The Future of NC Medicaid Behavioral Health: Will We Soon Be Down to Eight MCOs? Two More Monkeys Jumping off the Bed?!

Remember the song “10 Little Monkeys Jumping on the Bed?”

Ten little monkeys jumping on the bed.
One fell off and broke his head.
Mama called the doctor and the doctor said,
“No more monkeys jumping on the bed!”


I used to love that song as a kid.  I have two siblings and I distinctly remember our jumping-on-the-bed-game-while-trying-to-push-the-others-off-game.  Many times we would sing “10 Little Monkeys Jumping on the Bed,” while trying to push our siblings off the bed.

Here in North Carolina we started with 11 managed care organizations (MCOs) across NC to manage behavioral health care for Medicaid recipients.

MCO map

See the map? We began with 11 MCOs.  Today, we have 10 (Western Highlands Network (WHN) is no more) with strong possibilities of reducing the number of MCOs to 9…and then 8.

Rumor has it that Centerpoint Human Services (Centerpoint) and MeckLINK Behavioral Healthcare (MeckLINK) are on the brink of nonexistence.  “One fell off and broke his head.”

Centerpoint and MeckLINK are, however, moving forward to nonexistence in entirely different ways.  Centerpoint is looking to merge with two MCOs.  Both Partners Behavioral Health Management  (Partners) and Smoky Mountain Center (SMC) are getting updates as to Centerpoint’s merger plans.  Will Centerpoint break up its catchment area and merge with 2 MCOs? Or are those 2 MCOs the contenders?  Not sure. But either way, Centerpoint will be eliminated in the near future.

If SMC absorbed Centerpoint entirely, SMC will be HUGE!!

SMC began with Alexander, Alleghany, Ashe, Avery, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon, McDowell, Swain, Watauga and Wilkes Counties (15 counties).  Then SMC ate up WHN and acquired Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey counties. (15 + 8 = 23 counties).

Centerpoint manages behavioral health care for Forsyth, Stokes, Davie and Rockingham counties.

(15 + 8 + 5 = 28 counties).  Over 1/4 of NC’s counties.  The MCO map would be dominated by dark blue, and, as North Carolinians, let me ask you, do we want our state dominated by dark blue? What about Wolfpack red? 

Here is the MCO map, as of October 2013:

October 2013 MCOs

Partners’ catchment area is light yellow and includes Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry, and Yadkin counties (all in the west and bordering SMC’s catchment area).  If SMC continues to expand, like Stephen King’s “The Blob,” SMC may ooze into Partners. 

Unlike Centerpoint, at least on paper, MeckLINK is not willingly jumping off the bed and breaking its head.  MeckLINK is the only MCO run by a county (Mecklenburg county).  See the lone red county? In May, state lawmakers passed a bill that says a county can’t run its own organization.  Mecklenburg County Commissioners voted last Tuesday to work out a deal with Cardinal Innovations Healthcare Solutions (Cardinal) or dissolve MeckLINK when its contract expires next April.

Cardinal’s catchment area is purple and includes 15 counties.

But do not underestimate the power of usurping MeckLINK, even though it is only one county.  Mecklenburg county is one of NC’s most populous counties, which means it receives a hefty Medicaid budget.

Ten little MCOs jumping on our heads
One fell off; its assets in the reds,
DMA called the doctor and the doctor said
No more MCOs jumping on our heads.
Nine little MCOs jumping on our heads…

So which MCOs will survive? How soon until we only have 8 MCOs? Will all the MCOs be replaced with out-of-state, huge MCOs?  Will the future MCOs manage all Medicaid services?  Will there be carve-outs?  These are unanswered questions as we embark into the future of NC Medicaid managed care. 

One thing we do know is we started with 11 MCOs (all of whom were deemed solvent and competent by a state contractor) and, not even 1 year later, WHN falls…MeckLINK falls…and Centerpoint falls.


Maybe the 11 MCOs were not solvent and competent in the first place.  Why else would the MCOs keep jumping off and breaking their heads?  Silly monkeys.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on November 12, 2013, in Behavioral health, Budget, Cardinal Innovations, CenterPoint, Certification of MCOs, Division of Medical Assistance, EastPointe, Health Care Providers and Services, Managed Care, MCO, MeckLINK, Medicaid, Medicaid Budget, Medicaid Spending, Mental Health, Mental Health Problems, Mental Illness, NC, NC DHHS, North Carolina, Partners, Smokey Mountain Center and tagged , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. 6 Comments.

  1. By July 2014 Partners will merge with Smoky, the only people talking about Centerpoint is Centerpoint and W-SJ, 3-4 MCOs? Smoky takes everything west of the Yadkin. Centerpoint Mecklink, Sandhills go to Cardinal; Alliance stands alone; the remaining MCOs in the east merge with East Carolina MCO. Then you have 4 monkeys jumping on the bed.

  2. When will we get to three blind mice!!!!

  3. My former case manager, who went to work for Centerpoint when it became a MCO, said this whole thing might blow up (the LMEs becoming MCOs) and unfortunately she was right. I feel like we were led astray for over a year that when they became a MCO we would get more services and the money spent would be more flexible and could be moved around so my daughter could get a behavior intervention plan. Also that more people would get off the waiting list (including us that have been on it over 6 years) and get waiver slots. Instead we have already lost one service and if they merge with SMC looks like we will get even less hours. If they GA continues to release slots at the current yearly rate it could be over 12 mores years waiting for a slot for us. I hope they can eventually come up with a plan that is fair and reasonable!

    • Me too, Sandra, me too.

      I hope that you are appealing the lost service. You do not need an attorney in order to appeal it. I can give you a quick summary of “how to” if you would like. But I hope you are not just accepting the denials of service.

  4. Thank you for your concern. I have emailed the supervisor to verify that UM recently discovered that we can only receive one state funded service at a time. If I find out that my care coordinator was wrong, I will appeal loosing the service. Thank you for your blogs, I really enjoy them and check often for the latest updates. I even sang the MCO monkey song to my son today, LOL.

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