One week after state officials notified Western Highlands Network of plans to end its Medicaid waiver contract July 31, WHN board members report that the future of the Asheville-based organization will come in one of two ways: merge with another local management entity, or pilot an integrated health-care program.
“The state wants us to figure out what we’re going to do,” Western Highlands interim CEO Charlie Schoenheit said at the board’s April 12 meeting. “We’ve got a couple of weeks to come up with our plan. We don’t have a lot of time to mess around.” The Medicaid waiver contract expires July 31.
The first plan entails merging with one of 11 local management entities in the state. These organizations are available 24/7 for people to find information about how to receive services in their county for mental health, developmental disabilities or substance abuse. Schoenheit noted that Western Highlands has already “received letters of interest from across the state.” Under this plan, another organization would take over Western Highlands operations, while trying to keep as many of the existing staff as possible.
The closest management entity to Western Highlands is Smoky Mountains LME, which serves individuals in Alexander, Alleghany, Ashe, Avery, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon, McDowell, Swain, Watauga and Wilkes Counties.
Board member Mandy Stone says that should Western Highlands take this route, it would not be the first time a merger has happened in the state. However, it would be the first time that one occurred after a contract termination. “I think that’s what caused anxiety for providers and consumers. They wanted to know whether they were going to have local input in how we go forward,” Stone explains.
The second option involves creating a pilot program centered on the integrated care model, in which behavioral health care and medical health care coexist. This approach is comprehensive and looks at the whole person, Stone says.
Board chair Charles Vines says in the next two to three weeks, the board will be sitting down with state officials from and attorneys to sort out legal options for pursuing the pilot program.
“They [N.C. Department of Health and Human Services and N.C. Division of Medical Assistance] are willing to allow us to have input, lots of input, and we’re going to work to make the best decision we can,” Vines states.
The pilot program would align with the state’s long-range “Partnership for a Healthy North Carolina” plan, which “calls for the creation of several statewide Comprehensive Care Entities (CCE’s) that will provide the framework to deliver high quality, patient-centered care to Medicaid recipients.” Currently, the plan still needs approval from the North Carolina General Assembly after it was presented earlier this month.
Stone says, “We really think we’re the perfect community to pilot an integrated model. We have a real strong history with integration. It’s in our FQHC (federally qualified health center) at Minnie Jones, it’s a part of our hospital system, it’s a part of MAHEC and how they train docs.”
Both options were the result of an April 11 meeting in which six of the seven county managers who serve on the Western Highlands board traveled to Raleigh to meet with the Secretary of the state’s Department of Health and Human Services Alonda Wos, Director of the state’s Division of Medical Assistance Carol Streckel and N.C. DHHS staff to discuss the termination of the Medicaid waiver. Though board members said the state apologized for how Western Highlands was notified about its termination of the Medicaid contract on April 8, board members were not shy about voicing their frustration in receiving the email that Friday afternoon.
“We were here Friday morning [April 8] in a meeting. Now, you tell me that they decided at 3 p.m. [that day] to do this? No. They knew good and damn well what was going on and they had to know, or should have known, that we were here. They should have had somebody here and said, ‘Hey folks, we need to talk about this,’” board member Steve Wyatt told Xpress after the meeting.
Going forward, board members maintain that they’ll determine Western Highland’s fate based not only on what it means for the network’s more than 300 providers but for how it affects the more than 10,000 consumers the network serves at any given time.
“Our main objective is to make sure that, whatever process we end up with at the end of the day, we make sure everything is as seamless as possible to the clients and the providers at the end. The clients are the most important thing that’s on our mind right now. How we’re going to continue to take care of them and hopefully the transition will not affect them whatsoever,” Vines says.
“In the meantime,” Schoenheit says, “it’s business as usual. We are going to continue to do authorizations. We’re going to continue to take in new consumers through our access department. All these functions are still going to continue while we figure out what we’re going to do and while we’re making the transition.”