Wake OKs agency for mental health

RALEIGH -- Wake County's Board of Commissioners agreed Monday to establish a standalone mental health authority to oversee care for Medicaid clients with developmental disabilities, mental illness and substance abuse problems.

Although it was unanimous, the decision to comply with a state mandate came with misgivings and a few conditions.

Beginning in 2006, the state began requiring counties to take over the responsibility of dispensing mental-health care paid for by Medicaid dollars.

Medicaid, the federal agency that pays for health care for low-income people, will pay the Wake authority a per-person rate, in a managed care approach.

The state is attempting to recover from previous failed reform efforts, and to save money, by putting decision-making in the hands of a local authority.

As many as 500,000 more North Carolinians could be become eligible for Medicaid in the next few years.

Wake is expected to take over management of its Medicaid patients by January 2013, and likely will continue to use some county employees and some contractors to provide care.

Commissioner Erv Portman and some other board members were leery of such a deal because managed care has been tried for decades by public and private entities and has produced mixed results at best.

"Perhaps we will do a better job than the state will do," board Chairman Paul Coble said.

In conditions to the deal, the county is asking for state legislation to allow Wake to recoup several million dollars in startup costs for the program through a Medicaid administration fee, Coble said in Wake's application to the state.

Legislators would have to pass another bill to allow Wake to reconfigure its Human Services department, which now oversees Medicaid-paid care.

Clients' complaints

The nonprofit advocacy group Disability Rights released a statement objecting to the new approach, known as a Medicaid managed care waiver. Several such organizations, most covering several counties, are already operating in the state.

"In the six years the managed care waiver has been operating, we have seen patterns of complaints emerge among the clients in the waiver area," the group said.

The agency said their clients' complaints are in the following areas:

Failure to use fair procedures in dealing with complaints,

Internal decision-making on clients' care, which causes problems with checks and balances,

Limitations of the network of care providers.

The failure of the state to oversee the managed care operation properly.