State mental health cuts trickling down to locals

By Rebecca Troutman
Intergovernmental Relations Director

It came as no surprise that the Nov. 19 meeting of the NCACC Human Services Steering Committee largely centered on mental health reform and the state's efforts to right a derailed system.

Mike Watson, recently appointed assistant secretary for Mental Health, Developmental Disabilities and Substance Abuse Services, spoke to the many challenges facing the mental health system, particularly with regard to the hundreds of millions in state funding cuts enacted in the state budget.

Watson cautioned committee members that communities will see a cumulative effect of these cuts, with state service dollars reduced, Medicaid rates cut and Medicaid services curtailed. Local Management Entities (LMEs) were necessarily capping some services and closing down others.

To manage service dollar reductions while minimizing direct services impacts, Watson outlined the steps his division took to have LMEs report on how the cuts would be made in the community. First and foremost, LMEs were directed to protect crisis and core services. LME fund balances were also put on the line, with the local agencies "volunteering" $24 million in undesignated fund balances to offset the state's $40 million in cuts.

Watson also addressed the issue of how involuntary commitments are impacting sheriff's deputies and hospital emergency departments. He noted that the Sheriff's Association and the Hospital Association were meeting with division staff to help stakeholders understand why involuntarily committed patients are occasionally languishing in emergency rooms. Is it a matter of communication or a problem with placement opportunities?

Watson said he believes that the state's mobile crisis teams should help curtail involuntary commitments, while the department's principal initiative to expand community beds would help with placements.

Several steering committee members expressed concern with the contraction of community support services, the much-maligned service category that drove state and county Medicaid costs when implemented. While the General Assembly is requiring the phaseout of community support, given its serious problems with quality and medical necessity, the division is responding by seeking federal approval of replacement services provided through a clinical framework.

To help in the transition, the division is putting into place a comprehensive provider concept, whereby a qualified provider would have to ensure an array of services, be nationally accredited, have a physician at the top of the organization with his or her license on the line, have a clinical director, have a quality management program, and have a staff training program. During the shift from single-service providers to the comprehensive provider, Watson did acknowledge that small providers would be put out of business and that there would be access problems initially.

DHHS Deputy Secretary Maria Spaulding addressed the steering committee on several topics, including transition strategies for child support enforcement, caseload increases – particularly in food stamps and Medicaid – and statewide implementation of the Work First program's "Pay for Performance" initiative, whereby Temporary Assistance for Needy Families (TANF) clients must fulfill certain work and/or education requirements prior to receiving benefits.

Wilson County was the first county to experiment with "Pay for Performance" and won an LGFCU Employee Productivity Award from the NCACC for successful implementation.

Spalding also reviewed the Division of Child Development's methodology for distributing the governor's 5 percent budget reduction target: $12 million in child care subsidies will be held back via reversions from under-spending counties. She did share some good news: the child care Electronic Benefits Transfer (EBT) cards will roll out next summer, reducing administrative expenses and the potential for fraudulent activities.

With regard to aging, Spaulding said DHHS is working on a proposal to the governor to endorse a campaign to increase state readiness for North Carolina's aging population.

Paul Beddoe, NACo's health policy legislative staff, addressed the committee via web cam and reviewed the major differences between the Senate and House healthcare proposals, principally the Senate's provision to allow states to opt out of a public provider option and differing levels of Medicaid coverage and federal reimbursement to expand Medicaid coverage. Beddoe did emphasize that both bills would provide significant resources to public health.

Steering committee members also heard from Andrea Held with the N.C. Immunization Branch of DHHS on the H1N1 flu outbreak and county response via immunization programs. Held said that as of the committee's meeting date, roughly half a million doses of H1N1 vaccine had been administered, and a million more doses had been ordered. The state expects to receive more than five million doses.

In other committee actions:

• District 17 Director Dana Jones of Cherokee County was appointed steering committee vice chair by Chair Viola Harris of Edgecombe County.
• Members set their next meeting dates for Feb. 11 and May 13. Each date falls on a Thursday, and each meeting will be held from 10 a.m. – 2 p.m. at the Albert Coates Local Government Center in Raleigh.