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Budget impasse delays mental health services reorganization

The impasse on passing a state budget has created a holding pattern on the reorganization of how Medicaid patients, those with no insurance and those who cannot afford treatment receive mental health services throughout the state.

Managed care organization Trillium currently manages mental health, substance use and intellectually/developmentally disabled services for a 26-county area in eastern North Carolina, including Beaufort County. A state plan to move coverage for low- and moderate-risk patient services previously covered by Trillium to five insurance companies and assign Trillium the high-risk, high-cost patients is at a standstill due to a lack of a 2019-20 state budget.

“Consumers in Beaufort County will continue to be served by Trillium until the budget passes,” said Dave Peterson, Trillium’s Central Region director, at a recent Beaufort County Board of Commissioners meeting.

Peterson said a transition team had been hired to ease the rollover to the new system, as Trillium will now be managing the primary care needs of patients in addition to mental health, substance use and intellectually/developmentally disabled services. While Trillium currently contracts services to 500 providers, once the division of services takes place, the MCO will be contracting with thousands of pharmacies and primary care services, in addition to working closely with agencies such as the Department of Social Services and Department of Juvenile Justice to ensure patients get the services they need.

“We’re going to have to make sure we have some good communication between those other departments,” Peterson said.

In Trillium’s service area — a population of 1,411,829 people — there are 266,000 people who are Medicaid-eligible. In 2019, Trillium managed services for 57,000 people with mild to severe mental health needs: 71.4% of services provided were mental-health related; 19.3%, substance use-related; and 9.3% intellectually/developmentally disabled-related. The cost of those services was $475,921,857, according to Peterson’s presentation.

On a local level, Trillium provided services for 2,824 people in Beaufort County in 2019: 2,171 for mental health services; 752 for substance use disorder; 294 for intellectually/developmentally disabled-related services. The numbers do not add up, Peterson said, because a single individual may have received services in more than one category.

Amerihealth Caritas NC Inc., Blue Cross Blue Shield of North Carolina, UnitedHealthcare of North Carolina Inc., WellCare of North Carolina Inc. and Carolina Complete Health are now expected to begin providing services for mental health, substance use and intellectually/developmentally disabled to low- to moderate-risk Medicaid patients, those with no insurance and those who cannot afford treatment by July 2021.