Friday, July 13, 2012

Medicaid Waiver: North Carolina Medical Journal: WHN LME Predominantly Outlines Services to Citizens 21 yrs old and less: What has happened to the Adults w/ Mental Illnesses for this LME?

I have a subscription to the NC Medical Journal. A couple of months ago, they devoted the issue to mental health reform. Its full of stats and charts and the initial article outlines what is to be discussed but I am afraid I almost always come away from this journal scratching my head, seeing gaps in terms of 'well, what are the conclusions here given the data' that just puzzles the hell out of me. If there are so many adults w/ mental illnesses, why, for one, is WHN LME talking so much about using their resources for children and youths w/ mental health challenges? (see just below). And if there are going to be a massive number of people coming onto Medicaid rosters as of 2014 (that's less than 2 years away) why wouldn't the LME's be doing everything in their power to pull in all available providers when instead what is taking place is a staggeringly inefficient system which has caused Medicaid providers to flee that arena. I'm afraid this journal is kind of like an etch-a-sketch: I see some form of what is important but the outline is so vague and the missing pieces are so lost in the glossy 'ata-boy' take on matters which, incidentally, are life-threatening to quite a few citizens, that I sadly put it down and just blog on, for whatever that is worth. Here is the link to the issue: __________________________________________________________________ "Planned Changes in Child/Family/youth Services at One LME/MCO Don E. Herring, Marsha L. Ring Don E. Herring, MA/Psy, LCSW director of Medicaid operations, Western Highlands Network LME/MCO, Asheville, North Carolina. Marsha L. Ring, MA, LPA, HSP-PA director of clinical operations, Western Highlands Network LME/MCO, Asheville, North Carolina. Western Highlands Network (WHN) is a local management entity/managed care organization (LME/MCO) managing state and federal behavioral healthcare funds in Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania, and Yancey Counties. In January 2012, WHN had a general population of 535,492 and a Medicaid-eligible population of 80,297. During that month, the network provided services and supports to 7,785 active consumers through state, grants, and Medicaid funding. Of these, 3,075 were Medicaid funded and less than 21 years old. Of these, 3,075 were Medicaid funded and less than 21 years old.The children and young adults we serve, ages birth through 20, have historically been high users of long-term residential placements and psychiatric treatment facility services, which are high in cost and often take these young people far from their families or caregivers..... The waiver is structured to “reward” the LME/MCO for being a good manager of services. One goal is movement from expensive, high-end services of short duration to longer-term, in-home (or at least close to home) services;......".... ____________________________________________________________________________ (From other articles in the NC Medical Journal, URL above: ".....The North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services estimates that 393,151 adults living in North Carolina have a serious, disabling mental illness and that 246,230 children and youth have a serious mental, behavioral, or emotional disorder [1]....." "The adoption of the 1915(b)/(c) waiver allows each LME to manage the size and mix of its provider network to help improve cost-effectiveness while ensuring that individuals have a choice of providers for all services available..." "....Coordination of care is critical to support individuals’ recovery of control over their lives and determination of their decisions if they have a behavioral or developmental disability. Specifically, it is important that individuals who experience a crisis receive prompt follow-up care from a community resource. ...." "....In addition to making reforms in the private health insurance market, the ACA also makes important changes to the federal-state Medicaid program. Beginning in 2014,Medicaid eligibility will be expanded to cover all individuals with incomes at or below 133% of the federal poverty level established by the DHHS....."


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