Non-profits and the havoc they create (with our cash)

Government seems to do a masterful job of worsening every situation into which it inserts itself.  With the Balanced Nutrition saga, we are seeing a heck of a case study on how to screw up something as simple as feeding kids lunch. 

Those alleged wise people in Raleigh can’t seem to stop themselves from tinkering with stuff.  Even stuff that works. 

One of the biggest government foul-ups out there is in the field of mental health.  The Medicaid program has sunk its claws deep into the provision of mental health services.  Talk to anyone out there with friends or family members struggling with mental health issues.  There are a lot of people needing help but few resources available to help. 

In 2012, then-attorney general Roy Cooper signed on to a settlement with the Obama Justice Department which called for an end of the practice of inserting mental health patients in long-term care facilities – like rest homes.  The state of North Carolina would do it all it could — with cash and labor — to facilitate moving these patients from the long-term care facilities to independent private residences in the community of the patient’s choice.

Also in 2012, Dorothea Dix Hospital — the state’s flagship facility for treating the mentally ill — was shut down.  It is now a Raleigh park.   In the wake of moves like this, we found ourselves with a scenario where families – with little to no help or training – were left to deal with their mentally ill kin. We found ourselves basically sitting around waiting for something bad – something outrageous — to happen involving these people.

The wizards of genius in Raleigh decided to remake the art of mental health care financing into a regional affair.  Get it out into the hinterlands and among the people.  (Kind of like with feeding the kids at daycare.)

in 2013, the administration and management of Medicaid dollars was divvied out into three regions — eastern, central, and western — and their 11 total sub-regions.   Each sub-region was composed of Local Management Entities – Managed Care Organizations (LME-MCOs). (The “demise” of Cardinal Innovations — one of the largest and most politically-connected LME-MCOs –– should have been a HUGE warning heard all over Raleigh about what was likely to come.)

As of February 1, 2024,  the whole LME-MCO universe was shrunk to just FOUR member entities to serve the state’s 100 counties.

In 2013, Moore County was a member of the Sandhills Center LME-MCO entity.  Sandhills Center was headquartered in Moore, and the county government leaders had a seat on the Sandhills governing board.

With the 2024 mergers,  Moore County became one out of 46 total counties in the new Trillium LME-MCO.  (Sandhills Center had merged with Eastpointe. Trillium then gobbled them both up.) Moore no longer had a seat on the organization’s big board.  It was now a long-distance call to talk with Trillium’s leaders. But Trillium still wanted the county’s cash.

By July 2024, Moore County leaders were ready to kiss Trillium goodbye and go their own way on funding and managing mental health care.  A June 27 audit by the NC Department of Health and Human Services office of the Internal auditor — reviewing the merger time activities of Eastpointe, now part of Trillium — offered up some hellacious ammo for those seeking a divorce from Trillium:

[…] OIA identified several issues related to Eastpointe’s activities during and leading up to consolidation. A summary of the observations requiring management’s attention follows: 

1. The Eastpointe CEO received payments totaling $629,459 based upon an amended employment agreement that was not approved by the Board as required by state law. 

2. Eastpointe provided benefits to the CEO that were not provided to all employees, contrary to state law. 

3. Eastpointe staff made bonus payments to the CEO after being directed to do so by the CEO and the external general counsel. 

4. The Eastpointe CEO received an additional $78,021 bonus; the amount of the CEO’s bonus was not set or approved by the Board as required by state law. 

5. An employment agreement, the first between the Chief Business Officer and Eastpointe, was created for the Eastpointe Chief Business Officer 26 days prior to consolidation with Trillium and resulted in a severance payment of $383,110. 

6. The Eastpointe CEO authorized contract changes that were favorable to The Charleston Group, Eastpointe’s external general counsel, during the consolidation negotiation period. 

7. Eastpointe paid The Charleston Group $3 million in December 2023 for charges dating back to January 2021. 

8. Eastpointe paid legal fees of the external general counsel associated with a North Carolina State Bar grievance filed against the external general counsel. The CEO and the Chief Business Officer were unaware of key details of the payment(s). 

9. Eastpointe signed several contracts in December 2023 that were backdated. 

10. Eastpointe emails that constitute public records were deleted and not properly archived. 

11. Eastpointe did not provide notice to the public of certain Board meetings and failed to keep minutes as required by state law.

Recommendations 

1. Trillium should seek recoupment of $707,480 paid to the Eastpointe CEO and $383,110 paid to the Eastpointe Chief Business Officer. 

2. NCDHHS should implement mandatory annual training for all LME/MCO board members. 

3. In order to prevent abusive and/or wasteful contracts, during any future period where the NCDHHS Secretary has issued a consolidation directive, relevant parties should be prohibited from modifying or entering into new contractual agreements without receiving written approval from the NCDHHS Secretary. [….] 

This brings up the same questions we all had with Balanced Nutrition.  WHY spread this all out in an unmanageable, un-trackable nightmare?  Why insert middle-men of dubious necessity into the flow of things?  Why not block grants to counties? 

Politically-connected folks are getting P-A-I-D. But is the scheme really and truly addressing the need it was set up to address?