Mecklenburg wants Cardinal out, blames ‘vicious cycle’ of mental health care problems

Mecklenburg intends to abandon its fraught relationship with Cardinal Innovations Healthcare and, according to the county manager, instead wants an exclusive provider — a model similar to what was in place years ago.

County commissioners voted to begin the “disengagement” process from Cardinal last November, after Mecklenburg administrators alleged the managed care organization had repeatedly failed to deliver timely treatment options for people with developmental disabilities, as well as mental health and substance abuse conditions. The dispute also involves allegations that children in foster care programs had delays getting connected to adequate services.

Although Cardinal developed an improvement plan and began expanding its provider network, Mecklenburg County Manager Dena Diorio said systemic issues persisted.

Cardinal has operated with a “lack of urgency and thoroughness,” Diorio wrote in a scathing letter this week to Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services.

To remedy the crux of the problem and the county’s sheer size, Diorio said, Mecklenburg needs its own county-centric provider. (Before Cardinal, Mecklenburg did have its own behavioral healthcare system, called MeckLINK, which received federal Medicaid funds.)

In North Carolina, managed care organizations are paid with state and federal dollars to cover costs of mental and behavioral health care for those uninsured and people insured through Medicaid. Cardinal currently oversees services in 20 counties. At least a third of those counties — including Union, Cabarrus, Forsyth, Stanly and Orange — have also defected from Cardinal, outlining parallel struggles surrounding criminal justice, child welfare and homelessness, among other critical care issues.

But Cardinal Innovations says it has been working in “good faith” and is disappointed by Diorio’s decision that could put vulnerable residents at greater risk, CEO Trey Sutten said in a statement to the Observer. Sutten said the coronavirus pandemic and looming Medicaid transformation are already causing “enough disruption for individuals with mental health and behavioral health needs.”

”The clear progress we’re making shows that we are the right organization to serve Mecklenburg County,” Sutten said through a spokeswoman. “We hope to continue engaging with leadership across the County so that together we can thoughtfully consider the full needs of the community.”

Providers across the state face “difficulty in operating with limited resources to serve individuals with the most complex behavioral health needs,” Diorio wrote in the letter, which was shared with the Charlotte Observer.

Similar concerns are felt throughout Mecklenburg, Diorio said, including among local hospitals, first responders, courts, child care advocates and the county’s Mobile Crisis Team. She said her request was made not lightly.

On Friday, after news broke of Diorio’s letter, a North Carolina DHHS spokeswoman, Christine Mackey, told the Observer that state leaders believed they, the counties and Cardinal “were making good progress to avoid further county disengagement.”

Forsyth County will vote on disengaging from Cardinal next month, Mackey said.

“These actions are the first step in the disengagement process for these two counties,” Mackey said of Mecklenburg and Forsyth.

“Although there is a clear process...the addition of these two counties to the four previous counties that have requested disengagement will require the department to undertake a serious evaluation of what this means for Cardinal Innovations and, most importantly, the individuals served.”

Child welfare

Cardinal was embroiled in scandal in 2017, when a state audit revealed “unreasonable spending” and lavish parties among executives who were later ousted. Mecklenburg County commissioners say Cardinal forfeited the public’s trust, with lasting transparency issues.

Earlier this month, Cardinal touted new agreements with three Charlotte providers — Thompson Child & Family Focus, Alexander Youth Network and Pinnacle Family Service — to expand treatment options and prevent extended emergency department stays. It appeared to align with Cardinal’s action plan, released in November, that outlined strategies to remove authorization hurdles for foster care, streamline services and increase provider accountability, among other components.

Sutten said in a statement on Feb. 2 the specialized care services signaled “real improvements to support children in foster care, giving them a better chance to succeed and thrive.”

Diorio, in her letter to Cohen this week, offered a blunter assessment of emergency placements for at-risk youth.

Cardinal recently reimbursed Mecklenburg for $1.4 million, after the county had to intervene in emergency placements during fiscal year 2019, Diorio said. But as of Wednesday, at least 11 youth were in limbo — ranging from 28 to 158 days — awaiting the proper access to care.

“This indicates that we continue to experience the same challenges we have elevated to Cardinal’s leadership for many years,” Diorio wrote.

“It is a vicious cycle and the residents of Mecklenburg County who need their services suffer the consequences.”

This story was originally published February 12, 2021 at 4:45 PM.