When it comes to North Carolina’s approach to behavioral care, “Y’all never stick with one thing,” New York state mental health commissioner Mike Hogan said last summer.
His advice: “Stay the course.”
North Carolina has launched three major reforms since 2001 and, according to Hogan and others, has never stuck with anything long enough to see if it works.
For years, local governments ran so-called “area programs,” which coordinated mental health treatment for residents in a county or area. The programs had contracts with some providers and also had clinicians on staff.
In 1999, the U.S. Supreme Court ordered state mental health systems to have a local and non-restrictive focus.
In response, the state in 2001 cut its 39 area programs to 20 Local Management Entities, or LMEs. Instead of caring for patients in staff-run clinics, the LMEs oversaw care by certifying providers and reimbursing them.
The 2001 law failed on many levels. Supporting high-level services in rural areas proved difficult, and some large providers failed or stopped some services. Some were billing Medicaid for taking children on outings and helping with their homework. The state wasted millions.
From 2007 on, the state put more limits on services and more restrictions on providers. But Medicaid costs were still unpredictable.
In 2011, the state passed a law requiring all counties to organize into Managed Care Organizations, or MCOs, by this year. These districts get state and Medicaid money and are responsible for managing treatment within a budget.
The MCOs choose providers, oversee their work and evaluate patient progress. The providers bill the MCOs instead of the state.
MeckLINK, Mecklenburg’s MCO, started March 1. It has a $280 million budget and manages a network of nearly 400 providers.
Its birth was a noisy one. It was organized in eight months instead of the two years other MCOs had. Earlier this year, a state official moved MeckLINK’s money to another company because of fears about its readiness. The county appealed; MeckLINK passed two inspections, and the money was returned.
Executive Director Phil Endress expects MeckLINK to handle up to 4,000 calls a month. He says it will get quality and affordable care to those who need it. He describes the state’s new approach as “good policy, good science and good economics.”
Lynn Bonner of the News & Observer contributed.
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