The North Carolina Department of Health and Human Services announced last week that public MHDDSA services will be administered through a smaller number of administrative organizations. Additionally, services will be funded using a “waiver” which will mean that systems will have to become much more standardized in how they serve communities. In other words, we will eventually not have LMEs but will have a smaller number of regional administrators.
A Medicaid waiver means that a regional service administrator is given a set amount of funding and can use these dollars more flexibly and presumably more responsively than in our original way of funding services (where the money is specified for its use and less flexible). Of course, this is a very simplistic explanation. But what is known by people across the country is that waiver success depends on developing a community-level process that includes consumers and family members that inform the system of local needs in an ongoing way.
The Piedmont waiver has been a good example of this, some have said, especially in the area of developmental disabilities. Hopefully, it will continue to develop and strengthen processes that take direct input from consumers and families across all disability areas so it can become even more responsive.
Some people feel this move to waivers is wonderful news. They feel that in too many communities, the LME system has not had good enough results for the taxpayers’ expense and that they have not really helped consumers to thrive. So funding fewer administrations and moving to more responsive service planning sounds really great to many in our state.
Of course, waivers are not a cure-all. We may find that fewer people are found eligible for services in this process. On the other hand, a really good manager can use finite resources to accomplish more than a mediocre manager if he truly listens to his or her community to best understand its needs and how to maximize resources by working with other community assets.
To some people, this move to waivers is wonderful news. They feel that in too many communities, the LME system has not had good enough results for the taxpayers’ expense and that they have not really helped consumers to thrive. So funding fewer administrations and moving to more responsive service planning sounds really great to many in our state. Of course, waivers are not a panacea. We may find that fewer people are found eligible for services in this process. On the other hand, a really good manager can use finite resources to accomplish more than a mediocre manager.
What will be so important is that the best LMEs are awarded waiver management contracts. This means that the evaluation of proposals must be both intensive (deep evaluation based on community stakeholder report of community level MHDDSA history) and extensive (broad).
It means that many factors should be considered before selecting a waiver administration site. For instance (readers can problably think of more):
1. Historically, how well have funds been utilized? How much funding has been reverted to the state in the past five or so years? What innovative services developments have arisen through creative management and partnering? How are service gaps in local systems discovered? How has the LME responded to these? Who informs the LME BOD of community deficits or offers ideas for solutions?
2. How effective are partnerships between the LME and community agencies? What are funds granted to them actually purchasing? Are the results of these purchases measurable in terms of improving the lives of persons with psychiatric, developmental, or addiction related problems? Are contracts results-directed, with outcomes set as part of the contract and accountability held for these outcomes?
2. How many people are showing up in local emergency departments? Of these, how many of these actually need emergency interventions with inpatient care? How many are using state hospital beds? How does an LME rate as far as hospital versus community services?
3. What initiatives have taken place in the past five years that have been client-informed and which have resulted in improved quality of life and better health (mental, physical).
4. Have there been innovations developed to help with the folks with developmental disabilities who do not get their services through CAP?
5. DHHS should look at the LME’s approach to quality improvement not from a compliance perspective but from a results perspective. Is the process of a given LME’s quality improvement yielding better service results over time? What is the evidence?
6. How much “genuine welcome” had been extended to the consumer community to ensure that the customer’s voice informs system quality? Has the LME been open, transparent, and engaging with its local consumer base, or is it more insulated in how it does its planning?
Change certainly takes patience, and progress requires patience and hard work. Stay tuned to learn how you can advocate locally and at the state level for changes that bring responsive innovation and solutions.