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New law helps streamline mental health management

The Daily Reflector - 7/2/2018

A law that took effect this month creates a pathway for some people who suffer from serious and chronic mental health-related issues to work through a single agency to manage state funded services for both mental and physical health.

House Bill 403 modified the state’s Medicaid Transformation law to allow the state’s seven mental health managed care organizations to operate comprehensive plans that officials say should provide better health care at less expense for taxpayers, officials said. The two-tiered approach will allow some clients to access Medicaid funds more efficiently.

“This is good for the state because (care givers) can provide for individuals’ needs without them getting lost in a one-size-fits-all system,” said Leza Wainwright, chief executive of Greenville-based Trillium Health Resources, the local management entity that oversees Medicaid payments to providers in 25 eastern counties for mental health, substance use, intellectual and developmental disabilities care.

The new approach allows Trillium and the state’s other mental health LMEs to manage state dollars for physical health needs — services that previously had to be managed by agencies outside of the mental health arena, Wainwright said. “Managing the physical and behavioral needs of this population together saves the state money.”

The plans are designed to allow LMEs to more efficiently and effectively serve the complex needs of individuals with significant disorders and disabilities — populations they began serving independently in 2006 and then through Medicaid beginning in 2014, said Wainwright and Cindy Ehlers, Trillium’s vice president of clinical operations, who will play lead roles in implementing the state’s proposal.

“(The 2014 transformation) was a four-year arrangement, then it was an open question what would happen after that,” Wainwright said. “During that time, all of the stakeholders who really care about people with serious mental illness, substance use — and, of course, the opioid crisis has since exploded — and intellectual and developmental disabilities worried about what would happen to those folks when the state went into managed care (a system in which the cost of treatment is monitored for the state by a private managing company). This legislation answers that question for the foreseeable future.”

The law establishes a program in which most people who use Medicaid for standard physical health care are granted access to some mental health services — but not the high-end behavioral health care package. A mother in the Temporary Assistance for Needy Families program, for instance, who might need help with postpartum depression could have her needs met through a multi-session outpatient therapy plan through the regular Medicaid plan, Wainwright said.

The person with chronic persistent mental illness, however, will be served in a tailored plan that makes sure those needs are met, but also provides for proper physical health care and other benefit services, such as transportation and access to nutritional support.

The new law provides that managed care organizations like Trillium will be the sole entities operating the tailored plans during an initial four-year contract term with the state.

Those desiring to operate a tailored plan must apply to the North Carolina Department of Health and Human Services and pass a comprehensive readiness review. The law also requires selected managed care organizations to partner with a commercial plan or provider-led entity to integrate behavioral and physical health services.

“We applaud the North Carolina General Assembly’s decision to allow MCOs to continue utilizing our expertise and regional partnerships in serving those with complex needs,” Wainwright said. “The tailored plans will help provide continuity through the changes to come. We welcome the chance to expand our existing efforts to further incorporate the principals of integrated care.”

The state Legislature was successfully lobbied to allow this change in part through the efforts of the Advancing NC Whole Health Coalition, which includes Trillium Health Resources, Alliance Behavioral Healthcare and Vaya Health, all local management entity/?managed care organizations responsible for managing publicly-funded behavioral health and IDD services in North Carolina.

Together, they are responsible for managing more than $1.375 billion in public funds and 610,000 Medicaid covered lives across 52 counties. More information about the coalition can be found at

Contact Michael Abramowitz at or 252-329-9507.


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