NC lawmakers hand management of state’s mental health care system to DHHS secretary and hope for better results

By Taylor Knopf

North Carolina’s six local behavioral health management companies known as LME-MCO will soon undertake some significant restructuring.

Over the years, patients, their families and mental health advocates have filed repeated complaints about the lack of services some LME-MCOs provide and about the difficulties people experience in navigating the mental health system. State lawmakers also share the frustration of trying to hold organizations accountable when problems arise.

In 2013, North Carolina transitioned from a county-based system to a regional managed care system to provide behavioral health services to uninsured patients and Medicaid recipients. At the time, health leaders wanted to better organize the publicly funded behavioral health care system and save and use Medicaid dollars more effectively. But lawmakers have struggled to control local groups that manage state dollars and services. As community services began to dry up, complaints began to appear.

With the implementation of Medicaid managed care plans in 2021, some more treatable mental health patients have been included in these new standardized plans, which can handle those experiencing fairly common problems, like depression or anxiety. It is more difficult to treat people with severe and persistent mental health problems or people with intellectual and developmental disabilities who are expected to make appropriate plans to includes more targeted, in-depth services.

But the implementation of those tailored plans has been delayed multiple times.

State lawmakers have expressed frustration at the delay. There are also long-standing problems with how LME-MCO provides mental health services to children in foster care, sometimes hindering vulnerable children from getting help that they need.

The state budget passed by the General Assembly last month includes a large portion of policy changes on LME-MCO changes that ultimately give state Health and Human Services Secretaries the power to More control and supervision over teams. Secretary Kody Kinsley said his department is studying how to restructure the groups so they can focus on what they do best.

As mental health advocates wait to see how DHHS will restructure the groups, Disability Rights NC Public Policy Director Corye Dunn said she is eager to see the mental health system become publicly funded simplified to provide more options for people with disabilities. Her organization works to ensure better care for people with mental illness and disabilities.

Reduce the number of LME-MCOs

We have to improve the services that LME-MCO provides,” Rep. Donny Lambeth (R-Winston Salem) told NC Health News in an interview. I receive more complaints locally in my area about the lack of services the LME-MCO provides here than any other topic that could be a teacher problem.

Lambeth said he did not think some LME-MCOs would be financially viable long term and needed to reduce their numbers. Initially, there were 11 organizations statewide, but after the failure of one of the largest organizations in the Mountain West, the state pushed many organizations to merge. Now there are six companies, and two of them recently announced they would merge.

I will tell you that we spend a disproportionate amount of time throughout [state budget] Lambeth said the conference process was about LME-MCO. We weren’t completely convinced that we had the right solution.

Lambeth said lawmakers received significant feedback from LME-MCO as they discussed reducing group sizes during the budget negotiation period.

There are several LME-MCOs that provide excellent services. Lambeth added that people in those districts love the LME-MCO that serves them and they don’t want change. Change is often difficult and that is something we have to face.

As legislative budget negotiations concluded last month, Lambeth said lawmakers decided it would be best to give the DHHS secretary responsibility for deciding how many LME-MCOs there should be and how they should be structured. Bamboo them.

Dunn of Disability Rights said having too many LME-MCOs in the North Carolina system has caused problems for people with disabilities since the state moved to a managed care model.

It has created barriers to accessing care, depleted existing provider networks, and wasted money and other resources on duplicative functions, Dunn said. of employees statewide. Meanwhile, those who rely on those MCOs to access care will be stuck with whichever agency they are assigned to based solely on geography, the only population in our system There are no managed care organization options.

Lawmakers want specific changes

Sen. Jim Burgin (R-Angier) told NC Health News he is disappointed that LME-MCOs continue to delay coming up with appropriate plans, saying he does not believe they all see urgency.

Tailored plans are designed for individuals who need more extensive care and support than the average person with Medicaid coverage. Some uninsured people who once received care through LME-MCO will now be eligible for Medicaid, switching to those standardized plans. But the rest are those who will require more intensive management and resources.

Burgin said LME-MCO deals with the most fragile people in our society. When you talk about that population, you can’t get it wrong.

He added that we feel the Minister is the person closest to the situation to make those difficult decisions. This isn’t something he’s doing in a vacuum. We’ve all talked about it, worried about it and prayed about it, trying to make it work. But we feel like we’re moving in a direction where they will be responsive and accountable to all citizens.

With these changes to LME-MCO responsibilities, Burgin said state lawmakers want to see the successful launch of appropriate plans. Some LME-MCOs say they are ready to move forward.

“Successfully implementing these integrated health programs to better serve members and their families is our primary goal,” said Brian Perkins, senior vice president. president or strategic and government relations at Alliance Health, LME-MCO serves the Triangle region, as well as Cumberland and Mecklenburg counties.

Fundamentally, Alliance Health believes that a publicly managed care system is best for individuals in North Carolina. Perkins continued in an emailed statement to NC Health News. Throughout the state budget negotiations, it was encouraging to learn that many NC policymakers shared this belief and directed that the public system be restructured to ensure capacity and LME/MCOs will implement and operate Conformance Plans by July 1, 2024.

Joy Futrell, CEO of Trillium Health Resources serving the state’s easternmost counties, said she is pleased to see the General Assembly’s long-term commitment to the public health system and appropriate plans.

“We hope to be able to partner with new providers and stakeholders to begin serving residents soon to minimize confusion and ensure continuity of care for members and our recipient”.

In addition to coming up with appropriate plans, Burgin said state lawmakers want to see an improved Medicaid plan for children and families involved in foster care. The LME-MCO is responsible for providing services to this population and has been criticized for high-profile failures, including children with mental health needs having to live in emergency rooms and sleeping on the floors of social service offices.

The state budget includes the creation of a special statewide Medicaid program for children in foster care and their families that aims to integrate their physical and mental health care . LME-MCO has opposed similar proposals for years.

The state budget directs DHHS to issue a request for proposals from agencies that want to retain the statewide foster care plan contract, with new services to begin in December 2024.

As a result of these budget policy changes, Kinsley and his team at DHHS will now have more authority over the mental health services provided to the most vulnerable North Carolinians.

More authority for DHHS

We’re putting a huge burden on the secretary, but he knows we’re here to help him and solve this problem,” Burgin said. This is really a big problem and we will all focus on it.

Conversations about restructuring LME-MCO and holding them accountable to the people they serve have been going on for some time, Kinsley said, adding, “It’s great that we’ve outlined out the boundary and now we have moved forward.

DHHS is the exclusive payer for services provided by LME-MCO.

“It allows me as a payer to hold an entity responsible for a very focused mission over a very small population,” Kinsley said. When you talk to people across the state, everyone is happy with something LME-MCO is doing. For me, trying to hold them accountable for what they didn’t do is a struggle because under the law, they also get the contract regardless of their performance.

Kinsley said his department has analyzed the current LME-MCO system and will quickly make decisions on how to restructure them so people can specialize, focus and ultimately improve the system .

The LME-MCO representing the far western counties, Vaya Health, said in an emailed statement that the organization is confident that the secretary will carefully consider and make the best decision for its members, families, and families. families, providers, and counties to further strengthen public behavioral health systems and successfully launch appropriate plans.

As the state health department takes on more responsibilities, Kinsley said he still needs to invest more financially in his administrative team to run it all.

At the same time, he explained that a lot of the work the department does to get funding to community partners builds on existing strategies and can be scaled. He also applauded the rate increase that state lawmakers provided in the state budget for people working in state-run psychiatric facilities and some block grants to hire more administrators. subsidy contracts.

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