From left to right: Dr. Nora M. Dennis, lead medical director, behavioral health and health equity at Blue Cross Blue Shield NC Dr. J. Nathan Copeland, child and adolescent psychiatrist at Duke Health Cindy Ehlers, chief operating officer at Trillium Health Resources Sen. Graig Meyer, Orange County Democrat from Orange County Sen. Sydney Batch, Wake County Democrat Rep. Marcia Morey, Durham County Democrat
Speakers agree Medicaid expansion is key; GOP lawmaker says a vote could come as early as March
Cindy Ehlers is mother to a son with disabilities who came to live with her family as a traumatized young foster child.
Ehlers is also a chief executive officer at one of the state’s regional managed care organizations for people with mental illnesses, substance use disorders and developmental disabilities.
A featured speaker at a legislative breakfast on mental health last week, Ehlers said she started looking into what could have been done to prevent her son from going through five foster placements before his fourth birthday.
“What if his family had gotten services and supports in the home? Maybe he would not had to be surrendered for adoption.” Ehlers said. “What if the first, second, third, fourth foster families had gotten supports, maybe he wouldn’t have been abused. Maybe he wouldn’t have never even had trauma. He already had the deck stacked against him because he had autism, and was nonverbal and had a feeding tube, and lots of other medical conditions. He didn’t get the supports he needed as a little boy.”
Ehlers said that in her job at Trillium Health Resources she set out to improve services for children in the region with knowledge from her own experiences as a guide.
Trillium used $10 million to help start an in-home program that works with families to get needed services that Ehlers described as successful in reducing children’s aggressive behavior and families’ involvement with Child Protective Services.
A threadbare patchwork of services
Ehlers’ speech stood out because so much of what defines the state’s system of mental health services is not what it has, but what it lacks.
Years of inadequate funding and a threadbare patchwork of services means community mental health treatment for adults without insurance is severely limited.
Some Republicans in the legislature are talking about an infusion of $1 billion in federal money to shore up the mental health system using money from a signing bonus the state will receive if it expands Medicaid.
They wouldn’t have to look hard to find ways to use that money.
People in mental health crises languish for hours — and sometimes for days — in hospital emergency departments because of a lack of available psychiatric beds. Some leave without treatment.
Sen. Jim Burgin, a Harnett County Republican, said in an interview that his goal is to stop having patients end up in hospital emergency departments solely for behavioral health reasons.
“The goal is to come up with a comprehensive mental health plan,” he said. “The first step is to get facilities for children. We’ve got to intervene earlier in people’s mental health journey and we do that with early diagnosis and early intervention.”
Many adults who need mental health treatment cannot afford it because they are uninsured or their private insurance doesn’t cover all that’s needed.
Children spend days in local welfare offices waiting for places to go.
“In any given week, dozens of children in foster care are living in emergency departments and child welfare offices,” DHHS Secretary Kody Kinsley told the audience Saturday. Among the children for whom the state knows local child welfare offices cannot identify placements, 25% have been moved 50 times or more, he said.
North Carolina has the lowest per child spending for child welfare of any other state where administration is decentralized, he said. “Overall, we are 36th in the nation, at the bottom of funding per child,” Kinsley said. “You get what you pay for.”
Youth deaths by suicide more than doubled between 2011 and 2020.
Schools have a shortage of psychologists, social workers, and nurses.
More than 60 counties have no child psychiatrists.
An open letter in 2021 to House Speaker Tim Moore, Senate leader Phil Berger and Gov. Roy Cooper from the NC Healthcare Association, the NC Chamber and 10 other groups asked them to tackle what they called a “mental health state of emergency.”
The state continues to need more in-patient beds for children, geriatric patients and people with complex needs, NC Healthcare Association spokeswoman Cynthia Charles said in an email this week.
“We also need more community-based services to meet the high level of demand for patients who need behavioral health care,” she wrote. “Resources should be directed at strengthening the entire array of care and addressing the systemic inequities in our behavioral health care system such as the low reimbursement rates, poor provider networks, and workforce shortages. Initial investments are important, but sustained funding will the key to ensuring success.”
Medicaid expansion deemed essential
Central in Kinsley’s keynote address was the exhortation that Medicaid expansion remains the most important step the state can take toward providing needed behavioral health care.
When Kinsley and others mentioned Medicaid expansion, the audience cheered and applauded.
Medicaid would offer insurance coverage to people who now don’t qualify.
“If you have serious mental illness, it’s hard to maintain a job,” Kinsley said in an interview before his formal remarks. “If you can’t maintain a job, you don’t have health insurance. You see this population is disproportionately uninsured, so we really need to get them the coverage they need.”
Mental health parity — which requires some insurance plans to provide mental health coverage that is comparable to physical health coverage — is still lacking in public and private insurance, Kinsley said.
If patients can’t pay, clinics can’t afford to stay open.
He pointed to recent moves to bolster mental health care.
Five community behavioral health clinics were awarded a total of $20 million from a federal grant to provide comprehensive care to people with severe mental, behavioral, or emotional disorders.
To address some of the need for hospital beds, DHHS and UNC Health are going to convert the R.L. Blakely Alcohol and Drug Abuse Treatment Center in Butner into a 54-bed inpatient psychiatric hospital for children and adolescents.
And after a false start in the General Assembly last year, Republican legislators said Saturday they’re all but certain the legislature will vote to expand Medicaid this year.
North Carolina is set to get a signing bonus of $1.5 billion if it expands Medicaid.
Rep. Wayne Sasser, a Republican from Albemarle, said legislators are talking about spending $1 billion of that bonus payment on mental health.
Sasser told the audience that the legislature would probably vote to expand Medicaid in March.
“When, I said ‘when’ not ‘if’, we pass Medicaid expansion, it’s going to solve a lot of problems,” Sasser told the audience.
No shortage of needs
In a brief interview, Sasser said the House Health Committee leaders met last week with Kinsley and his staff to talk about how to use the Medicaid expansion signing bonus.
“The consensus is with my Health chairs and with the department, that mental health is not only the biggest issue that we have in the state, but nationally.”
Democrats who spoke Saturday had plenty of ideas on ways to improve the mental health system.
Sen. Sydney Batch of Wake County said pediatricians and schools should identify risks early and direct families toward help.
Rep. Carla Cunningham of Mecklenburg County said the state needs to pay attention to health equity.
“We have a ways to go,” she said. “It’s not just going to take dollars. It’s going to take some creativity. It’s going to take some innovation and it’s going to take a lot of readiness on our part.”
Rep. Marcia Morey of Durham said the state should stop cutting taxes. A 2.5%, the state’s corporate tax rate is the lowest of any state that collects corporate taxes. The rate is going to ratchet down to zero by the end of the decade.
“We’re shrinking what’s available,” she said. “We could use that money to fund in-home services. Kids need their families.”
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