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In clash over mental health care, anti-immigrant policy draws feds' scrutiny

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Martha Olaya-Crowley said this was coming. The chairwoman of the board of directors for El Futuro, a nonprofit mental health care provider, warned in March that a policy that imperils affordable mental health care for Orange County's poorest undocumented immigrants would attract federal scrutiny. Apparently, Olaya-Crowley was right.

A spokeswoman for the Office for Civil Rights (OCR) in the U.S. Department of Health and Human Services confirmed Tuesday that her office is investigating Cardinal Innovations, based in Kannapolis. Cardinal disburses state mental health funds in a 15-county region that includes Orange, Chatham and Alamance. Durham and Wake counties are served by a different provider.

Advocates for the Latino community say federal officials are trying to determine if Cardinal has broken federal discrimination laws by denying reimbursements for the treatment of undocumented immigrants.

"This population, regardless of race, ethnicity, nationality or language, has people with afflictions related to mental health and substance abuse," Olaya-Crowley says. "It is absolutely irresponsible to neglect their treatment. They might not be your relative, but they live next door to all of us."

OCR spokeswoman Brigette Scott said the office does not comment on investigations until their conclusion.

El Futuro executive director Luke Smith explained the controversy focuses on state funding, designated as integrated payment and reporting system (IPRS) dollars. This money is typically used to pay for services not covered by Medicaid. State regulations bar the use of Medicaid cash on undocumented immigrants, as reported by INDY Week in March.

"These are the people who the emergency room can't turn away," says Smith. "And these are the people who are flowing down to El Futuro."

Smith says roughly 70 percent of El Futuro's clientele rely on IPRS funding, which is funneled from Cardinal to the nonprofit.

The previous public management agency—the Orange Person Chatham Mental Health, Developmental Disability and Substance Abuse Authority (OPC), was in charge of the disbursements until the state phased in Cardinal Innovations last April.

Since then, El Futuro—which has offices in Carrboro, Durham and Siler City—has been forced to absorb the cost of treating undocumented immigrants in the Cardinal Innovations region. El Futuro officials say, as a result, the nonprofit is projecting an estimated shortfall of 10 to 15 pecent—$100,000 to $150,000—of its annual budget.

Cardinal Innovation's no-reimbursement policy could threaten the financial future of the nonprofit, which is one of few mental health care providers specifically treating the Latino and undocumented community. The Pew Hispanic Center estimated last year that the state's undocumented population is about 325,000.

"We will continue to serve everyone, regardless of their citizenship. I cannot tell you exactly how, but we are committed to that," Olaya-Crowley says.

Cardinal Innovations spokeswoman Rachel Porter declined to comment on any investigation.

"Services are provided under each of those [circumstances] depending on individual eligibility requirements," Porter wrote. "We cannot speak to how OPC managed this before Cardinal Innovations' expansion into Orange, Person and Chatham counties in April 2012."

Porter, however, did not respond to inquiries on why the agency is denying IPRS funds for the undocumented community.

The state says it has no say-so in the matter. Julie Henry, a spokeswoman for the N.C. Department of Health and Human Services, says the state delegates responsibility for the region's IPRS dollars to Cardinal. "We would not be responsible for that decision," Henry says.

According to the OCR website, the office can decide whether an agency receiving federal health and human services dollars is breaking the law. If a violation is found, the agency is typically given 60 days to make corrections, or it risks "enforcement proceedings" that could ultimately end federal assistance.

Cardinal receives federal and state funds, although, at press time Tuesday, Porter said she could not say whether the agency specifically receives U.S. Department of Health and Human Services dollars. [Update: Indeed, Cardinal Innovations receives federal funding.]

Olaya-Crowley says she believes Cardinal's policy violates Title VI of the nation's Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color and national origin for programs and activities that receive federal financial assistance.

"With all the tragic events that have been going on in this country with violence and people with mental illness, it is extremely important that North Carolina will do everything it can to protect the community," she says.

The OCR investigation marks at least the second time federal investigators have scrutinized North Carolina's mental health system. State leaders settled a lawsuit with DOJ last August after federal officials accused the state of institutionalizing too many of its residents with mental illness.

The settlement committed the state to an eight-year, $287 million plan shuttling thousands of institutionalized individuals into community-based treatment.

North Carolina was already in a state of transition before the settlement, assigning control of public mental health dollars to regional groups known as managed-care organizations, or MCOs, such as Cardinal Innovations.

These groups are lauded by some for their business-oriented approach, a method some said would make the state's mental health system more efficient. Critics, however, counter the MCOs' cost-cutting, bottom-line management is denying expensive but necessary services for some of the state's most mentally ill residents.

Mental health experts told INDY Week in March that immigrants face unique mental health risks typically associated with migration: trauma from cultural clashes as well as depression and anxiety brought on by family separation, especially among younger Latinos.

A 2011 Centers for Disease Control risk study reported clearly elevated numbers of attempted suicides in Latino youth in the 12 months prior to the survey.

According to the survey, 6.9 percent of Latino males and 13.5 percent of Latino females attempted suicide. For white teens, the numbers were 4.6 percent and 7.9 percent, respectively, for males and females.

Leaders in Orange and Chatham have already complained that Cardinal Innovations' policy on undocumented immigrants is more bane than boon, forcing some to seek more expensive treatment in crowded hospital emergency rooms.

"These are human beings," Orange County Commissioner Earl McKee told INDY Week in March. "They are people. They're not just numbers on the page. If they have legitimate health concerns, those issues should be addressed. Cardinal Innovations, for whatever reason, is not addressing all these issues."

Smith says the concern is well-founded. Early intervention for mentally ill residents is typically considered more effective, he says, and far cheaper for the state.

"That's not a really good scenario there," Smith says. "But we do have a good scenario here, and it's relatively low-cost and at-hand."

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