If You Care About Mental Health in NC, Learn These Letters

A, B, C, D...LME/MCO?

As we finish up Suicide Prevention Awareness Month, it’s time to talk about the alphabet soup that is mental healthcare in North Carolina. Some people are lucky enough to be able to pay for their care out-of-pocket, or through their group insurance. But what if you don’t have those options? Where do you go?

The letters to know are L-M-E-M-C-O: Local Management Entities/Managed Care Organizations. An LME/MCO is an organization that manages mental healthcare for North Carolinians who qualify for Medicaid.

Unsurprisingly, they’re controversial.

Where Did They Come From?

LME/MCOs started when the state government wanted to stem rising mental healthcare costs in 2001. Back then, mental healthcare was a fee-for-service system, meaning any doctor could bill the state Medicaid system for services at any time. This made state costs unpredictable. Not ideal.

The state tightened that up with LME/MCOs. They operate by managed care, meaning the state gives them a certain amount of money per patient and no more. This ensures that the state knows where its mental healthcare dollars are going, allowing for better and easier state budgets.

Where Do They Go?

The catch: LME/MCOs are merging, and often. In 2001 North Carolina had 39 LME/MCOs. As of this summer, we’re down to four.

Why? Partly to make state’s Medicaid reform plans easier to roll out. But all the merging is controversial because it’s creating instability in the system. As provider systems change, people have a harder time knowing where to go for help. Advocates are worried that all of the agencies getting lumped into four big groups takes resources away from the local level, even though patients are almost always best served by the providers they know and trust — the ones that are close to them.

Disability Right North Carolina points out that LME/MCOs require A LOT of documentation throughout the year to prove the need for services, which is hard for patients’ families. Also, some programs that helped patients build skills and integrate back into their communities have been cut.

And then there’s the money question. Basically, LME/MCOs get paid by the head. It’s known as a capitated system. If they don’t spend all the money the state gives them, they get to keep the extra. Which is all well and good — unless all that extra cash is going to administrative costs rather than back into community-oriented programs. Some people fear it is.

Take a Stand

Mental healthcare is a complicated issue; we get it. But it’s also an issue that touches almost all of us, statistically speaking, so we encourage you to have an opinion. Tell us what you think. Is the state doing a good job taking care of our most vulnerable citizens, or do we need to step it up even more?

Let us know in the comments. And while you’re at it, keep up with issues that affect your health costs by joining the Coalition.

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  • commented 2016-09-29 22:57:36 -0400
    Being a foster parent and having to deal with this issue, it is very frustrating having so few options even in emergency situations. Moses Cone only puts bandaids on the problem and just moves on to the next head.. Finally we had to go to Chapel Hill to give the kid a fair chance at help. The system is severely broken and more and more people are in need of services every day with less options everyday. This means they come to the emergency rooms and take up beds needed for others. People still want to stick there heads in the sand and pretend there is no problem because it’s an awkward topic that we just don’t want to talk about or accept. It here it’s not going anywhere and we need to fix the system and that includes a doctor on site not in a sattelite office being streamed to a TV in room 60 miles away, how do you evaluate someone like that? Not very well I found out.’sorry for the rant, but this ticks me off big time.
  • commented 2016-09-29 22:55:30 -0400
    Being a foster parent and having to deal with this issue, it is very frustrating having so few options even in emergency situations. Moses Cone only puts bandaids on the problem and just moves on to the next head.. Finally we had to go to Chapel Hill to give the kid a fair chance at help. The system is severely broken and more and more people are in need of services every day with less options everyday. This means they come to the emergency rooms and take up beds needed for others. People still want to stick there heads in the sand and pretend there is no problem because it’s an awkward topic that we just don’t want to talk about or accept. It here it’s not going anywhere and we need to fix the system and that includes a doctor on site not in a sattelite office being streamed to a TV in room 60 miles away, how do you evaluate someone like that? Not very well I found out.’sorry for the rant, but this ticks me off big time.
  • published this page in Blog 2016-09-29 08:09:30 -0400

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