And Then There Were 10: Reducing the Number of MCOs?
And the mental health system spirals downward….
There is talk that Western Highlands, the Managed Care Organization (MCO) currently servicing eight Western North Carolina counties, Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey, will be the next casualty to the MCOs.
The MCOs, formerly called local management entities, are the regionally-based agencies that receive a set monthly payment from the state to provide both state- and Medicaid-paid services. With that money, the MCOs must allot services for everyone under their care.
Rumors at the Capitol is that Western Highlands may be swallowed up by Smoky Mountain Center, the MCO regionally adjacent to Western and servicing 15 counties.
Currently, Western Highlands has no CEO. No Chief Financial Officer. And the Chief Medical Director is near-retiring.
But the lack of leadership is not the only issue with Western.
Health care providers have complained that the majority of authorizations for new services or renewed services are being denied by Western.
The whole point of the MCO-based Medicaid system is to allow the state to dole out chunks of Medicaid funds to each MCO. Then the MCO approves services for Medicaid recipients until the money runs out.
Considering this is only the 2nd year Western Highlands has been servicing the 8 counties, it seems a bit odd to be denying so many services, if this is actually happening.
Here are the current MCO jurisdictions:
Another rumor is that the goal is for the number of MCOs to be in the single digits. Who is next???
If the next casualty MCO is the MCO least-competent, maybe NC leaders should begin planning for a different mental health system….without MCOs.
So far, it appears that MCOs have all the Medicaid funds for mental health with zero guidance from the state. See my blog: “NC MCOs: Accountability Must Be Somewhere.”
So is it good or bad that Western Highlands may be swallowed up? I don’t know. How competent is Smokey Mountain Center?
Posted on March 8, 2013, in Affordable Care Act and tagged Buncombe County North Carolina, Managed care, MCO, Medicaid, North Carolina, Transylvania, Western North Carolina. Bookmark the permalink. 11 Comments.