Caresource Payment Clawbacks Jeopardize Behavioral Healthcare Access across Ohio

OHIO - Behavioral health providers across Ohio are reeling after a sudden decision by CareSource to slash reimbursement rates and demand repayment of funds from the past two years-shifting the financial burden of its own error onto the very providers sustaining the state's mental health system. Providers were formally notified of the 15% rate reduction and retroactive recoupment of payments, a process known as a "clawback," just this week, though clawbacks had already begun. The impact is immediate and severe: providers will be paid significantly less for delivering the same services moving forward, while also being required to repay funds CareSource now claims were overpaid due to its own rate miscalculation.

Behavioral health practices are reporting a wide range of financial impacts, from clawbacks of $6,000 to over $100,000. With potential recoupment amounts so large, behavioral health providers are already considering whether they will need to close their practices due to the financial losses. Samantha Willi, LPCC-S, owner of CLE Counseling & Wellness Center, states that, "Upon conducting an internal audit, we have identified 5,886 claims that appear to be impacted as of April 21, 2026, representing an estimated total of over $95,000 in potential recoupments."

There are significant concerns about downstream effects on access to care, particularly as clinicians reassess their willingness to accept Medicaid clients amid financial instability and uncertainty. For Medicaid users seeking care, these dynamics can translate into reduced provider availability, longer wait times, and increased barriers to accessing timely and appropriate behavioral health services. NASW Ohio has heard from many providers who fear closure, and the effects it will have on their community.

"I am a solo practitioner, and this is my only career and my only source of steady income," private practice owner, Adina L. Fox, LISW-S, stated. "This recoupment will be devastating financially. I may have to work a second job to make up for the money taken by CareSource," she said. "CareSource's actions will also negatively affect CareSource Members, as some practitioners will have to close due to the recoupments, and other practitioners may choose not to take new CareSource clients."

With 75 of Ohio's 88 counties already designated as mental health professional shortage areas, this issue will exacerbate Ohio's behavioral health crisis. While Medicaid recipients may see the first impacts of this, it is likely to affect all Ohioans seeking care due to the large-scale disruption to the sustainability of Ohio's behavioral health workforce.

The National Association of Social Workers, Ohio Chapter (NASW Ohio), is organizing behavioral health providers and community members across Ohio to push back on CareSource's actions. Providers, organizations, and community members can sign NASW Ohio's petition to the Ohio Department of Medicaid at naswoh.org/CareSourcePetition. NASW Ohio is also organizing a protest outside of CareSource headquarters in Dayton, OH, on Friday, May 1st at 3 PM. Those planning to attend can RSVP at naswoh.org/CareSourceProtest.

The National Association of Social Workers (NASW), in Washington, DC, is the largest membership organization of professional social workers. It promotes, develops, and protects the practice of social work and social workers. NASW also seeks to enhance the well-being of individuals, families, and communities through its advocacy. If you would like more information, please reach out to NASW Ohio at [email protected] or call 614-461-4484.