By Rose Hoban
Cardinal Innovations, one of North Carolina’s state-funded mental health managed care organizations, announced last week it would be changing the benefits offered to people with mental health and substance use issues and intellectual and developmental disabilities, effective this Friday.
In a bulletin issued to service providers dated Nov. 11, Cardinal announced that people currently receiving services such as treatment from a Community Support Team, which provides “community-based mental health and substance abuse rehabilitation services” for people with “complex and extensive treatment needs,” will continue to receive those services. But effective Nov. 20, no new clients will be eligible for the service.
All told, new clients in Cardinal’s catchment area, covering 16 counties throughout the Piedmont, will lose access to 11 services, including respite care, which gives a break to families caring for a loved one with complicated needs, and a program designed to provide intensive services for children with antisocial, aggressive or violent behaviors.
Rep. Nelson Dollar (R-Cary), one of the architects of the state’s mental health MCO system, said he found the move “disturbing.”
And officials at the state Department of Health and Human Services said they were still trying to get “clarification” on Cardinal’s announcement.
Sitting on cash
Since North Carolina moved to place the mental health system into the hands of state-funded local management entities/managed care organizations (known as LME/MCOs) in 2011, an array of organizations have been managing state money to provide services to people with mental health issues and developmental disabilities.
The system was implemented statewide in 2013, and since then the General Assembly has allocated LME/MCOs extra money to build up their risk reserves, to be used in the event of an influx of expensive patients. Lawmakers have also allowed LME/MCOs to hold onto any money they’ve saved in the process of providing care, with the understanding that extra money should go for filling the gaps in care.
For example, Leza Wainwright, head of Trillium Health Resources, told N.C. Health News this August that her organization was using cash reserves to build after-school and summer camp programs for children with intellectual and developmental disabilities in the 24 eastern counties in which Trillium provides services.
But over the past year, lawmakers grew concerned that LME/MCOs were sitting on hundreds of millions of cash instead of implementing those new methods of care.
In this year’s state budget, the General Assembly cut funding to LME/MCOs by $110 million. At the same time, the budget bill instructed the organizations to maintain services at the same level as last year, paying for that care out of their reserves.
So the move last week by Cardinal has many concerned.
“Legislators said not a single person should receive a cut,” said Corye Dunn from Disability Rights North Carolina. “I believe that legislators will be angry.”
“The state budget clearly outlined that reductions were to be made to reserves and would not impact ongoing services and the provision of services to the various populations,” said Dollar, who is the House appropriations chair and negotiated the budget deal with the Senate. “The documents we’ve seen thus far would indicate significant reductions of services to a variety of populations moving forward.”
“I think Cardinal seems to be setting up a major conflict between carrying out the state’s budget and what the General Assembly has laid out,” Dollar said. “I imagine there’ll be quite a bit of discussion in the coming days and weeks about what Cardinal is proposing to do.”
Questions about clarifications
“Transitioning the 11 identified services will not create gaps in service for Cardinal Innovations’ members not currently receiving these services,” said Christine Beck, Cardinal’s vice president for clinical operations, in a statement released on Monday.
“For each service being transitioned, an alternative service or services remains available to address our members’ needs,” the statement read.
The statement called the changes “part of an ongoing process to evaluate and innovate the way we pay for and deliver care to North Carolina’s most vulnerable citizens.”
But Courtney Cantrell, director of the state’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services, said she still has questions about the changes. She only heard about the changes late last week after Cardinal made the announcement. She said she spent the weekend trying to get clarification from Cardinal about their changes.
“That bulletin wasn’t clear,” said Cantrell on Monday afternoon. She said she’d spoken with officials at Cardinal to get clarification.
“And I still have questions about their clarification.”
“They’re guaranteeing … that they’ll be living up to the letter of the law,” Cantrell said. She also emphasized people from her division would be watching to make sure Cardinal provided the same level of service as last year.
Julia Adams from The Arc of North Carolina said her organization would also be watching to be sure Cardinal lives up to its obligations.
“The benefit package has been changed and the concern we have is around access,” Adams said. “If I’m a current patient, I’m OK. But if I show up next week and I need this and qualify for this service, then what?”
“If you don’t currently have service and you are placed in a group home, where are you going to go during the day?” Adams asked.
Mental health services advocate Laurie Coker said some of the proposed cuts affect services that are less dependent on doctors and pills and instead rely on peer support and case management.
“All too often people want to pare things down to just medication, and if they won’t take the pill we’ll make them take it,” said Coker, who leads the North Carolina Consumer Advocacy, Networking, and Support Organization. “But it’s a false assumption that the pill is the answer.”
Coker said psychiatric medications end up being more effective when patients are held accountable for their actions and have things in their lives to look forward to. She said the mental health programs on the Cardinal chopping block are those that provide those kinds of supports and encourage that kind of accountability.
“It’s misguided to think that it’s going to cost less to remove these supportive services,” Coker said.