Amid anxiety, mental health group says few changes in works

For more than a year, thousands of families relying on Mecklenburg County for mental health services have worried about the future care for their relatives.

They fear services will be cut or even denied, and many don’t know whether their relatives will see the same providers after Kannapolis-based Cardinal Innovations Healthcare Solutions takes over Mecklenburg’s mental health services starting Monday.

Cardinal CEO Pam Shipman said they shouldn’t be worried.

She said the agency’s goal is that consumers and their families will see little if any change – at least in the early going – from services they got from the county’s MeckLINK Behavioral Healthcare, forced by a new state law to shut down Sunday.

To start out, those services will remain the same at least until their MeckLINK contracts expire. Then care will be reassessed by a clinical team under Cardinal’s medical director, Shipman said.

“We hope at the consumer level that they won’t notice anything,” said Shipman, whose agency will oversee Mecklenburg’s yearly $200 million allotment in federal Medicaid money and $17 million in state money. “They’ll have the same providers, and we have been able to hire a lot of the staff from MeckLINK. So the people that they’re used to working with, the majority of those are the same.”

Cardinal has hired more than 100 MeckLINK employees and extended contracts to 450 Mecklenburg providers, Shipman said. Two weeks ago, the agency began holding forums to introduce Cardinal to Mecklenburg families.

She stressed that Cardinal’s denial rate is 1 percent. “Our goal is not to deny,” she said. “It’s to make the right clinical decision for the person. If the service definition says they get 10 sessions, but it’s determined they only need 25 percent of that, that’s what they get.

“On the other hand, if they need double that, that’s what they get. That decision is made by clinical people, not by finance people.”

‘Seats at the table’

As MeckLINK’s shutdown approached, Mecklenburg residents voiced concerns, emailing county commissioners and speaking up at commission meetings.

Turmoil surrounding the merger began in December 2012, when the state tried to assign to Cardinal oversight of Mecklenburg’s mental health services. The county threatened to sue and the state allowed the county to continue to operate MeckLINK – until state legislators passed the law in June to force the merger and Mecklenburg lost control of the services for 120,000 residents eligible for Medicaid funds.

Before handing over the oversight, Mecklenburg won an important concession from Cardinal: County commissioners will appoint two members of Cardinal’s 15-member board and Cardinal will appoint two mental health experts from Mecklenburg to that board.

“We are encouraged that we’ll have seats at the table with Cardinal,” County Manager Dena Diorio said.

But Diorio still has concerns.

“We are concerned that our consumers are not going to get the same level of care,” she said. “It’s out of our hands now. The contract for mental health services is now between the state and Cardinal.”

In addition to Medicaid money, the state granted Cardinal authority over dispensing $17 million in state money for services to Mecklenburg residents who aren’t Medicaid-eligible. Over the years, the county has matched that amount to fund gaps once the state money ran out.

Last week, those consumers got some good news when Cardinal said it would fund crisis, safety-net outpatient and residential services at least through June 30. Then Diorio said the county would continue funding for services through the same period for nearly 530 residents with a variety of child and adult mental health problems, and intellectual and developmental disabilities.

She said Mecklenburg will work with Cardinal to come up with recommendations for funding after June 30.

That brought relief for families such as Joanne and Stephen Kelley, whose 43-year-old autistic son Matt is in a group home. But the relief is only temporary.

“We know we’re OK through June and that Matt won’t get kicked out in April,” Stephen said. “But no one has assured us that funding continues beyond June 30.”

No money-saving goal

Yet the future services for all consumers is uncertain. Many consumers and Mecklenburg officials believe the state forced the merger just to save money, as part of an effort to bring Medicaid costs under control.

Shipman, who coordinated Cardinal’s development of the Medicaid waiver pilot that began in 2005, said the agency has a 40-year history of managing mental health care. The model, she said, works because Cardinal can “customize the waiver” to each county.

She and Nicole McKinney, head of Cardinal’s Mecklenburg operations center, said the goal has never been to cut costs..

“Nobody ever told us when we did the pilot that our goal was to save money,” Shipman said. “But what you find is that if you get people to the right care, and if you have a network that has the right array of services, on balance your costs go down.”

For instance, she said, some of Cardinal’s counties had no outpatients services, driving patients into “advanced care.”

“That’s your most expensive level of care,” Shipman said. “So they may not have needed that level of care, but if that’s all there was, that’s what you got. So we’re building back this outpatient network.”

Mecklenburg officials such as Diorio and county commission Chairman Trevor Fuller say Mecklenburg’s variety of cases will be unique to those found in Cardinal’s 15 more rural counties.

They wonder whether Cardinal is ready.

“I don’t know if Cardinal understands the complexity of our (mental health) business here,” Diorio said. “Time will tell.”