State Budget Update

I always look forward to news from Raleigh which Rep. Verla Insko (D-Orange) sends in her e-news regularly. She doesn't mince words and we're able to get an understanding of how legislative decisions really impact us across the state. Her update on Thursday offered a rather bleak view of what's in store based on the Senate passing their version of HB 200 on Appropriations which is a breakdown of proposed spending for the next two years. Rep. Insko's update predicted the House would vote to ratify the bill by week's end, which did happen on Saturday, June 4th.

She reported, "The state Senate has passed a damaging budget that appears poised to pass the House before the end of the week. I believe the Governor will veto the bill – as I have been telling you; but, whether House Democrats will be able to sustain her veto is now in question. Five House Democrats will vote for the bill - as they did for the House proposal that was passed a few weeks ago.

"Until recently, it was my understanding and my belief that these would vote to sustain the Governor’s veto. As a result of negotiations, these five legislators gained some concessions, so the support of the Governor’s veto is now in doubt. We need just two of these legislators to change their minds, and I am still hopeful that they will because if this budget goes into effect, the damage will take years to correct.

"I have done my best to keep the most harmful aspects of this budget from going into place, but the majority appears determined to pursue a course of action that will mean thousands of layoffs, fewer preschool services, less access to healthcare and less protection for the environment."

Cuts that impact those of us concerned about the quality of care and mental health services in North Carolina will happen through a $2 billion cut in Medicaid, the elimination of the state's Health and Wellness Trust Fund and a cut to Education, which includes impacts to special education services as 2,245 teaching assistants positions will be cut across the state. That translates to a financial loss of about $3.4 million to our Chapel Hill-Carrboro City Schools and $2.1 million in budget cuts to our Orange County Schools districts. This includes a drastic cut to early child hood programs resulting in the closing of local partnerships and elimination of critical education and health programs for children identified from age birth to five as being at-risk.

We can hope that Governor Bev Perdue will veto this bill, however, House democrats might not be able to sustain the veto. The five democrats who voted in favor of HB 200 will put the Governor's veto in jeopardy. Rep. Insko says we need just two of these five to be swayed to support the veto. She fears if this bill goes into effect it will take the State of North Carolina many years to recover from the damage.

How can you help? Contact each of the five democrats (Rep. William Brisson, Rep. James Crawford, Rep. Dewey Hill, Rep. Bill Owens and Rep. Timothy Spear) who voted in support of HB 200, as well as the republican representatives and let them know of your disappointment. Encourage them to support the Governor's veto so our state is not again thrown into a downward spiral that will take years to correct. Mental Health, Developmental Disabilities and Substance Abuse sufferers have had a decade of roller coaster rides when it comes to their treatment services being adequately funded - and so has education and other vital areas that effect the quality of life in NC. Their email addresses and other contact info can be located at http://www.ncleg.net/gascripts/members/memberList.pl?sChamber=House.

Time is running out, so please don't hesitate in letting them hear from you.

Sincerely,

Julie J. Bailey

Interim Executive Director

MHA of the Triangle

Community Support fiasco redux? The weekly rate for case management

After the problems created by the North Carolina Department of Health and Human Services through the Community Support service definition and billing structure, resulting in over $400 million in waste and a sharp decline in service quality, Department leadership needed to take a close look at how financial incentives influence the delivery of services.  It had been apparent from the time the draft service definition for Community Support was released that the new scheme was going to encourage providers to use less qualified staff to provide services in order to increase the bottom line.

 One need not be an economist to understand that if you set up a system which pays the same rate ($64/hr.)  for a service performed by someone with a high school diploma as someone with a master’s degree, and authorize each to perform essentially the same services, businesspeople will tend to utilize staff that are cheaper to employ in order to maximize profits.  The Department failed to grasp basic capitalist principles that the new system was founded on.

One of the driving forces behind mental health reform was the notion that the invisible hand of the market would insure that the system would be transformed into a more effective and efficient one, because public providers are inherently lazy and wasteful, and those in the private sector are high-performing.  You will not find this belief articulated in the Blueprint for Change, but it was key to shaping reform.  This idea was pushed by lobbyists for large provider companies, and only continues to gain currency in today's political environment.  Privatization, some would have you believe, is the answer to all of societies problems, from fighting wars to supervising parolees. 


Through reform, responsibility for the care of the state’s most vulnerable citizens was transferred from people who saw themselves as public servants, doing what needed to be done because they were responsible, to people who see themselves as purveyors competing for revenue in the private marketplace. It seems that administrators in the Department, many of whom have been public servants for decades, have not made the necessary shift to a more capitalist mentality.    

By introducing a weekly case rate for case management services, the Department has again developed a service and reimbursement schedule that invites both fiscal abuse and reduced service quality.  Case managers will bill $81.25 for the first 15 minutes of service per week.  It’s a different scheme, founded on the same faulty assumption that sealed the fate of Community Support.  The assumption is that providers will adhere to an ethical code and do the right thing for consumers, without regard to financial incentives.  What is the incentive in this case?  Provide 15 minutes of service per consumer, per week and no more, regardless of clinical necessity.  The provider agency will be paid $81.25 if they provide 15 minutes or 15 hours of service to a consumer. 

Mental health providers are not an inherently greedy lot, but they live in the same capitalist society as everyone else.  The incentive to exploit this easily exploitable payment structure will only be exacerbated by the fact that providers have been treated badly by the state, with reduced reimbursement rates (some retroactively imposed), expensive mandatory trainings, and constantly shifting regulations. 

I am not an economist or a railroad engineer, but the light at the end of the tunnel is looking a lot like a train.

Welcome!

Welcome to the new blog for Mental Health America of the Triangle!

MHA of the Triangle was formerly  the Mental Health Association in Orange County.  We are now affiliated directly with Mental Health America, the nations oldest mental health advocacy organization.  With our new name, we promise to continue to provide the same kind of innovative solutions, advocacy, and education that we have been providing since 1966 to the wider Triangle community.

We will be bringing information and discussion about mental health and agency related topics here.  Please share your thoughts and ideas with us!