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Agency’s savings on mental health costs are costly

The Daily Reflector - 2/11/2017

The way things appear to Trillium Health Resources, none of its good deeds — and the people they benefit — will go unpunished.

Three years ago, the state agency that manages Medicaid reimbursements for mental health, substance use and developmental disability service providers in 24 area counties was able to accrue $80 million in one-time savings by working with providers to create operational efficiencies.

Trillium’s board of directors decided to reinvest the savings in projects to benefit the communities it serves. It now has an extensive portfolio of projects, including 30 all-inclusive accessible playgrounds like the one it built in 2016 at the Town Common in Greenville and a $10 million, 200-bed substance abuse recovery center announced for Greenville last June.

It also funds crisis intervention training for law enforcement agencies who serve people with mental illness, substance use and developmental and intellectual disabilities; an early childhood home visiting service; a transitional sober living center for recovery from drug and alcohol addiction; mobile crisis management services; and more.

“Through grant partnership with our local communities and giving back to them while recognizing the special population groups we serve, we’re always trying to increase support for people to live more inclusively in their communities without a paid service,” Trillium CEO Leeza Wainwright said.

Cut and run

Multi-million dollar cutbacks in state funding along with a mandate by the state that Trillium maintain spending levels on core services, however, are now forcing the agency to spend down the remainder of its savings, about $50 million, on day-to-day treatment services instead of the community-based projects.

Two years ago, the N.C. General Assembly reduced the amount of appropriations for management organizations like Trillium based on the amounts it saw them accrue in savings. Trillium’s cutback was $17 million last year and will be $23 million in 2017, Wainwright said. Next year’s cut will be determined during the current session and might mirror last year’s amount, she said.

“They saw how much we had earned, looked at the expenses they had in other areas and forced us to spend our savings money on the things they reduced spending for,” Ehlers said. “The General Assembly is ‘helping us’ spend our $80 million savings really quickly.”

Trillium does not provide direct care, but manages care providers who serve people who receive Medicaid, are uninsured or cannot afford services. The organization also works collaboratively with local nonprofits, other governmental agencies, medical providers and hospitals.

Its core treatment services in 2016-17 are supported by a $444.7 million budget. That includes $41.2 million in revenue from its 24-county local service areas and the Medicaid fund balance, $25.6 million in Trillium’s fund balance, and $377.9 million from state and federal funds.

The Legislature’s directive prohibits Trillium from determining the best uses of its money, according to Wainwright and Clinical Director Cindy Ehlers. They must continue providing for core services exactly as they have been even though funding has been reduced.

Gain without pain

Why would the Legislature do that?

“They get the money with no noise,” Ehlers said. “If providers and consumers don’t see a difference, either in improvements or declines, nobody will come to them complaining of funding cuts.”

In actuality, if the state funding ends, not only will the beneficial reinvestment projects end, it could lead to a massive reduction in community-based services, the Trillium executives said.

“People living in group homes will lose funding for that. Children that receive developmental therapy or adults who have significant disabilities all will lose those Trillium-managed services if the budget reductions are not addressed in this legislative session,” Ehlers said.

The Legislature’s decision also is tied to federal block grant funding for substance abuse prevention treatment and community mental health. It loses a dollar in federal funding for every dollar it drops from state funding. So it forced Trillium and the other six regional managed care organizations to continue those expenditures.

Wainwright and Ehlers are trying to educate their providers and consumers — and communities — about the problem, hoping the General Assembly will take notice and put the money back in the budget.

Contact Michael Abramowitz at mabramowitz@reflector.com or 252-329-9507.

PLAYGROUND ACCOLADES

Uptown Greenville, the city of Greenville's downtown development organization, recognized Trillium Health Resources’ contributions to the Trillium Park at Town Common as the "Public Project of the Year.” The award was presented at Uptown Greenville’s annual meeting, The State of the District, on Tuesday.

“The Public Project of the Year award is designed to recognize a significant project in the Central Business District of Greenville. The Trillium Park at Town Common exemplifies collaboration, inclusivity, and creates a fun and playful atmosphere for all,” said Ryan Webb, Uptown Greenville Chairman.

Trillium awarded 30 grants across its 24-county region as part of its Play Together Grants for Accessible Playgrounds. Each park includes specialized equipment, and most include a Liberty Swing for children and adults who use wheelchairs, rubberized surfaces, and double wide ramps — accommodations that provide an opportunity for individuals of all ages and abilities to play together.

“We are honored to receive this award and are so grateful to the local communities who have partnered with us to create these playgrounds,” said Leza Wainwright, CEO of Trillium. “The Park at Town Common provides a place for children of all abilities to enjoy play time with their peers, and adults and family members with disabilities can also participate in outside play together. When children have the chance to play together, they focus on having fun and not on what makes them different.”