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Polk faced with Medicaid waiver decision

Polk County commissioners must decide whether to join a Medicaid waiver that would essentially send Medicaid operations back to counties.
The state currently contracts out Medicaid related services and decided last year to send that service back to local management entities (LME). Polk County’s LME is Western Highlands, which it joined with seven other counties around 2002 when the state decided to reform mental health, substance abuse and developmental disability services.
Polk commissioners have been trying to educate themselves on the details of the reform and what it will mean for the county for the past couple of months, but the issue is complicated. An informational meeting was held at the Polk County Library on Feb. 3 and commissioners met again about the waiver Monday, Feb. 7.
Niels Eskelsen, Medicaid Waiver consultant and former Piedmont Behavioral Medicine CFO, will tell Polk commissioners about his experience with the Medicaid Waiver program on Monday, Feb. 21. The meeting will begin at 3 p.m. in the commissioner’s meeting room of the Womack building.
The Polk County Mental Health Advisory Board attended the county’s Feb. 7 meeting and recommended that the county approve joining the Medicaid waiver program.
Mental health advisory board chair Kathy Romich presented the recommendation, saying after much deliberation and research, the board supports Polk County joining the 1915(b)(c) Medicaid waiver.
“It is the resolution of MHAB (mental health advisory board) that this decision will allow Western Highlands Network to manage and authorize all Medicaid behavioral health services with the highly qualified, experienced and dedicated staff already in place, while continuing to develop and maintain a stable and competent provider network to deliver these services to the mental health participants of Polk County,” Romich told commissioners.
Romich complimented Western Highlands’ staff and said she fears if Polk County doesn’t have that local connection, area residents  couldn’t get the same level of care. She added that Western Highlands goes out of its way to provide solutions.
“You’ve heard all the important financial stuff and that’s very important,” Romich told commissioners, “but I see the clients every day and see their struggles. Western Highlands has been most supportive. I can have a crisis and they will send someone to talk face to face.”
Polk County Manager Ryan Whitson has cautioned commissioners that with the waiver, there will be a cap on Medicaid funding; currently there is no cap. Medicaid funding is an entitlement program and Whitson questions who is responsible for paying for the services when Western Highlands’ allotted Medicaid dollars run out.
Western Highlands CEO Arthur Carder attended Polk’s Feb. 7 meeting and urged Polk to join the waiver.
“The goal isn’t to hurt anybody,” said Carder, “the goal is to better utilize the services we have.”
Carder said currently, ValueOptions manages Medicaid for Western Highlands. He said there is no cap on funding currently and the state spends and spends. Those services could be managed better, Carder said.
The goals of the Medicaid waiver are to increase consumer access care, improve the quality of care and to demonstrate cost effectiveness, Carder said.  He said the waiver is bringing the management back locally.
“The state hasn’t managed our dollars well,” Carder said. “I don’t think we’re going to do that. I don’t think your county managers are going to let us take advantage of the system.”
Western Highlands at one time handled Medicaid, but the state took the service back a few years ago. By giving it back to counties, LMEs would administer the service with state and federal funding. In Western Highland’s case, that would mean approximately $93 million for Medicaid. Carder estimates that about 50 additional employees would need to be hired.
Western Highlands consists of the counties of Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey.
A majority of Western Highland’s eight-county entity will have to approve the waiver in order for Western Highlands to join. So far, the counties of Yancey, Mitchell and Transylvania have agreed to join. Buncombe County recently tabled the decision. The Western Highlands board has asked counties to make a decision before April 8, so it is unclear if Polk County will make a decision Monday or table the resolution.