State's hand-me-downs a bad fit for counties

Over the past several years, consultants from the School of Government and Leading & Governing Associates have conducted hundreds of interviews with county commissioners, state legislators and other state and local officials around the nation as part of the Association’s Strategic Planning and Visioning initiative. Several distinct themes have emerged from the data that has been collected.

When the Board of Directors meets Oct. 14-15, we will address many of these themes and determine which issues should be priorities for this Association. This promises to be a challenging and exciting time for this Association as we reinvent ourselves to meet the changing demands being placed on counties.

One notable theme that has emerged is cause for concern. Interviews reveal that many North Carolina county officials – and some state elected officials as well – feel that the state-county partnership is in disrepair. Our decades-long struggle for Medicaid relief is perhaps the most glaring example of this fractured relationship, but there are other examples.

While counties have clamored for the past several years for help from the Legislature on issues like Medicaid relief and increased revenue options, the General Assembly has ignored us and instead pursued initiatives like smaller class sizes in the lower grades, expanding Medicaid eligibility or regionalizing the Mental Health system.

There was a cost to counties in every instance – a cost that, for the most part, the state simply passed down to us. That is why many local officials believe the state-county relationship needs a serious examination.

Unfortunately, we received yet another dose of bad news in September. Officials from the Department of Health and Human Services informed counties of a potential $28 million deficit in funding for Mental Health, Develop-mental Disabilities and Substance Abuse Services’ Local Management Entities (LMEs) in the current fiscal year due to a shortage of state funds to support the cost model used to predict program management resource needs.

The solution proposed by DHHS is to contract with no more than 10 LMEs for two specific functions – Utilization Review (UR) and Screening, Triage and Referral (STR). The department would then reduce management payments to the remaining LMEs not selected to perform UR/STR functions effective beginning in January 2006.

This solution runs counter to DHHS’s original plan for consolidation of functions, which are intended to be addressed in the local business planning process. Savings resulting from consolidation are to be maintained in the services system to meet the growing community needs caused by downsizing of state psychiatric facilities. They are not to be used as a way to reduce available funds.

This latest miscalculation is yet another example of why counties continue to ask for additional funding options from the state. As long as the state feels that the one way to rectify its mistakes is to make counties foot the bill, then local officials will continue to believe that the state-county partnership is frayed.