RALEIGH -- Under pressure to change its handling of behavioral care, Wake County is considering an independent authority to oversee treatment for people with mental illness, developmental delays and substance-abuse problems.
Wake citizens receive about $200 million in federal, state and local funding for behavioral care, with oversight of the program divided among state and local officials. Legislation, passed in 2006, that has dramatically lowered the number of local oversight agencies was expanded this year to include Wake County.
Many counties across North Carolina have joined together in multicounty behavioral-care agencies, one option that county commissioners discussed in a Monday work session. But county manager David Cooke instead recommended that Wake create a new authority of between 11 and 25 members, appointed by the county commission. The county must submit its plan to the state by Oct. 1.
"It's really about creating an MCO, or a managed-care organization," county manager David Cooke said.
The new entity that county staff is proposing would operate much like the county Board of Alcoholic Control, an independent authority appointed by the county commission, but in control of its own operations, Cooke said.
Denise Foreman, assistant to the county manager, said consumers interviewed have mostly favored keeping control of their care within Wake County. Ann Akland, a longtime advocate for people with mental illness, said she also favored a Wake authority rather than a new program within county government.
Some commissioners were skeptical of the notion that the county government has the expertise to revise behavioral health care.
"We're out there with this great track record of mental health reform and now we're doing it again, quickly?" asked commissioner Joe Bryan, referring to largely unsuccessful efforts by state government to make over mental health care.
The county will still be responsible for the financial stability of the authority, Cooke said. Mike Watson, deputy secretary of the state Department of Health and Human Services, said the local authorities will be much more carefully monitored than during past state attempts to reform mental health care.
In his own business, board member Erv Portman said, health insurance costs rise by about 20 percent a year. How, he and other commissioners asked, can the county do a better job when health insurance is not their area of expertise?
Watson, the state official, said each county will decide on the average amount of money to be available per patient per month, based on recommendations from the state and from the commissioners.. In addition, the counties will have more flexibility in deciding on how to spend federal, state and local tax dollars.
"It's the ability to take savings and turn them into services that aren't being provided," Watson said, mentioning that respite care is now being offered in some counties using this approach.
