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Shortcomings invited mental health fight

Even so, Mecklenburg right to appeal state’s seizing Medicaid

If Mecklenburg County commissioners needed any reminder about what is at stake in their complex, bureaucratic tangle with the state over mental health money, the answer sat a few feet away.

North Carolina has stripped Mecklenburg of its authority over more than $200 million in Medicaid money. As commissioners and county staff hashed through that decision’s implications for hours Tuesday, patients with mental illness sat nearby. One burst out with uncontrollable yelps every minute or so. Another sat silently, hunched over, eyes closed, holding his guardian’s hand.

These are the helpless people whose lives are at the center of the current administrative dust-up.

It’s a dust-up that could have been avoided with a better performance from Mecklenburg County leaders. Given nearly three years to prepare, the county waited until the relative last minute to get moving. Now its procrastination has caught up with it, potentially costing the county millions of dollars and hundreds of people their jobs.

To save money, the state is moving toward a managed-care approach for mental health, substance abuse and developmental disability services. Mecklenburg voted in spring 2010 to create its own managed care organization, known as MeckLINK, to administer Medicaid money spent on Mecklenburg residents.

The county dragged its feet, though, not hiring a leader of the effort until August of 2012. MeckLINK chief Phil Endress and his team appear to have been working frantically since then to get ready by a state deadline of Feb. 1. But a consultant hired by the state, Mercer Government Human Services, warned in October that Mecklenburg was behind schedule.

Mecklenburg County Manager Harry Jones and his staff communicated inadequately with county commissioners on the county’s progress. On Dec. 31, outgoing Gov. Bev Perdue’s health secretary, Albert Delia, awarded control of the program to Cardinal Innovations Health Solutions in Kannapolis. Gov. Pat McCrory’s health secretary, Aldona Wos, stood by that decision last week.

By failing to convince state officials that its program was adequately developed, Mecklenburg created the setting that allowed this last-minute curveball.

That said, it’s not at all clear that Delia and Wos acted appropriately or legally. Charlotte lawyer Dan Bishop, who is representing Mecklenburg, makes a compelling case that they didn’t. Bishop argues that the state never gave Mecklenburg official notice that it faced a hard Feb. 1 deadline. He also says that Delia skipped a step by abruptly taking the program from Mecklenburg rather than first letting it collaborate on the effort with a state-approved partner.

Bishop raises questions that warrant a second look, and commissioners were right to vote to appeal the decision this week. Perhaps they can get the decision overturned; at a minimum they might recover some of the $3 million the county has already spent preparing.

Advocates and providers have raised questions about whether Cardinal would be a responsible overseer. Cardinal has an established track record and does this work for 15 other counties. We question whether any private entity, with an incentive to cut costs and boost profit, is best suited to care for some of society’s most needy. We value the efficiency a group like Cardinal could bring, but put the highest priority on best serving the consumers of these services.

Theoretically, such services are best provided locally, allowing for local oversight. Mecklenburg’s lack of credibility and performance, however – on this issue and so many others – muddies that question.

The whole episode attests, again, to the need for a board of county commissioners that aggressively fills its role of monitoring Jones and his staff and holding them accountable. Perhaps this new board, sworn in last month, is up to that task.

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