Morning Zen

North Carolina moving way too fast with Medicaid consolidation efforts

April 18, 2013

Holy smokes – if you live in North Carolina, it is best not to take a nap or close your eyes for a minute – cuz things are changin’ much too quickly for our liking. Here is the latest…

Medicaid overhaul (no, Tar Heels ain’t expandin’)
With much fanfare, Governor McCrory announced that North Carolina would not expand Medicaid, they would “fix” it instead. In what some consider a bold stroke (and what we consider not as well thought out as it should be) the Governor laid out a plan to create “comprehensive care entities”, four to be exact, who would be responsible for helping patients navigate the health care system. Read the press release here.

Okay, so what does that really mean?
Pretty simple – it means that McCrory’s plan would put three to four for-profit companies or nonprofit agencies in charge of all aspects of the state’s $13 billion Medicaid program – physical, behavioral and dental. The rationale is to create a system that treats the “whole person” with integrated services. On the surface, the goal sounds pretty plausible, right? But it’s the “Gettin’ there” that may be a bit problematic.

Read the Bill introduced into the General Assembly proposing a unified public health system that would consolidate mental health into the public health domain here.

What concerns the Children’s Mental Health Network
For starters, North Carolina has been through consolidation efforts before. For a trip down memory lane on previous attempts to streamline consider this excerpt from a report by In the Public Interest:

  • In 2001, North Carolina’s General Assembly passed the “Mental Health System Reform Act,” which required local jurisdictions to separate the management of mental health services from the delivery of those services. Previously, local entities such as counties and regional agencies delivered mental health services by directly employing the care providers. The 2001 law required the governmental local management entities (LMEs) to contract with private providers to serve area residents who needed mental health services. The local counties and regions no longer directly controlled the provision of services, but instead were responsible for managing provider contracts.    

    Shortly after the new system was put in place, numerous problems occurred. Many highly trained mental health care workers left the field as private providers took control of service delivery, decimating the professional public-sector workforce.  Furthermore, the fragmented system created through privatization had a tremendous negative impact on the quality of services provided to clients. Many times, important mental health services were no longer even available to clients. Private providers engaged in “cherry-picking,” offering only the most profitable services, such as “community support” services. These services include basic assistance and mentoring, and such tasks as running errands for a client or helping with a child’s homework. They could be performed by low-paid, unlicensed personnel. Many providers focus on these highly profitable community support services and left seriously ill clients without the more costly care they needed.

    Reports of cost overruns estimate that the state wasted at least $400 million in community support services offered by private providers that were unnecessary for the client or not even performed. As a result of the in treatment offered by the private providers, the number of North Carolinians with mental illness who ended up in emergency rooms or jails significantly increased.         

Ironically, on the same day Governor McCrory was laying out his plan and justifying why privatizing the Medicaid system was necessary, North Carolina’s U.S. Senator Richard Burr was giving out a national award to N.C. Medicaid for significantly lowering costs while delivering extremely high-quality care. Huh?

Governor McCrory’s #1 claim as to why North Carolina should pursue the privatization route is that “[NC Medicaid Community Care] does not focus on measuring and improving overall health outcomes for recipients.”

 Yet a look at a recent study last year of how children and others on NC Medicaid are using health services found numerous examples of better outcomes. Community Care of North Carolina has both a detailed process for measuring quality of care delivered by providers statewide and for encouraging better quality– the “Quality Measurement and Feedback” program.

So, for us at the Network, we find ourselves repeating the phrase made famous by songwriter Ian Hunter, “Once bitten, twice shy.” It sure does feel like North Carolina may be headed down the same road as in 2001, only this time on a grander scale. We will be watching closely to see how they plan to overcome the debacle know as mental health reform a mere 12 years ago. Whatever steps are taken to improve access to care need to be open, transparent and include plenty of time for input from community members.

  • Network faithful – if you are seeing this type of rapid change in your state, let us know. We are very interested in tracking how these rapid-fire initiatives end up impacting children, youth and families and those who serve them.

Scott Bryant-Comstock
President & CEO

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