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After months of turmoil, MeckLINK still faces uncertainty

After 10 months of turmoil, MeckLINK Behavioral Healthcare could be headed for extinction and its thousands of consumers who depend on mental health services sent to Kannapolis-based Cardinal Innovations Healthcare.

That was the same managed-care organization that state health officials attempted to merge MeckLINK with in late December. Former acting N.C. Health and Human Services Secretary Albert Delia told Mecklenburg he was reassigning oversight of its millions of dollars in Medicaid money to Cardinal.

The county hired a lawyer and threatened to sue. Delia’s successor, current Secretary Aldona Wos, relented and allowed Mecklenburg County commissioners to continue operating MeckLINK.

But after legislators passed a law in June requiring a regional, independent authority to govern the agency, commissioners have grappled with what to do.

It has no leader, after its director, Phil Endress, left last month to take a job in New Jersey. Some providers have accused MeckLINK of not paying them, and no one knows the latitude the state will offer Mecklenburg if it does decide to create a one-county authority.

Under the legislation, the county’s options are few: Mecklenburg could create its own authority with an independent board that it chooses, a plan that likely would be too expensive and that the state apparently doesn’t like. Or it can merge the agency into an established organization like Cardinal, which oversees services for 15 counties.

If it’s the latter, some commissioners have said they want the merger to be with a group willing to give Mecklenburg say over the county’s Medicaid money.

At their meeting last week, commissioners instructed assistant County Manager Michelle Lancaster to negotiate with state health officials to find a workable solution – perhaps creating a hybrid authority where the county would appoint authority members but contract services to Cardinal or another managed-care organization.

In her discussions, Lancaster will try to include Cardinal and key legislators such as Republican Rep. Nelson Dollar of Raleigh, one of the June bill’s sponsors.

By November, she’ll report findings to a committee of four commissioners appointed by board Chairman Pat Cotham. The committee, in turn, will make recommendations to the board.

Commissioner Bill James voted against the committee idea and made it clear he wouldn’t vote for a single-county authority. He’s ready for the county to simply turn MeckLINK over to Cardinal.

“This is a dead man trying to negotiate with the Devil,” James said. “The state for some reason wants us to merge with Cardinal. … I’m not going to be a party to dragging this out.”

Cotham said she’s leaning in that direction. “We tried to make it work, but we got dealt a bad hand,” she said. “It’s getting time to fold up the tent. I would rather us spend this time helping the 200 (MeckLINK) employees, the citizens who need these services and the providers of those services and try to come up with a better deal for them.

“The state keeps changing the rules – it’s the state doing this. Not us.”

Still, some commissioners like Democrats Trevor Fuller and George Dunlap weren’t ready to walk away from MeckLINK.

“I just resist throwing up my hands until we’ve done the last thing we can do,” Fuller said. “I want us to be able to tell constituents that we tried everything we could do, but this is what we got and we’re going to make the the best of it.”

Accounting questioned

Meanwhile, the county continues to sink money into MeckLINK, about $90,000 a month, for administrative costs – after loaning it $8.4 million in start-up costs that the county may never get back.

Commissioners voted Tuesday to allow staff to account for the $8.4 million as in-kind services – and not a loan – to give the appearance that MeckLINK isn’t millions of dollars in the hole.

It’s an “honest (accounting) treatment,” assistant county manager Dena Diorio told the board.

James, a retired accountant, said he saw the practice as “dishonest” and on Wednesday emailed Cardinal, DHHS officials and Dollar that it “doesn’t change the fact that we are still owed the money and we are subsidizing MeckLINK in a significant way.”

He wrote the numbers MeckLINK is reporting to Raleigh “are mostly smoke and mirrors and the statistics used to show MeckLINK’s performance are not real.”

Some commissioners say the creative accounting gives the county more leverage to negotiate a better outcome for MeckLINK and to prevent the state from cancelling its contract with the agency and turning it over to Cardinal.

“Mostly this discussion seems about Mecklenburg County’s inability to pull the trigger and transfer MeckLINK,” James wrote. He added that part of the hesitation is political, and part is a reaction to how the Mecklenburg was treated by the legislature.

The county wants to be reimbursed the $8.4 million – if not from MeckLINK, then the state or Cardinal.

‘The forgotten 200’

Meanwhile, commissioners continue to hear unsettling reports about Cardinal from mental health consumers and advocates.

At the Tuesday meeting, Beverly Corpening, mother of a child with severe mental health issues, urged the board to pursue a singe-county authority.

Corpening said MeckLINK works.

“There are very few organizations that take the time to listen and actually follow-up to help,” she said. “No matter what anyone tells you, I know that MeckLINK has been a constant and dependable rock. I’ve tried every organization in existence … and I know what works and I do know that MeckLINK works.”

She said she didn’t understand why MeckLINK’s thousands of consumers would be turned over to an organization that is involved in lawsuits.

Cardinal has been the subject of a class-action lawsuit alleging the agency didn’t properly alert about 700 consumers that services were being cut. In March 2012, Federal District Judge Louise Flanagan sided with plaintiffs and filed an injunction against Cardinal that allows consumers to keep their Medicaid services.

Cardinal lost an appeal in May, and is still providing services to those consumers, said Doug Sea, a Charlotte attorney who handles Medicaid cases for Legal Services of Southern Piedmont.

Not only are consumers in limbo with MeckLINK’s fate, but so are the more than 200 employees that former director Endress rapidly hired to get the agency running and to meet state deadlines.

They’re calling themselves “the forgotten 200,” said MeckLINK worker Darren DuBose.

“Throughout the whole process, no one has talked about us,” DuBose told the board. “We come to work on a daily basis and have done our best for the people who cannot fight for themselves.

County wants ‘some control’

The board sent a questionnaire to three managed-care organizations interested in overseeing care for Mecklenburg’s 155,000 consumers and families. They got a response only from Cardinal.

The Kannpolis group wrote that it would hire some MeckLINK employees, but didn’t commit to how many.

It also didn’t commit to naming a Mecklenburg commissioner to its board, commissioner Fuller said.

“That’s why we want to hold some control,” he said. “They obviously want to run the show and don’t want any outside interference. There’s a lot at stake for a lot of our people, consumers and MeckLINK employees.”

Sea urged commissioners to take the single-county authority approach and keep MeckLINK, particularly at a time when Gov. Pat McCrory and state legislators are discussing a significant overhaul to the state’s Medicaid program.

Legislators ordered DHHS to prepare a Medicaid reform proposal by March 2014 – about the time governance of MeckLINK would have to be turned over to an authority with an independent board.

“I think Mecklenburg spent a lot of money and effort to create MeckLINK, and it’s perfectly possible to create an authority that complies with the legislation without doing away with MeckLINK, and having all these people lose their jobs and causing all this disruption to people who need its services,” Sea said.

Jane Wallwork, mother of a 39-year-old son with disabilities, suggested the county recruit another managed-care organization to join MeckLINK.

“That could be accomplished without diminishing the role of MeckLINK,” Wallwork said. “I’ve seen a difference with MeckLINK. I’ve met people who really care that my son’s needs are met and his rights served.”

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