People with mental illness in Wake County could benefit from $14 million returned by Alliance Behavioral Healthcare, the publicly funded organization that provides care in Wake, Durham, Cumberland, and Johnston counties.
Given the perennial shortage of money available to care for people with mental illness, the refund might come as something of a surprise. Denise Foreman, Wake County assistant county manager, told commissioners at their January 16 how it came about.
"We've used state dollars instead of local dollars, or had projects that took a little longer to get started, so we have accumulated savings over the past five years," Foreman said.
Commissioner Matt Calabria called the leftover funding a "major, major deal."
"This is the first time we are really showing this publicly," Calabria said at the commission meeting. "Through good management, we have saved fourteen million dollars."
However, some advocates for people with mental illness are looking askance at the return of unspent money to Wake County. Ann Akland has been a major voice for that constituency for more than twenty years, serving on state boards for the National Alliance on Mental Illness.
"It has bothered us that there's that money and that the county hasn't used it, and they know about all the needs out there for mental health," Akland says. "We've been really concerned about the county sitting on that money. We'd be really concerned if it got directed toward building a park or bike lanes."
Like Foreman, Kelly Goodfellow, chief financial officer at Alliance, said the returned money represented savings in cases where programs didn't pan out or were delayed, in addition to situations in which the organization used state funds first. Until this year, the unspent money appeared on Alliance's books. This year, it's available to Wake County.
As one example of how Alliance saved money, the organization has contracted with medical professionals to look after the "Fragile Five Hundred," Wake residents with complicated needs that might go unmet under Medicaid, the state and federal program for low-income people and children. The contractor for the Fragile Five Hundred is paid on a fee-for-service basis, not based on a set amount per person, as in managed care.
"Instead of Alliance paying them one hundred dollars per person, they pay them based on the actual cost of the program," Foreman said.
Last year's county and schools budget generated debate about what would happen to extra revenue that accrued from property taxes. This year, county staffers are recommending specific uses for the money returned by Alliance. It's currently restricted for use in behavioral health programs but could be moved to unrestricted status by vote of the Board of Commissioners.
Members of the Wake County school board fought hard in the last budget cycle to add money for social workers and counselors to help at-risk students fare better in public schools. Commissioners turned down that request.
"School counselors are in the realm of behavioral health," Foreman said. "But they were asking for ten million dollars in recurring funds."
Adds Akland, "We wouldn't want the school system to manage that money anyway."
Wake staff members planning the behavioral health spending from the returned money are proposing projects that will only last one year.
"When it's on their books, they have more flexibility," said Goodfellow. "They have the ability to fund more quickly."
Commissioners agreed earlier this month to spend $325,000 of the money and heard plans for how to use the rest. Wake plans to spend $90,000 for expert help in planning permanent supportive housing for people getting out of inpatient care, $35,000 for a consultant on special projects, and $200,000 for services to identify the people who belong to the category called "familiar faces"—those who have multiple encounters with the county jail, area hospitals, EMS, and other pieces of the sprawling network that takes on those with behavioral health problems.
Last October's packed Behavioral Health Summit produced a wealth of ideas for dealing with these folks and other consumers—ideas that are still being turned into reality, Foreman said. More approaches that hatched from the health summit could be funded by the money returned by Alliance.
In planning for the fiscal year that starts July 1, county staffers have proposed spending $8 million for permanent supportive housing for people leaving institutional care, $2 million for adult crisis services, $2 million to expand the scope of next year's contract with Alliance, and $1 million to turn the summit's concepts into reality.
Among the ideas advanced was the use of data analysis to coordinate care and information in ways that result in lower costs and better outcomes.
At the commission meeting, Foreman faced a battery of questions on whether the county's population with mental illness was being served well by the five-year-old relationship with Alliance, known as an LME-MCO, or local management entity-managed care organization.
Instead of providing care directly or through contractors, Wake County pays $27 million a year to Alliance, which selects companies or agencies to care for people with specific behavioral health needs. The LME-MCO approach is in use across North Carolina.
"The promise was that, by more effectively managing these services in a professional environment, we could deliver better outcomes for our community at a lower price and controlled cost," Commissioner Erv Portman said. "What do we do to get the money we fund for mental health to help people and not in our fund balance at the end of the year?"
After five years of contracting with Wake County, Foreman said, Alliance is better equipped to match its $27 million annual contract to Wake County citizens' needs.
"We won't see these types of savings in the future," she said.