Message from the CEO - May 2019

Cardinal Innovations Healthcare — May 08, 2019
May is national Mental Health Awareness month, and at Cardinal that means it’s a chance for us to get the word out about the importance of caring for your mental health. We have a lot of things going on this month to support this effort - be sure to follow us on Facebook to see how you can help spread the word about mental health awareness.

While we’re on the topic of mental health awareness, I’d like to talk to you about people with complex mental health needs and Medicaid reform. As you are well aware, North Carolina’s Medicaid program is in the midst of a transformation that will result in two sets of health plans to care for people with Medicaid: Standard Plans and Tailored Plans. Standard Plans will cover all benefits for non-specialty, healthy Medicaid eligible individuals. These will begin rolling out in November 2019. Tailored Plans will cover all Medicaid benefits for individuals with complex health needs who require specialty care for intellectual and developmental disabilities, mental health conditions, and substance use disorders (addiction), most of whom are already covered by LME/MCOs today. LME/MCOs will begin operating as Tailored Plans starting in July 2021. We have a one-pager that explains this in greater detail, you can access that here.

My point with explaining this today is that we have a responsibility to make sure NC DHHS executes Medicaid Transformation in a careful, thoughtful way. We’re concerned that people with complex health needs will be missed during this transition, and become enrolled in Standard Plans. Standard Plans may or may not be prepared to care for or understand the unique needs of these individuals, and certainly will not offer the array of necessary services.

This concern has a real implications for North Carolinians with complex health needs. I want to share just a few examples of real members (with identifying information removed), that NC DHHS’s current assignment plan would incorrectly enroll into a Standard Plan:
  • One member is a man in his 50s. His diagnoses include major depressive disorder with psychotic symptoms; bipolar disorder; post-traumatic stress disorder; and alcohol abuse. This means he feels very sad and sometimes may think he sees or hears things that aren’t there. He has periods of time when he feels very happy and times when he is not happy and doesn’t want to do anything at all. Something bad happened in his past that caused him to be very afraid and think it may happen to him again. He has a team of therapists working in the home and assisting him with daily activities to support him in the community. He has someone to help ensure he is taking important medications that help him.
  • One member is a woman in her 30s. Her diagnoses include major depressive disorder, post-traumatic stress disorder, and adjustment disorder with anxiety. She was sexually abused as a child and has been using cocaine since she was in her teens. More recently, she has begun using heroin. She has depression where she feels extremely sad and sees and hears things at times that are not there. She also has anxiety, where she becomes very edgy and can’t control or stop this feeling when it happens. When she has a situation where she is not comfortable, she may feel as if she’s having a heart attack. She recently visited a hospital emergency department and been admitted to a psychiatric hospital. She has someone to help ensure she is taking important medications that help her. She has a team of therapists working in the home with her and assisting her with daily activities to support her in the community.
  • One member is a child whose diagnoses include bipolar disorder, oppositional defiant disorder, schizoaffective disorder, and violent behavior disorder. This means he can’t control how he responds to day-to-day routines. His behavior is not like other children his age. He can’t be left unattended and is extremely challenging to manage at home. He doesn’t go to a regular school and has a team of therapists coming into the home to help him and his family care for him. He recently visited a hospital emergency department and was admitted to a psychiatric hospital. 

These are just three of hundreds of people we identified that would be incorrectly be enrolled in Standard Plans with NC DHHS’s current approach to enrollment. We are working with our partners at the Department to talk through our concerns in detail – but, like I share with you all the time – your voices are stronger than ours could ever be.

If you share our concerns with NC DHHS’s current approach to Tailored Plan enrollment and plan assignment, I urge you to share them with public officials. You can submit your concerns to NC DHHS by emailing, or by sending a letter to The Dept. of Health and Human Services, Division of Health Benefits, 1950 Mail Service Center, Raleigh NC 27699-1950. You can also share your concerns with elected officials at the NC General Assembly. You can find out who represents you in the NC House and Senate at this link. I hope you agree that it is critical that NC gets Medicaid transformation right and takes care of the people who need it most.

I want to take the rest of my time here today to thank members of the NC House of Representatives. You may remember me talking about mental health safety net dollars called “single-stream” funds a couple of months ago. These funds are state dollars that support behavioral health and substance use (addiction) services for people who do not have health insurance and don’t qualify for Medicaid. This provides our communities with a safety net, allowing LME/MCOs to provide services outside of Medicaid eligibility and restrictions. You may also recall that these dollars pass right through Cardinal – every dollar received is directly invested back into services and supports for our members and their families.

Today I’d like to thank members of the NC House of Representatives for their measured treatment of Single-Stream Funding and their fair distribution of cuts in their recently passed budget bill (HB 966). Our fight is not yet over though. As the budget now goes to the NC Senate, we urge state Senators to offer the same fair treatment of single-stream funds. If you feel so moved, we ask that you contact your legislators, thanking members of the House and asking members of the Senate for their support. You can find who represents you in the NC House and Senate at this link.

Thanks for taking the time to read this important message today. I hope that we’re giving you information that is helpful, relevant, and interesting. Want to see more or less of something? Want to write a guest blog? Please make sure to let us know. We only grow and do better when we work together.
Trey Sutten, CEO
Cardinal Innovations Healthcare

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