Mecklenburg wants to break ties with a healthcare agency. Here’s what happens next.

Mecklenburg County is preparing to sever ties with Cardinal Innovations Healthcare, the managed care organization that oversees behavioral-health treatment in 20 counties across North Carolina.

Local officials leveled accusations against Cardinal in February just before the COVID-19 pandemic hit — detailing a pattern of inadequate access to service and substantial wait times for some of Mecklenburg’s neediest residents. The county, for example, blasted Cardinal’s faulty handling of emergency placements for children who are abandoned or neglected.

Months later, county administrators say those problems persist, with piecemeal progress made for overhauling treatments tied to behavior health, criminal justice and child welfare, among other critical programs.

Cardinal is slated to submit an improvement plan next week, but county commissioners unanimously voted Wednesday to allow County Manager Dena Diorio to start what’s known as the “disengagement” process from Cardinal.

“We believe beginning this process is still warranted because of a lack of confidence in Cardinal’s ability to make the necessary changes,” Assistant County Manager Anthony Trotman told commissioners. “Mecklenburg County residents continue to go without appropriate services and timely treatment.”

As a temporary solution, Trotman said, Mecklenburg has been forced to enter into contracts directly with providers to ensure patients are not overlooked.

Trey Sutten, Cardinal’s chief executive officer, argued Mecklenburg’s decision is “disappointing” and “inconsistent” with the organization’s efforts so far.

He reaffirmed Cardinal’s intent to deliver a concrete plan to county leadership, while shifting blame for certain lapses on a complex state funding structure. Commissioners and county staff also repeatedly discussed the complex web of behavioral health care, exacerbated by Mecklenburg’s limited role as outlined by state statute.

“No single organization can single-handedly solve the issues raised today — they’re systemic,” Sutten said during the public comment period. “By increasing the risk of interruption to care, we’re talking about further jeopardizing the health and well-being of some of your most vulnerable constituents at the worst time while we’re dealing with this pandemic.”

‘Action is required’

Wednesday’s vote means Mecklenburg must find another agency better equipped to handle individuals with developmental disabilities, in addition to mental health and substance abuse concerns. Diorio mentioned Partners Behavioral Health Management, another licensed entity serving some of Mecklenburg’s adjacent counties, as a viable option.

Diorio said about nine of Mecklenburg’s peer counties — including Cabarrus and Union counties — are pursuing the same disengagement action with Cardinal, partially fueled by a Medicaid transformation that could further complicate matters when it takes effect in July.

“It’s all the same stories — it’s all the same frustrations,” Diorio said. “I need to make sure that I protect the interests of the county so if we need to get out, we can get out.”

Commissioners openly criticized Cardinal’s shortcomings, describing the pain of people desperate for proper care.

“We’ve been patient for a long time. I think for the good of the families involved, it’s good to start this,” Commissioner Pat Cotham said. “Action is required now.”

Commissioner Susan Rodriguez-McDowell said the county’s move is long overdue, adding Cardinal has lost “all credibility.”

“With the window closing, we have to accelerate and go as fast as we can,” Rodriguez-McDowell said. “We have to think of the children and all of the people who have been reaching out to us with problems.”

Discussions are already underway with Dr. Mandy Cohen, secretary of the state Department of Health and Human Services. If Cohen approves Mecklenburg’s intent to break away from Cardinal, the county must then publish its plan and next steps online — while allotting two months to seek public feedback.

Cardinal has been embroiled in controversy since its inception. Cardinal replaced MeckLINK, the county’s own behavioral healthcare system that received federal Medicaid funds, in 2014.

In May 2017, Cardinal drew sharp scrutiny when a state audit revealed “unreasonable spending,” including lavish Christmas parties, expensive in-state flights and an inflated salary for Richard Topping, the ousted chief executive officer who was paid more than three times the limit set by state policy.

By November 2017, after Topping and three other executives were paid $3.8 million in severance, DHHS took control over Cardinal and fired its board members.

This story was originally published November 4, 2020 at 10:25 PM.