Western Highlands Mulls Options After State Pulls Medicaid Contract
By Peggy Manning
This story was originally published in the Carolina Public Press on April 13.
A week after learning that state health officials have terminated the agency’s contract to provide behavioral health services to Medicaid recipients, the Western Highlands Area Authority met Friday to discuss what happens next — including whether another managed care organization could take the contract or whether to develop a pilot program offering integrated health services.
According to network leaders, agency representatives have met with state officials and legislators and discussed what to do next with the agency that provides mental health, substance abuse and development disability services to residents in Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey counties.
On April 5, a representative for the Division of Medical Assistance, a division of the N.C. Department of Health and Human Services, called WHN interim CEO Charles Schoenheit to announce the termination of the state Medicaid contract, a move that essentially means that the network will no longer be able to receive Medicaid dollars from the state for services. Schoenheit then immediately called Chairman Charles Vines to notify him.
“I was shocked. It was wrong and not professional the way the state handled this,” Vines said during an interview on Monday. “It was already on their (N.C. Department of Health and Human Services) website before we got notice.”
That message was shared with the DMA staff Thursday, Vines said, when he and six others on the eight-member board met in Raleigh to discuss the termination. DMA representatives made it clear that the termination decision is final and will occur July 31, Schoenheit said Friday.
“They were firm that this is not going to change,” he said. “We have a couple of weeks to decide what we are going to do as a consequence and come up with a plan.”
“The obvious option would be to align ourselves with another MCO (managed care organization),” Schoenheit told the board on Friday. “We have received a couple of letters from MCOs.”
One managed care organization that has been mentioned as a possibility is Smoky Mountain Center, which provides behavioral health services for residents of Alleghany, Alexander, Ashe, Avery, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon, McDowell, Swain, Watauga and Wilkes counties. Another possible choice would be Partners Behavioral Health Management, which serves the residents of Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry and Yadkin counties.
Another option for Western Highlands, Schoenheit said, would be to develop a pilot project based on the integrated care model the state plans to roll out in 2015. That approach involves coordination of primary care and behavioral healthcare for people who may turn to their primary care physician with mental health problems. It also includes those undergoing treatment with a mental health professional, but who also suffer with chronic illnesses brought on by poor health habits.
“We could do a pilot project that would likely be copied throughout the state,” Schoenheit said.
He said that, until a plan is developed, Western Highlands would continue to do business as usual through the end of July. That means there will be no anticipated interruption in services to consumers within the eight-county WHN service area, he added.
Vines also stressed during an interview on Monday with Carolina Public Press that Western Highlands would likely continue to operate as a local management entity, though the Medicaid funds make up a large portion of the organization’s operating budget.
Friday’s meeting of the Western Highlands Area Authority was packed with providers and others – some offering support and other leveling criticism at the agency, which has suffered in the last year with multimillion-dollar budget shortfalls and the subsequent firing of its CEO.
Jill Nicolino, a psychologist at Koru Psychological Services in Asheville, praised Western Highlands, which, she said, has “proven to be absolutely the best network” she has ever worked with.
“This organization runs extremely well and this (termination) is a huge loss to the community and the people we serve,” Nicolino said.
On the other hand, Michael Faulkner, an Asheville social worker, said that providers have had to overcome some major obstacles and have lost money over the past 10 years. He said some providers still do not want to be part of the network, and he challenged the board to take a step back and look at why that may be.
Still, Faulkner suggested that Western Highlands is best suited to manage behavioral health services for the region it serves.
“If we can’t do it, who can?” he posed.
Vines said at the conclusion of Friday’s meeting he felt much better about the future of Western Highlands after meeting with the Division of Medical Assistance, although he did not elaborate.
“Now, we must move forward on a fast track plan,” Vines said. “Hopefully, this will be a seamless process that won’t affect services,” he said. “I think good may come of this.”