Uncertainty precedes mental health care merger

Janet Imrick
Randolph Hub 

ASHEBORO — The Sandhills Center merges with two other mental health care agencies in 2024. Randolph County Commissioner David Allen worries that timeline is too rushed to benefit patients.

"It's a decree that came from Raleigh but is not by any stretch realistic," he said.

Allen is on the Sandhills Board of Directors and chairs their Finance Committee. As of mid-December, he says they've gotten very little information about the newly merged Local Management Entity-Managed Care Organization (LME/MCO) that will oversee Randolph County and 45 other North Carolina counties, stretching to the coast.

At the conclusion of Sandhills' Dec. 12 board meeting, Allen did not yet know the name of the new LME/MCO. "There's going to be a lot of confusion in the next several months," he said. "And the population you're dealing with needs stability, not confusion."

LME/MCOs coordinate care for mental, behavioral, intellectual and substance use health issues. Sandhills will merge with Eastpointe and Trillium Health Resources on Jan. 1.

"It's going to take the local flavor of providing health services from the local entity, the counties, and move it to the state,” Allen said.

Short timeline's effect on immediate care

Tracie Murphy, director of the Randolph County Department of Social Services (DSS), said that with so little in writing, it's difficult to prepare staff and keep services up to speed. "I am very, very concerned about what happens with our high acuity children when — not if there's an emergency — but when there's an emergency," she said.

Communication and responsiveness are areas where Murphy says Sandhills has historically done well. She's been able to call Sandhills CEO Anthony Ward or his predecessor Victoria Whitt when a child with complex behavioral health needs was brought to DSS on short notice.

"We can't plan these events. They happen Friday at 5 o'clock. They happen the day before a long holiday," Murphy said. "Sandhills knew the needs of our community, and they knew the resources in our community, and they could respond quickly to assist us."

Other places that will be affected are the Daymark Recovery Center — owned by Sandhills — and the Randolph County Detention Center, another frontline for mental health care.

"The recidivism rate of people going back to the detention center can be quite high if they don't have a service,” Allen said.

At the November commissioners meeting, Commissioner Hope Haywood raised concerns for Randolph County's new veterans treatment court. "One of the things that has to be in place for it to work is a mental health treatment provider," she said. "Now we're going to be working with some unnamed entity that encompasses 46 counties."

The transition for providers will begin on Feb. 1. In a press release, Trillium said, "We will protect care continuity by honoring all provider contracts (for those in good standing and serving members in affected counties). It is important that members remain with their current provider or care manager."

Ward issued a statement, saying, "This consolidation agreement has been structured to preserve the local connections that are critical to North Carolina’s public behavioral health system. We are excited to bring a strong network of providers and knowledgeable staff to the consolidation to continue our good work."

Questions about local representation

The North Carolina Department of Health and Human Services (NCDHHS) is launching Tailored Plans, intended to provide integrated services for Medicaid beneficiaries with complex behavioral health conditions, intellectual and developmental disabilities, or traumatic brain injuries.

The General Assembly gave NCDHHS Secretary Kody Kinsley authority to approve mergers and acquisitions of LME/MCOs, in part to help launch Tailored Plans.

Anticipating this, Allen said Sandhills entered into talks to merge with Eastpointe, the LME/MCO with a catchment area east of Raleigh and south of Fayetteville. Then on Nov. 1, Kinsley issued a Secretarial Directive, dissolving Sandhills and merging Eastpointe as the surviving entity with Trillium, which covers North Carolina's coast.

The directive reads, "The area authority resulting from this consolidation will build on the strengths of each organization to better meet the needs of the population of the new catchment area, prepare for Tailored Plan launch, and streamline operations."

When the merger only involved Sandhills and Eastpointe, Murphy hoped they would retain a local partner in the community. "What we're concerned about,” she said, “is if they fold Sandhills into Eastpointe, then basically, [Sandhills] is not a player at the table."

Trillium CEO Joy Futrell will remain CEO; Eastpointe CEO Sarah Stroud will become president. Allen has not heard what roles Ward and the rest of Sandhill's leadership will be given, nor how board representation will be divided between counties.

Trillium’s statement said, “As part of the agreement, all existing employees who desire employment and are in good standing will retain their positions."

Agencies wait for more communication

When asked for comment, NCDHHS shared the Nov. 1 Secretarial Directive and Trillium's press release. The full directive can be read on the NCDHHS website.

Trillium says it will hold information sessions for providers. Its head of engagement has contacted Murphy about scheduling a meeting, and Murphy hopes she will soon have more guidance.

She and her staff have already spent the past several months preparing for the expansion of Medicaid. Commissioners approved 22 new DSS staff positions in August. She's filled about half of those.

Secretary Kinsley, Murphy said, routinely updated DSS directors on the Medicaid expansion in 2023. She hopes the state gives this merger a similar level of attentiveness. "I would hope that they've already done this, is start their focus with the end in mind. And the end is better services for our citizens wherever they live in North Carolina."

Murphy says for the sake of getting those services to the people who need them, the direction needs to be well thought-out. "Those numbers aren't just numbers to me,” she said. “Those are the people. Those are children. Those are families. Those numbers represent the people in our community."