Commissioners hear update on county behavioral health provider during Medicaid expansion

Published 12:05 am Sunday, December 10, 2023

SALISBURY — The Rowan County Board of Commissioners heard an update on the rollout of Medicaid expansion and the new state budget and how those will affect the managed-care organization system in the state during their meeting on Monday. The presentation was given by Zach Shepherd, the community relations regional director for Vaya Health, the MCO which handles Rowan.

The MCOs are regional organizations that handle behavioral health treatment for the state. The Department of Health and Human Services recently ordered that the number of organizations be reduced from six to four. The four left are Vaya, who handles the western portion of the state; Partners Health Management, who handles the western Piedmont region; Eastpointe and Trillium Health Services, who handles the eastern half of the state; and Alliance Health, who handles the urban counties. The dissolution of Sandhills Center to bring the number down to four meant that Vaya added Rockingham County to its coverage area as well.

Shepherd said that the company is planning to take on an extra 471 members as a result of the Medicaid expansion. He also reminded everyone that if they believed they may be eligible for the expanded Medicaid to visit the NCDHHS’s website at https://www.ncdhhs.gov/ to see if they qualify.

Shepherd also spoke about initiatives that Vaya is taking in its programming, such as the “Pathways to Permanency” program, which is a collaborative effort between Vaya and county governments to find stable, permanent homes for children in foster care. Vaya’s website said the program aims to address challenges by families and individuals seeking permanency by promoting dialogues, embracing inclusivity and leveraging data-driven approaches.

The commissioners took particular interest in the N.C. Innovations Waiver system, which is designed to help meet the needs of intellectual or developmental disabilities who prefer to receive long-term care at home instead of in an institutional setting. Shepherd noted that the state budget added 350 slots for the innovation.

Commissioner Mike Caskey, who has a son who qualified for the waiver system, said that when he requested a waiver the statewide waitlist was 10 years long.

“Ten years is, that’s a lifetime for those that do qualify and the state puts them off. That’s a generation, how can that be something that’s acceptable?” asked Commissioner Jim Greene.

All of the commissioners asked what the issue was with the 10-year waitlist and what it was caused by, to which Shepherd said that funding is the one reason that stands out. However, Shepherd also said that it does not all boil down to funding, and that finding an answer to this is complicated

“That is a good question commissioner and I don’t know that I can answer that. Certainly, more funding helps and this Medicaid expansion helps tremendously, so I feel like we will start to see a lot with this waitlist since we’ve gotten expansion,” said Shepherd when asked by Commissioner Craig Pierce what he believed the answer to the issue was. 

Commissioner Judy Klusman provided a historical overview of how the current situation came to be, explaining that the waiver came about as an effort by the state to allow people with intellectual or developmental disabilities to receive the care they desire instead of being limited to care centered around institutional settings.

“To me, there’s a breakdown somewhere and I think to fix the problem that’s what we have to identify first, is where is that breakdown. As much money as the state has in their funding balance, there should be an answer here. If the state says ‘we are going to help people in this particular situation,’ they have to come up with something better than 10 years,” said Pierce.

Caskey noted that the problem also stems from what he sees as a misunderstanding of the “mental health issues we have in our country.” He said that in his job as a police officer, probably 80 percent of the people he deals with have either intellectual issues or mental health issues and that there is a constant effort to work towards better methods of working with them.

Both Chairman Greg Edds and Caskey said that they did not want the discussion to be viewed as an attack on the N.C. General Assembly, because nobody had all the answers on this issue.

“As a nation, our mental health issue is exploding as well. Why aren’t we asking, why is that? Typically, those aren’t things we talk about, we just fund them,” said Edds.

Although the commissioners did not take any action at the end of the discussion, Klusman did ask Shepherd to research the exact population and funding numbers surrounding the issue and return to the board.