Danielle Fazio: Keeping her Clients Calm Amid Medicaid Cuts

Danielle Fazio is a private mental health trauma therapist based in Wilmington, North Carolina. Since starting her practice just over a year ago, she has become one of only eight private providers in her area who accept Medicaid. Danielle specializes in treating trauma as well as anxiety disorders. About 60 to 75 percent of her patients rely on Medicaid to access the care they need.

When news of Medicaid funding cuts began circulating, Danielle approached the situation with care and intention. She researched North Carolina’s laws and policies to understand what was unfolding. Aware of how easily fear can escalate, especially among those already managing mental health challenges, Danielle made it a priority to communicate calmly and clearly with clients. “I don’t want my clients to be scared, so I give them a very grounded perspective of what’s happening in North Carolina.” She added, “My clients would come into the session and be like ‘Well am I getting my services cut? Will I not see you anymore? And I’m like, ‘From what I hear, no, your services won’t be affected.’ I’m not even mentioning what’s happening in the future. I’m staying in the present moment right now, because I don’t want them to spiral mentally. I just try to keep everyone calm.”

Despite this calm outlook, Danielle is concerned about legislation that would require Medicaid recipients to work or volunteer 20 hours per week to keep their benefits. She knows firsthand how difficult this can be for people living with mental health conditions. “With mental health disorders, like anxiety or depression, it may impede functioning day to day. You may not be able to function at school, work, or home,” she explains. “It’s a neurobiological thing. There is a lot of nuance with it,” she said. “Each patient might have a different struggle, and they may not necessarily be on disability or caretaking.”

Danielle also worries about Medicaid-funded programs that provide essential services beyond direct therapy. She shares a recent example from North Carolina where the Healthy Opportunities Pilot (HOP), a comprehensive program to test and evaluate the impact of providing select evidence-based, non-medical interventions related to housing, food, transportation and interpersonal safety and toxic stress to high-needs Medicaid enrollees, was cut. “I’m more worried about the programs, not necessarily the individual providers,” she says. These cuts can leave vulnerable people without the support systems they depend on.

For now, Danielle remains focused on continuing to provide care and staying grounded through the uncertainty. She has prepared backup plans, including possibly shifting toward private pay services, but prioritizes keeping her clients calm and supported. “If I have to, I’m going to shift toward private services, but for the time being I’m just trying to stay grounded and calm for my clients, “she said. “If issues come up, then I’ll work with them. We’ll figure out a way for them to still get services or advocate for disability,” she shares.

Danielle’s story shines a light on the realities behind Medicaid cuts, the direct impact on providers and the families they serve. Through her thoughtful approach and dedication, she offers hope and steady care in a time of confusion and concern.