LAKE COUNTY – Counties in California are now required to adopt the 1115 waiver, which expands alcohol/drug treatment services to anyone on Medi-Cal.
The entity/entities to implement the waiver are currently under review by Lake County Behavioral Health.
A survey of the stakeholders took place and a zoom meeting is scheduled for Thursday to help determine if Behavioral Health will take on the full responsibility or partner with a private agency.
This waiver was previously offered to the County of Lake and declined. Currently, those in need of substance or alcohol treatment must go through the county for funding. According to some county medical providers, people are falling through the cracks while they await services.
Some stakeholders and medical professionals are urging Lake County Behavioral Health to partner with Partnership HealthPlan California to address addiction services.
In coming weeks, the Board of Supervisors will discuss the potential partnership.
According to Dr. Robert Gardner, Alcohol and Other Drug Services (AODS) outlined the 1115 waiver on Jan. 28, which could be a huge benefit to the people of Lake County.
“It is sad that Lake County could have joined this waiver four years ago and had the many enhanced services offered and AODS chose not to,” Gardner said. “Every Lake County patient who needed services could have been covered. In spite of all the health providers requesting behavioral health to contract with Partnership HealthPlan, our county did not take advantage of this great opportunity claiming financial limitations without accurate basis. I have referred many people for services to County AODS and patients complain it’s difficult to make contact and they are often unable to obtain needed services.”
Lake County Behavioral Health (LCBHS) Director Todd Metcalf acknowledges the department is short-staffed and has a “relatively high vacancy rate for clinical positions sin both the mental health and substance use disorder treatment programs.”
However, he said, only a small proportion of Drug Medi-Cal Organized Delivery System (DMC-ODS) services are provided directly by LCBHS staff. Presently, LCBHS contracts with various providers in and out of Lake County to meet the treatment needs of beneficiaries and would continue to expand this contracted provider network under DMC-ODS.
Gardner said, “With limited resources, AODS has been unavailable over different COVID periods and the period around Christmas and the New Year. When somebody’s child, sibling or parent can’t get prompt services, they may die or go back to substance abuse.”
There are only a few programs available in the county for those suffering with addiction.
Metcalf said, “only a small proportion of direct treatment services are provided by LCBHS staff. LCBHS staff would continue to contract with both in-County and outside providers for all other levels of care identified in the implementation plan. It is noteworthy that regardless of the model, the county is responsible for ensuring the delivery of all services, including monitoring, billing, quality-assurance and quality improvement. The county cannot delegate its responsibility of ensuring that the standard terms and conditions of the DMC-ODS are being met.”
Metcalf also added, “Under DMC-ODS, residential treatment is a covered benefit so no beneficiary who meets the criteria for that level of care will be ‘turned down.’ As part of the current State Plan requirements, individuals requesting treatment services who cannot access services immediately are placed on a waitlist and managed based on regulations that require priority placements given to those with the greatest need.”
TULE House Medical Director Kimberly Fordham thinks Partnership would do a better job implementing the waiver for several reasons.
She said it has already been successfully working with Lake County to improve quality of care. It has incentive programs to motivate providers to meet health metrics and constructive audits, rather than penalizing audits without guiding feedback like Lake County Behavioral Health has done, according to Fordham.
“This helps to move us all forward, rather than what feels to be attempts to destroy competing programs,” Fordham said.
She added that Partnership does not present a conflict of interest as their only interest is lowering the overall health care costs while creating a healthier county.
“Lake County Behavioral Health, on the other hand, has given the impression on numerous occasions they feel only they are capable of directing patient care, even if this causes significant delays and might not be in the best interests of our patients. I feel they could actually do a better job serving our population if they didn’t have the burden of managing the waiver at the same time,” she said. “They do not seem to care or even want to discuss the idea that they are the only entity that wants them directing the waiver.”
Metcalf maintains, however, LCBHS has worked diligently with limited funding to ensure Lake County residents needing treatment not presently covered by Medi-Cal are linked to appropriate services. He said by entering into DMC-ODS, LCBHS will be able to receive significantly more funding to support these needs, such as residential treatment services.
Fordham said, “I am also questioning Lake County Behavioral Health motives and how that will ultimately impact available services in Lake County. Maintaining its status quo would likely close many of the programs struggling to help the substance use disorder population, she said. “For example, they are currently not allowing a single Lake County woman to receive treatment at Tule house.”
Tule House in located in Upper Lake. It is an eight-bed residential treatment program designed to treat substance use disorder for the perinatal population.
Director of Hilltop Recovery Services, Lori Carter-Runyon also expressed frustration with Lake County Behavioral Health, saying it “takes forever to get through the referral process. They cannot even get a simple contract corrected since January. They do not have the staff capable to do their jobs, let alone do more.”
Gardner feels strongly that Lake County Behavioral Health doesn’t have the infrastructure and experience to administer this program.
“Government is usually less efficient than private enterprise. These are life threatening medical decisions and need to be made by an agency with a medical director and tons of experience and medical consultants,” Gardner said.
Partnership HealthPlan of California Behavioral Health Administrator Mark Bontrager said, “Perhaps the biggest benefit to several of our smaller counties is the reduction of the administrative burden to administer this program. The administrative burden is profoundly less for a county to join the Regional Model compared to doing it independently.”
Metcalf said the final decision to partner or not to partner, will be based on what’s best for residents of Lake County.
