Friday, March 09, 2012

The Medicaid Waiver is Failing Miserably at the Level of Services and Costs to Taxpayers

Richard Craver who writes regularly on NC mental health issues, wrote the following article at the Winston-Salem Journal recently:

"UPDATE: CenterPoint to ask for $1.53 million from Forsyth County to help with Medicaid transition"

here is my comment placed after the article. You too could put your two cents in.



Will this torture never stop? No, it will not stop until all these little companies---and that includes the LME's----are not scrambling for the various bits of Medicaid pocket change. Yes, that means CENTRALIZED administration and Medicare----with its administrative costs of around 5%. So, we're paying HOW MUCH to have the LME watch the transition of paperwork while the providers are waiting on their authorizations so they can see their patients so they can stay out of the hospital and save Medicaid money?

And the scrambling for the money has, of course, been part of the course as associated with being a provider, specifically, a clinical psychologist. I am still waiting 6 weeks later, to have the initial part of my application to CONTINUE to be a Medicaid provider as associated with the catchment area of WHN LME. I made a presentation to the WHN LME board this past Friday: no information. I call up the Provider Relations Department of WHN LME: no information. I have never been charged w/ a Medicaid violation; I have a spotless ethical record; I am a licensed psychologist. Then I have weeks after that to have the rest of my application reviewed WHEN I HAVE BEEN A MEDICAID PROVIDER WITH NO DIFFICULTIES FOR OVER 7 YEARS IN NC.

Mr. Craver, the reporter for this article outlined the purpose of the Medicaid Waiver which has now been hoisted onto Western Highlands Network (WHN) LME in western NC. This LME oversees 8 counties, mostly rural, with 80,000 Medicaid eligible patients and a less than 5% use of mental health $$ for the month of January, 2012, according to WHN LME recent board meeting graphs and information---handed out to the public March 2, 2012.

In the article, Mr. Craver stated: "The primary goal of the waiver program is to combine the management of Medicaid and state funds at the community level to reduce costs and add more accountability and consistency to behavioral-health reform."

If the LME cannot plan what monies it is going to need as per Mr. Craver's article----and they KNOW how many Medicaid eligible patients are associated with their LME S when they create projections for funding----then please give Medicaid back to the state where it was functioning perfectly well from this provider's perspective.

As for the state funded clients, specifically, those without any insurance---no Medicaid, no Medicare, nothing-----very few providers can or are willing to work with those patients due to the enormous paperwork challenges. I gave up years ago.

So, we have management entities, specifically the LME's like Centerpointe and Western Highlands Network LME who have the following problems under this Medicaid waiver:

1. they hold their hands out to the counties in a bait and switch maneuver after they have been granted the ability to supposedly manage Medicaid----which they obviously cannot do as described in the article....

2. they cannot process provider applications in a timely manner; they cannnot process paperwork for the companies rendering services to Medicaid clients----even with an expanded new set of hirees at the LME----thus causing Medicaid fraud to be committed----either that or the companies collapse....

3. due to the inefficiency of these two LME's or the fact that the providers are barred because they speak up, providers will continue to collapse and mental health care will continue to deteriorate under the Medicaid Waiver as the LME is not able or willing to continue to certify providers who have been working w/ Medicaid patients for years.....

4. As associated with the Medicaid waiver and how it was created by Piedmont Behavioral Health, the LME's, including WHN LME Board were required to sign a non-disclosure agreement which disallows Medicaid clients and providers from obtaining any information about what has happened, for instance, to their provider application----with no calls returned. The WHN LME attorney told the WHN LME CEO who told the chair of the Board that 'there has to be a '100% positive vote on this Medicaid waiver' last June, 2011......another piece of arm-twisting.....

So, you have a public health entity, specifically, the LME's, under this Medicaid Waiver, otherwise known as The Borg (see Startreck, the Second Generation) which beg for additional monies, cannot manage their money, cannot manage their paperwork at practically any level for any sustained period of time, who allow providers to see less than 5% of the Medicaid clients in a population of patients that research would indicate have a lot of mental health challenges due to: poverty; lack of jobs; poor education; poor transportation.

This Medicaid waiver is not working. And its not going to work because of the way it was set up which is completely interwoven with non-transparency,arm-twisting, lethary, inefficiency, LME's heavy w/ administration costs and no direct patient care, and not least, cronyism. It is the worst of all possible worlds.

I called Western Highlands Network LME this past week, indicating that I had a suicidal Medicaid client: they told me to have the client call the hotline. The person there said she had 'nothing to do w/ the provider network end of things.' So, add lack of communication within the LME to the long list of what the LME's are not able to do under this Medicaid waiver.

Marsha V. Hammond, PhDLicensed Psychologist, Asheville, NC Mental Health Reform blogspot:


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