is already in overload mode,” she said. “With Medicaid it would be necessary to hire someone to handle insurance billing.”

Dr. Stephen Speidel also said his busy practice in Poulsbo would not benefit financially from taking Medicaid patients, although like other naturopaths, he’s had requests from people with Medicaid coverage who are interested in receiving primary care.

“I’m completely booked for 10 hours a day, several weeks out, so having access to a greater pool of patients through Medicaid at a lower reimbursement rate isn’t to my economic advantage at all,” Speidel said. “Naturally, though, my primary goal is helping people, not profit.”

One way he does that is by offering discounts to military personnel and their families, whose TriCare coverage doesn’t cover naturopathic care.

Ruth Bowen, office manager at Speidel’s clinic, also said many patients are government employees, and during last year’s federal government shutdown Speidel did not collect payments from any affected patients until they were getting paid again.

One other consideration for Speidel is that Medicaid patients, although they could get office visits covered, would struggle to afford the full cost of a naturopathic care regimen. A naturopath’s approach to healing and good health de-emphasizes prescription drugs and may include vitamins, tinctures, herbs, etc., that would not be paid for by typical prescription coverage.

Even though he’s not going to be a Medicaid provider, a major change is coming to Speidel’s practice that will help expand access to naturopathic care. 

He’s been in the same small office for 28 years, but is preparing to move in July into a new 7,000-square-foot building on 10th Avenue just east of State Route 305. With the additional space, he plans to bring on another naturopath as well as other practitioners — an acupunturist, chiropractor, massage therapist and physical therapist. 

A former patient of Speidel’s who lives in San Diego and is considering a return to Poulsbo is interested in joining the practice. His credentials include a naturopath license and an M.D. degree.

Speidel, 62, wants to spend more time researching natural treatments for diseases, and he plans to bring in young naturopaths who have finished their medical education and mentor them as they start their careers.

“He wants to train the next generation of naturopaths,” Bowen said.

 

 
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