TCC lays off 45 employees amid financial strain, Medicaid changes

PORTSMOUTH, Ohio — The Counseling Center eliminated 45 positions this month, as the Portsmouth behavioral health provider faces financial pressure from declining client numbers and continuing challenges with insurance and Medicaid processes.

TCC announced the reduction in force, saying the decision was necessary after the organization considered other options for addressing its financial situation.

"Unfortunately, TCC implemented a reduction in force this week due to continued census declines and ongoing challenges with insurance processes," TCC said in a statement on Aug. 13. "This was an extremely difficult decision that was not made lightly."

The layoffs come as behavioral health providers across Ohio navigate changes to Medicaid managed care, reimbursement policies and insurance authorization requirements.

TCC did not specifically attribute the 45 layoffs to federal or state budget cuts;, however, the organization cited insurance processes and declining census as two of the factors contributing to its financial difficulties.

Those challenges come amid significant changes to Ohio's Medicaid system.

Ohio Medicaid implemented new utilization-management policies for community behavioral health and substance use disorder services beginning July 1. The changes established additional requirements intended to ensure that services are medically appropriate and that Medicaid spending is properly managed.

Ohio Medicaid's managed-care system has also been the subject of controversy this year after CareSource, one of the state's largest Medicaid managed-care organizations, announced changes affecting payments to certain behavioral health providers.

CareSource said in April that some providers had been reimbursed at rates that did not align with its interpretation of applicable billing rules. The company initially planned to reduce future payments to 85% of the previous rate and seek repayment of certain payments dating to 2024. After criticism from providers and concerns about the potential effect on patients, CareSource reversed its decision to seek the retroactive repayments but continued with the reimbursement changes going forward.

Reimbursement changes, rules

The developments have added another layer of financial uncertainty for behavioral health organizations that rely heavily on Medicaid reimbursements to provide services.

Jodie Gullet, a former TCC employee who was among those affected by the layoffs, said changes involving managed care organizations and Medicaid rules have contributed to financial pressure on behavioral health providers.

"With the MCO changes and the different, you know, the difference that they've come up with in the Medicaid rules and all the stipulations and whatnot, the company would have had to have made cuts to be able to survive and not go under," Gullet said.

Gullet said the cost of providing care makes financial stability particularly difficult for organizations serving people with behavioral health needs.

"Treating our clients and providing them the care that they deserve and need costs money," she said.

The layoffs are also occurring against the backdrop of broader changes to federal Medicaid policy under President Donald Trump.

The Trump administration has pursued policies aimed at reducing federal Medicaid spending and changing eligibility and coverage rules. The administration also recently finalized a policy that will prevent states from receiving federal Medicaid funding for certain gender-affirming treatment beginning in October.

Ohio's Republican-controlled Legislature has also made Medicaid spending and oversight a significant issue during the state's current budget cycle. The state's most recent operating budget includes changes affecting Medicaid administration and provider payments, while Ohio Medicaid continues to modify reimbursement and utilization policies for behavioral health services.

Looking to the future

For TCC, however, the immediate financial problem extends beyond any single policy change.

The organization said its leadership, executive board and legal counsel are reviewing costs and operations in an effort to ensure its long-term sustainability.

"The reduction in force affected 45 valued team members across several areas of the organization," TCC said. "TCC has offered severance benefits to those impacted and remains committed to supporting them through this difficult transition."

Gullet said her experience working for TCC was positive, despite the circumstances surrounding her departure.

"I was treated very well," she said. "My supervisors and even my above supervisors was very good to me."

Gullet said supervisors worked with her when personal circumstances affected her ability to work and provided her with time off when she needed it.

"It was really a nice place to work," she said.

Gullet also rejected criticism circulating online that TCC's decision to eliminate positions demonstrated that the organization did not care about its employees.

"That's so untrue," she said.

TCC said it does not anticipate additional workforce reductions in the immediate future, although officials acknowledged that the effects of insurance industry changes and client census trends remain difficult to predict.

"While we do not anticipate additional workforce reductions in the immediate future, the ongoing effects of insurance industry changes and census trends remain difficult to predict," TCC said.

The organization said it will continue evaluating its operations while attempting to maintain services for its clients and patients.

TCC said its priority remains maintaining the quality of care while navigating the financial pressures facing the organization.

"We remain deeply committed to our clients, patients, employees, families, and the broader community," TCC said. "We will continue working diligently to maintain stability, navigate these challenges responsibly, and fulfill our mission of providing exceptional care and services."