Blog Archives

What the Heck are the NC MCOs’ Jurisdictions?

Since the new MCO (managed care organization) system is SO new to the Medicaid system in North Carolina (as in since February 1, 2013), I though it would be prudent to explain what the in the heck is the MCO jurisdiction system.

An MCO is defined, generally, as:  a health care provider or a group or organization of medical service providers who offers managed care health plans. It is a health organization that contracts with insurers or self-insured employers and finances and delivers health care using a specific provider network and specific services and products.

In NC, the MCOs are the messengers to the Division of Medical Assistance (DMA)…the middlemen…the ears of DMA.  Instead of 100 separate LMEs, the 11 or so MCOs are supposed to create more of a state-wide, uniform Medicaid criteria.  Now, I am not sure if the below image correctly depicts the jurisdictions of all the MCOs.  It seems as though the MCOs’ jurisdictions change quite often, but the image below is the most current jurisdiction map I could find. Please, if someone else has a more current map, please share.

Image

 

Medicaid Recipients Under 21: Not Allowed to Self-Refer Selves to Mental Health Services

In the wake of the killings in Connecticut and with all the recent discussions nationally about mental health, I realized something yesterday that floored me:

In North Carolina, an 18-year-old Medicaid recipient is not allowed to self-refer him or herself to a therapist.

According to DMA Clinical Policy 8C, a Medicaid recipient,  under the age of 21, who wants to seek mental health services by a therapist (Outpatient Behavioral Health services) is required to have an “individual, verbal or written referral, based on the beneficiary’s treatment needs by a Community Care of North Carolina/Carolina Access (CCNC/CA) primary care provider, the LME-MCO or a Medicaid-enrolled psychiatrist.”

Medicaid recipients over the age of 21 can self-refer him or herself to mental health services.

Adam Lanza, the boy who shot so many innocent children and teachers in Connecticut, was 20-years-old at the time of the horrible event.

Yet, if he lived in North Carolina, he could not have self-referred himself to receive therapy.  He would have needed to see a doctor first.

I understand that Medicaid recipients under the age of 21 CAN see a therapist. But, by placing another hoop for them to jump through (seeing another doctor first), just makes it that much harder to receive therapy. If access to mental  health services is that important, why make it more difficult for Medicaid recipients under 21?

Surely, a 20-year-old Medicaid recipient has the capability to determine whether he or she is in need of therapy.