Meck commissioners to take action against state in Medicaid debate

Meck commissioners to take action against state in Medicaid debate

Mecklenburg County Manager, Harry Jones listens during a County Commissioners meeting at the Government Center Tuesday, January 8, 2013


by DAVID PERLMUTT & APRIL BETHEA / Charlotte Observer

Posted on January 8, 2013 at 11:17 PM

CHARLOTTE, N.C. -- Mecklenburg commissioners agreed unanimously Tuesday to file an administrative appeal with the state over a recent decision to reassign supervision of the county’s federal Medicaid funds for mental health services to an outside agency.

Commissioners also directed county staff to continue to work toward having the Medicaid program up and running, and to engage consultants to ensure the county will be ready by Feb. 1.

The vote came after commissioners met for nearly two hours with attorneys in closed session to weigh what if any options the county could take. The special meeting came a day after County Manager Harry Jones said he did not believe the state’s decision to redirect the Medicaid money complied with state law.

Last week, outgoing Health and Human Resources Secretary Albert Delia to redirect about $200 million in Medicaid money from the county’s MeckLINK Behavioral Healthcare and let Kannapolis-based Cardinal Innovations Health Solutions administer the money. New Secretary Aldona Wos told Mecklenburg leaders Monday that she stands by that decision.

Delia and Wos said state law required that Delia decide by Jan. 1 if MeckLINK was ready to start the program by a soft launch date of Feb. 1, already extended a month for Mecklenburg.

The official launch date is July 1. MeckLINK chief Phil Endress told the Observer last week that his agency would be ready by Feb. 1.

But the state’s consultant, Mercer Government Human Services, concluded that MeckLINK had too many unmet requirements to overcome.

Mercer did conclude that MeckLINK could be ready by April 1 – or three months ahead of the official launch.

Yet Delia on his last day in office on Dec. 31 gave the program to Cardinal, a managed care organization formerly known as Piedmont Behavioral Healthcare that oversees Medicaid programs in 15 N.C. counties.

Cardinal CEO Pam Shipman said recently that the company did not know in advance of the decision that MeckLink wouldn’t be allowed to go forward, but said they were not surprised. For example, she cited an October report from Mercer that "documented serious deficiencies."

In an e-mail to Cotham, Shipman said Cardinal has worked with other local management entities to help them prepare for the waiver. But, she said, the company has "long promised the General Assembly and the Department that we would be a back-up for any LMEs that cannot go live, or that go live and fail to be successful. It is more important for the waiver to be expanded successfully than it is for any single LME to be successful."

Some critics of the state move have voiced concern about whether Mecklenburg residents could see service cuts if the Medicaid program is overseen by an outside agency.

In her letter to Cotham, Shipman appeared to try to alleviate some concerns from critics. Shipman, who said she coordinated Cardinal’s development of the Medicaid waiver pilot that began in 2005, said she believes the model allows the company to "customize the waiver to local communities."

"We will not impose a cooker cutter model on Mecklenburg," she wrote. "We work very hard to ensure that the needs of all the people we serve are met."

Cardinal would earn about $20 million annually in administrative fees, Philip Endress, head of MeckLINK told commissioners last week.

County officials planned for MeckLINK to oversee the Medicaid program. They have spent about $3 million preparing to take over the job from the state. In August, the county hired Endress to head MeckLINK, which was formerly the county’s mental health department.

Since then, he has hired 131 staffers – in addition to 73 already working for MeckLINK – to make it all work.

Some county leaders say they fear those workers could lose their job under Cardinal.

In her letter to Cotham, Shipman said she anticipates Cardinal would establish a local office in Charlotte and have "75+ people" working to support Mecklenburg.