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Warnings Aplenty That MeckLINK Unprepared

North Carolina General Assembly

Mecklenburg County Commissioners are shocked and livid that the state has removed hundreds of millions of dollars of Medicaid funds from MeckLINK, the county’s mental health service agency. Commissioners are pointing fingers and leveling accusations at the state, but the decision had been a long-time in the making.

In October, state officials told a General Assembly committee that MeckLINK was behind schedule in its preparation to manage over $200 million in Medicaid funds for the county. Lawmakers and staff were uncertain the agency could be ready for final approval by January 1, 2013—the Secretary’s legal deadline for a decision. Several senators and representatives expressed skepticism about MeckLINK's preparedness.

“I would like those members of the staff that think Mecklenburg County is ready by January 1st to please stand and put their careers on the line that that’s going to happen,” State Senator Tommy Tucker said at the committee meeting. “I don’t see anyone standing up, though.”

The transition to MeckLINK is part of a state change to how Medicaid funds for mental health services are disbursed. The county chose to administer funds itself, and spent $3 million and hired 131 workers to expand it. By overseeing the Medicaid program itself, the county stood to make $20 million from fees this year.

But, the Department of Health and Human Services stripped MeckLINK of its responsibility on Monday in favor of another organization. Phil Endress, MeckLINK’s director, says he doesn’t understand the decision.

“In all honesty I don’t know,” Endress says. “I think we have made tremendous progress toward becoming ready to become viable. I thought we were on a path toward being approved.”

When they found out at a public meeting Wednesday, several commissioners cried foul.

“I can’t help but believe there is something that smells funny about this whole thing,” said Commissioner George Dunlap.

Last night, Commissioner Bill James wrote in an e-mail statement, “I wouldn’t be surprised to find money and jobs for pols at the end of this.”

But, back in October, Health and Human Services Secretary Al Delia told the General Assembly committee that he would strip the county of responsibility and put another managed care organization—or MCO—in charge, if it appeared MeckLINK would not be ready by the deadline.

“We will be prepared should they not succeed in meeting those milestones and being able to go live,” Delia said. “We will be prepared as a department to assign Mecklenburg to another MCO region.”

By law, Delia had to make his decision on January 1, 2013, one month before MeckLINK’s deadline to be ready on February 1, 2013. Delia and his department have relied on reviews by Mercer, a consulting firm, to determine counties’ readiness to take over these Medicaid funds.

In its reviews, Mercer had consistently found MeckLINK’s preparations inadequate. Director Phil Endress was not brought on until August 2012. In October, 140 positions had yet to be filled—nearly two-thirds of the agency’s 220 total anticipated staff. And, Mercer cited numerous unresolved issues with the agency’s financial and IT systems, including that the health record and billing system  was not yet operational. Many of those problems had been resolved by the final review in December, but not enough, according to Mercer.

Read the draft of Mercer's final report.

On December 20, Mercer completed its final review of MeckLINK before Delia’s January 1 deadline. In an e-mail to Department of Health and Human Services staff, Mercer consultant Katherine Sternbach wrote: “The consensus of the Mercer team is that the extensive work remaining in the financial and information technology areas raises serious concerns about MeckLINK's ability to successfully accomplish the remaining tasks by February 1, 2013.”

The company estimated it would take until April 1st for MeckLINK's financial and IT systems to be fully operational.

“It was sad because they did much better on the clinical side,” Sternbach wrote in a subsequent e-mail to the DHHS team.

The Secretary decided on December 31st that Cardinal Innovations will take over the Medicaid funds. Formerly known as PBH, Cardinal is the state’s oldest and largest managed care organization. Cardinal expects it will take four months to set up in Mecklenburg.

That is not the end of MeckLINK, though. County Manager Harry Jones says the city is appealing to the McCrory administration to overturn the decision.

“We’ve invested far too much to walk away at this particular point,” Jones told the County Commissioners on Wednesday.