Friday, March 02, 2012

WHN LME Graphs for January, 2012 Medicaid Services

Today, at the WHN LME Board meeting, along w/ last month's minutes, which are, I believe, available on line, were two pages of graphs. I do not know if the graphs are available at the LME site.

Boy, are they misleading until you study them---even when you study them. The way the x-axes are numbered makes it look like a lot of people are getting services but across all the counties there is a mean of about 3.2% "Penetration Rate."

3.2%. That's how much of the Medicaid population is receiving any mental health services at all. That's astounding in a population that is impoverished, without resources, jobless or with low paying jobs, no childcare, and no transportation in mostly rural western NC.

These are the titles of the 6 graphs:

"Number Medicaid Eligibles"
"Number Served"
"Penetration Rate"
"Number of Persons Served by Total Funding"
"Number of Persons Served by State Funding"

And what does 'Number Served' mean? Does it mean someone called the LME? Does it mean a provider was reimbursed? What does it mean?

The "Number Medicaid Eligibles" for the 8 counties associated w/ WHN LME is over 80,000 people.

The "Number Served" in January, 2012 for mental health services of any kind, associated w/ Medicaid was less than 3000 people.

What's the difference between the two categories as above of "Number Served" and "Number Persons Served by Total Funding"?

Is the latter the dually eligible clients ? Most Medicaid clients are dually eligible. That means that they have Medicare as primary and Medicaid as secondary. Is the category "Number Persons Served by Total Funding" associated with the dually eligible clients given that there's about 30% more people in that category versus the "Number Served"?

Given that I cannot get any information about my Medicaid provider application from WHN LME, I don't hold out any hopes that I will get answers to these questions. I'll either have to bring it up at the next board meeting or try NC DHHS. Maybe Verla Insko (D-Orange county) who used to be the co-chair of the Joint legislative Oversight Committee for Mental Health Reform would know.

Does anyone know? Why are there no explanations for what the titles refer to?

Are these standard graphs across the LME's? If not, why not? There's no ability to compare if these are not standardized across the LME's. I have a sinking feeling that the LME's simply create graphs that make them look good. However, there's nothing good about these WHN LME graphs. It paints a picture of an LME that is heavily administratively funded doing not much of anything except pushing paperwork and blocking providers.

So, we've got millions of $$ being handed to LME's that basically coordinate the care for a very little number of the insured they are supposed to pay attention to.


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