LINCOLN - The envelope didn’t surprise Dru McMillan. But when she opened the letter and read the number, she felt sick.

“If you agree with the determination, please submit a draft in the amount of $21,042.73 within 30 days,” it read.

McMillan is a Lincoln therapist. She has long served a majority of patients who use Medicaid, the government-funded cheap or free insurance, to pay for mental health care.

The letter came from an auditor working for one of three massive insurance companies the State of Nebraska is paying $4.25 billion, over six years, to oversee the state’s Medicaid program. It accused McMillan, through various technical measures, of overbilling the government for services she provided her patients.

Since May the organization has surveyed 126 mental health providers and found about 20% are so unhappy with the state’s Medicaid program that they plan to leave it. The bureaucracy of Medicaid is a hassle, Vandercoy said. Audit anxiety might push more away, even as Nebraska struggles with a shortage of mental health providers.

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