A lady telephoned me today. We will call her Dannae (because her name actually is Dannae, and she gave me permission to use her name). Dannae used to have a company, Three-D’s Forever, Inc. d/b/a Step Down Group Home.
Dannae used to manage a group home for mentally ill teens in the Sandhills catchment area. Sandhills Center is one of our 11 (soon to be 10) MCOs and serves 8 counties: Anson, Harnett, Hoke, Lee, Montgomery, Moore, Randolph and Richmond. The eight county catchment area has a population of approximately 556,000 individuals.
From the time Sandhills Center (Sandhills) went “live” (contract effective date December 1, 2012, and “live” effective date April 1, 2013) until the day her company closed, May 3, 2013, Dannae and Step Down had difficulty dealing with Sandhills.
Throughout January 2013, Sandhills informed Dannae that forms were missing from the application; on or about February 8, 2013, Sandhills conducted a safety, site-visit check. On or about February 17, 2013, Dannae received a letter from Sandhills saying the site visit was fine.
April 1, 2013, came and went and Step Down still did not have a contract with Sandhills. She was told by Sandhills that everything had been approved and Step Down was on the list for approval. Yet, Step Down had consumers in Sandhills catchment area with no Medicaid contract. Numerous communications went back and forth.
April 24, 2013, Sandhills contacted Step Down saying that it had been approved and a contract would follow. But still…no signed contract.
Two check periods passed with no Medicaid reimbursements paid to Step Down.
The last contact from Sandhills was April 24, 2013, saying Step Down was approved.
Step Down was forced to close its doors May 3, 2013.
May. It is mid-August.
Sadly, Dannae is now unemployed. Prior to May 3, 2013, she contributed to society. She ran a business. She helped Medicaid recipients. Now, because of Sandhills and the bumpy (to say the least) transition to Sandhills, Dannae’s company is nonexistent.
Yet, I googled Sandhills’ Medicaid providers today. An amazingly, long list of Medicaid providers is on Sandhills’ website as “Current Medicaid…Provider List.” Here is the page in which I was interested:
I know. The print is small. But click on the picture and you can enlarge it. See Three D’s Forever, Inc d/b/a Step Down?
This is a list of Medicaid providers in the Sandhills catchment area that I pulled from today, August 19, 2013. Three and 1/2 months after Step Down was forced to close, Sandhills still lists Step Down as a Medicaid provider.
Dannae told me that Medicaid recipients/guardians are still calling her for mental health care appointments because of Sandhills list of “current” providers.
Who is supervising Sandhills’ marketing of closed providers? Who is to say that Three D’s Forever, Inc. d/b.a Step Down is the only closed provider on Sandhill’s list?
Who is ensuring that Medicaid recipients have adequate access to mental health care?
Apparently not Sandhills, which, apparently, does not even know that Step Down is out of business. Surely, not the Department of Health and Human Services (DHHS), because after the MCOs went live, DHHS cannot even track mental health services. DHHS has no idea who is getting or not getting services. The providers certainly cannot ensure adequate access. Once the providers go out of business, the owners are concerned about their own monetary situations (and understandably).
This leaves the Medicaid recipients’ guardians, if applicable, who pull up the Sandhills current Medicaid provider list and start calling around. They call Step Down only to be told Step Down is closed.
How many other providers on Sandhills’ list are closed? Or no longer accepting Medicaid?
Wasn’t Sandhills contracted to manage behavioral health Medicaid care in 8 counties?
Then how can Sandhills be oblivious to the fact that a provider on its “Current Medicaid…Provider List” is closed?
As for Dannae, whether Sandhills is managing Medicaid behavioral health car within 8 counties adequately enough is a non-issue. Her company is closed.
She is just another victim of State non-oversight.
For a full rundown of his comments, please click here.
In essence, Gov. McCrory admitted that the current Managed Care Organization (MCO) situation is not working. Holy cow!! Finally!
Secretary Aldona Wos stated, “We have a system that doesn’t meet the needs of the patient, that doesn’t meet the needs of the taxpayer.” Oh, holy WOW-ness!! (I’m doing the Snoopy dance in my head).
Gov. McCrory stated that, by 2015, three or four MCOs will be the private entities in charge of Medicaid for NC. Right now we have 11 MCOs. Hmmmm…so here we have a huge change….Good? Or Bad? Well, one thing to say for it, it’s a change. Anything has to be better than our current situation, right? Let’s analyze:
The map above depicts the current MCO jurisdictions. So, in the next year and a half, which MCOs will close?
My guess? The smallest MCOs.
Regardless, what did McCrory propose this morning? And is this a fix?
- Today Gov. McCrory stated that by 2015 only 3-4 MCOs will be in existence.
Good? Bad? Or Ugly? It depends. Will those 3-4 MCOs act like the current 11 MCOs? Will the Division of Medical Assistance (DMA) be able to supervise these private MCOs? Obviously the answers to those questions determine the answer.
- Today Gov. McCrory stated that the MCOs would be state-wide.
Good? Bad? Or ugly? Good!!!! YES! YES! YES! What does that mean? That means (from how I understand this proposal) is that if a Medicaid recipient does not want to deal with East Carolina Behavioral Health (ECBH) (I am only using ECBH as an example), then the recipient could choose to use another MCO. Whereas, currently, the Medicaid recipient is forced to use the MCO that’s jurisdiction covers the county in which the recipient resides.
I must say, statewide MCOs could be a really good thing. If, and only if, (1) the MCOs are supervised (it does not behoove NC to contract with a few MCOs, which end up putting their own profits ahead of the NC Medicaid recipients); (2) (in my humble opinion) the MCOs are not compensated by the amount NOT spent on Medicaid services (there needs to be an incentive to COVER recipients’ services, not to DENY the services); and (3) if there is some sort of consistency among the 3-4 MCOs (we don’t want Medicaid recipients to have to “shop” MCOs to find services; there should be a statewide consistency).
So, was today a step forward in Medicaid reform? I think so. But there are potential dangers that could make today’s reformation (for lack of better words) NOT good. If we move forward thoughtfully and understanding of possible downfalls, these new changes could result in positive outcomes in North Carolina Medicaid.
One (of many) of my concerns? What happens to the health care providers that go bankrupt because of the MCOs between now and 2015?