Polk commissioners agreed last week by a majority vote to join the 1915(b)(c) Medicaid waiver program for mental health, developmental disabilities and substance abuse services.
If approved by Polk’s mental health local management entity (LME), Western Highlands, the change will mean Western Highlands will administer Medicaid services. The state currently contracts Medicaid services with ValueOptions and the state is trying to phase the services back to LMEs.
Polk County approved a resolution Monday, Feb. 21 to join the program. The vote was 4-1, with commissioner Tom Pack voting against the move.
Commissioners heard last week from Niels Eskelsen, formerly with Piedmont Behavioral Healthcare, which joined the Medicaid waiver program in 2005.
Eskelsen recommended that Polk join the program, saying after five years, Piedmont is operating 20 percent under the state’s costs per person. He also said consumer surveys have been done and consumer satisfaction has improved. He said having LMEs take over the service has helped control spending and improve consumer and provider satisfaction.
Pack asked if Medicaid funding is capped through the Medicaid waiver program and Eskelsen answered “yes,” but said funding is based on a fixed rate, not a fixed sum.
“This could get complicated real fast,” Eskelsen said. “They do cap funding that the LME is going to have, but it’s based on historical costs. They give you a fixed amount based on the number of Medicaid recipients who live in your area. If the number of Medicaid population goes up, you will get more.”
Eskelsen said the big risk is that Medicaid is an entitled service, meaning you can’t deny a Medicaid recipient a service that is recommended, but the LME is obligated to find and fund those services.
If the majority of the eight counties in Western Highlands approve the Medicaid waiver, Western Highlands will receive approximately $93 million more in funding for the Medicaid service. The added responsibility will mean approximately 50 more employees for Western Highlands.
Western Highlands has recommended that its counties approve the waiver, as has the Polk County Mental Health Advisory Board.
Of the eight counties in Western Highlands, only a few have voted on the waiver, but all have been in favor.
The resolution that Polk County approved last week included language that ensures Polk will not be financially responsible for any more funding to Western Highlands than it gives annually for the services.
The resolution also calls for the eight county managers to continue to oversee the Western Highlands board and that monthly reports be given. Polk County Manager Ryan Whitson is the current chair of the Western Highland board.
Western Highlands consists of the counties of Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey. Polk County joined the LME in 2002 after the state reformed mental health and mandated that counties join together to form LMEs.