Wake County Loses Administrative Control of Mental Health Services

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Wake County will lose ultimate control of its mental health services in the coming year. Instead of creating a new organization to manage mental health care in Wake County, human services personnel will spend the next few months merging with the Durham Center, the mental health management entity in Durham County.

A new state law required all counties in North Carolina to drastically overhaul the way they pay for mental health with Medicaid — or be taken over by an outside organization. Wake County applied for a waiver to be able to meet new state rules, but the state rejected the application last week.

On Monday, members of the Wake County Commission voted to merge Wake’s mental health services with the Durham Center, which manages mental health for Durham, Johnson and Cumberland counties.

County mental health administrators spent much of the summer and fall applying to the state for a waiver to Medicaid, the combined state and federal program that pays for much of mental health care. State lawmakers passed a law in June requiring all mental health local management entities (LMEs) in the state to apply for the waivers or be taken over by an LME that has. The waivers are necessary for mental health management agencies to change their payment and organizing structures to look more like an HMO.

But state administrators rejected Wake County’s application in a letter received by county officials Nov. 1. The letter stated multiple deficiencies in Wake County’s proposal such as no plan to obtain national accreditation for providing mental health services, lack of detail in staffing plans and incomplete information about the county’s information technology plan, among other concerns.

Deputy Wake County Manager Joe Durham said merging with another county’s LME means a loss of some control.

“By Wake not having an LME, there is the potential for job loss,” Durham said. “But those people would be able to apply for jobs in Wake County government and the other thing is for them to apply for jobs in the new managed care organization.”

Durham County has already agreed with Cumberland and Johnston counties to take over their mental health LMEs. Wake will become the fourth county to join the new organization, which will eventually be renamed.

Deputy County Manager Durham said Wake County mental health officials have been talking to administrators from the Durham Center for several months about the possibility of a merger. One of the sticking points has been the composition of a 15-member board to oversee the combined agency. Durham County would have a board majority, with the rest of seats distributed among Wake, Cumberland and Johnston county representatives.

“There is a concern about control,” Durham said. “But it’s eased by knowledge of a merger or consolidation. That’s what we’re thinking.”

At a Board of Commissioners meeting Monday, Wake human services personnel presented their merger plan. Commissioners unanimously approved the plan, as did representatives of an advisory committee of mental health clients and their families.

One thought on “Wake County Loses Administrative Control of Mental Health Services

  1. This shows the long ago predicted trend of LMEs evolving into larger and larger business entities. The 1980’s business ethos of ‘bigger is better’ that supposedly resulted in downsizing of middle level ‘bureaucrats’ in the merger and acquisition phase of the American business world since the Reagan era, resulted in jobs being lost, previously well integrated services being outsourced to contractors with lower pay scales, disintegration of centralized control and accountability, fractionation of services into foxhole locations of spun off business entities, less well trained workers, poorer service at most levels, increase in profit growth as the prime goal driving M&A’s etc. We have already seen most of this in the mental health reform “businessized” reform movement including outrageous salaries for CEOs, loss of many front line services, dumbing down of workers’ skillsets, novel service delivery models that at times result in much poorer modes of service, no accountability, longer bottlenecks in hospital ERs all over the state, misguided downsizing in inpatient state facilities, erosion of the private sector, abandonment in huge numbers by private practice providers who found working ‘in the system’ to be a nightmare that put paperwork first and service and ethics and quality of care following by wider and wider margins with each new iteration of the reform’s structure. Now the Medicare Waiver movement ironlically stresses ‘quality of care’ but is about again doing less with less.