Privitization of disability services in Wake County

Why were the Wake County Human Services clients not given their right of "choice," which was greatly touted under the privatization plans by NC DHHS in 2001? Many clients were not even informed of the pending changes, let alone given their choice of provider within their Person Centered Plans. Some got notices undated and with no name signed just last week

The main complaint against the system where local "area programs" operated by the counties provided care for mental health, developmental disabilities, and addiction clients was that there was no choice. Which, in fact, was not true. Area Programs had hired staff, but they also contracted with local non-profits to provide care in many cases.

Now Wake County is the last program to hand off its direct care of clients to private providers, who are managed by the Managed Care Organization (MCO), Alliance Behavioral Care of Durham. The clients with mental health issues were assigned--they did not choose--either UNC Healthcare or Monarch, a private non-profit provider.

These are top-notch providers in my opinion, but it still does not change the fact that informed choice by the clients was not available. And for other disability services in Wake County, no choices are available. Only one provider for each category was approved to provide services by Alliance MCO.

There are many clients rights issues involved. These clients are not commodities to be divided up by Alliance MCO to private providers.

There is also the question of legal liability for those without appointments—800 of them. I hope Wake County and Alliance Behavioral Care MCO have their liability insurance policies paid up.

As a clinician from UNC said about this fiasco, "What we needed here was some case management...oh, yeah--NC doesn't provide that service any more to mental health clients."

For those who missed my previous post of the WUNC story on the transfer of services, here is the link to listen to their program from Friday morning.

I will have more on this issue in a post in a day or two. Having trouble getting the leaders at Wake County and Alliance Behavioral Health to respond to calls and emails.


Arrogance of power is an ugly

Arrogance of power is an ugly thing in any sphere, but when it shows up in mental health services, it's time to push back and push back hard.

Love this comment:

I hope Wake County and Alliance Behavioral Care MCO have their liability insurance policies paid up.

Neither party has a monopoly on arrogance of power

Legislation passed in 2011 required the N. C. Department of Health and Human Services (DHHS) to restructure the management responsibilities for the delivery of services to individuals with mental illness, intellectual and developmental disabilities, and substance abuse disorders through the 1915 (b)/(c) Medicaid Waiver.

I am a realist. The bottom line comes first for Legislators, Bureaucrats in DHHS and the LME/MCOs' leadership. The people they are supposed to serve have no money, no power, and no voice in the halls of power.

But we have to keep pushing from the trenches. Clients deserve that much.

The federal regulations on the Medicaid waivers require choice, but in fact consumers of public mental health services have less choice of services and service providers than they did just a few years ago. In fact, they have no more choice in some cases than under the defunct "area programs" abolished under the Democrats' regime in 2001, when Sec. Odom was in charge.

The result of repeated consolidation of LME/MCOs and the frequent loss of providers, in part due to slow pay and no pay by the state's Medicaid contractors, is that the clients are frequently lost between the cracks and totally ignored.

We have gone from over 30 LMEs to less than half that number in 2013.

The leaders promise more radical changes in the future, but they cannot tell us what those changes will look like. Some officials say only 3 Managed Care entities will be the final result.

Progress at MH/DD/SAS in NC?


There are multiple goals for expanding the 1915 (b)/(c) Medicaid Waiver that include:

Improve access to Mental Health/Developmental Disabilities/Substance Abuse (MH/DD/SA) services

Improve quality of MH/DD/SA services

Improve outcomes for people receiving MH/DD/SA services

Improve access to primary care services for people with mental illness, developmental disabilities and substance abuse issues

Improve cost benefit of services

Empower consumers and families to shape the MH/DD/SA services system through their choices of services and providers
(emphasis added)

Effectively manage all public resources assigned to the MCOs


Martha Brock