Last night, the Buncombe County Commissioners delayed a vote of support or rejection of a proposal for Western Highlands, an eight-county Local Management Entity (LME) for mental health services, to participate in a 1915(b)/(c) Medicaid waiver. Like all programs, the waivers are billed as panaceas. However, they take a directed strike at existing problems with mismanagement.
Mainly, the programs would give local agencies and clients more say in treatments. Funds could be moved around to meet needs in something more akin to real-time. Although the program looks like it will cost more by reaching out to those not using their entitlements, it is expected to reduce waste, fraud, and abuse. In short, professionals will be able to assess where funds should go rather than being presented with a lump sum that has to be spent on some state or federal decree. Perhaps Orwellian, the waivers call for the creation of a single-source database that would integrate services, removing duplications of effort and eliminating bad synergies from fragmented services.
Even communism looks good on paper, so will the waivers work? Experts at the JLF have published favorable commentary on preliminary results:
PBH (Piedmont Behavioral Health) has worked under this system and had better care and cash results than other management entities.
A waiver may be the only way for North Carolina to afford Medicaid next fiscal year, but Washington is about to get approval for a waiver that it might not be able to afford.
