Feds question NC's mental health funding

https://www.wral.com/feds-question-mental-health-funding/13209524/

Raleigh, N.C. — The federal government is raising questions about how North Carolina pays managed care companies that provide services to mentally ill and developmentally disabled people at the same time the state is looking at making broader use of managed care to control Medicaid costs.

State officials say they were "surprised" by the missive and seem unsure what to make of the federal government questioning a system that the U.S. Centers for Medicare and Medicaid Services, CMS, has reviewed and approved numerous times. At the very least, the letter roils the bureaucratic waters at a time when state lawmakers and the McCrory administration are trying to push forward with a remake of the state's Medicaid system.

Currently, 10 Local Management Entities / Managed Care Organizations, abbreviated as LME/MCOs, provide care for low-income people with mental illness, substance abuse problems or developmental disabilities throughout the state. The "managed care" part of that system is seen as an essential part of controlling the state's costs. Each organization gets a set amount of money to care for people in its geographic area, rather than charging the state for each service provided. For purely physical ailments, Medicaid pays for care through a fee-for-service model.

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Federal officials appear to be asking the state to either put those mental health contracts to bid or pay those LME/MCOs based on a fee-for-service model, either of which could undermine the delivery system North Carolina has been building and mean another round of changes for mental health consumers.

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