Many mental health providers must now change the way they help people.
According to the Virginia Department of Medical Assistance services, it's a way to save money and still provide quality care.
Providers say the changes could make it tougher for those on Medicaid to get help with their mental illness.
Many of the people who work with the poor and mentally ill agree something needs to be done to curb state spending on Medicaid.
But they also feel strongly that the state's plan could be devastating.
"There probably will be at least 25% of the people who receive this service who are going to lose it," one provider estimates.
There are several organizations that say they advocate for the mentally ill who are poor.
As of December 1st an emergency ordinance from the state now requires they change how they advocate; something many say is for the worse.
An emergency ordinance says there is no public debate.
"Really, the biggest change is needing documentation of prior mental health treatment for our clients before we're able to start services with them," said Alyce Dantzler with EHS support services.
The new rules say that in order to continue receiving mental health services, patients have to show they've either been in a psychiatric hospital or received a note from a doctor saying they need help.
Many of these Medicaid recipients don't have phones or access to the internet so getting in touch with doctors is a challenge for everyone.
"Many of these clients are homeless, we have no way to stay in touch with them between when we get that assessment and when we get that documentation and that's going to result in them not getting services," Dantzler added.
Aside from providing documentation, providers say they won't be allowed to help clients like they used to.
"Before we could teach them coping skills to handle the depression first, build that therapeutic relationship with them through clinical measures and then be able to work on skills training they need," she said.
Now, providers can only do the skills training.
The state says it's still teaching the mentally ill how to be contributing members of society.
Providers say it's nowhere near enough.
"If you don't have that therapeutic base, you're really just treating the symptom and not the illness itself and then you're not going to have long term success," Dantzler said.
Each of the providers we spoke to say there are plenty of providers out there who do cheat the system to make more money.
These providers suggest state audits of the quality of care.
They say that will mean saving money and patients receiving better care.