Starting July 1 the organization responsible for managing mental health care for Medicaid and uninsured patients across half of the state will take on the physical health care of people with several mental health needs.
Trillium Health Resources Regional Vice President Dave Peterson reviewed the organization’s work for the 2022-23 fiscal year and its efforts to implement the state’s tailored plan for mental and physical health at a recent Pitt County Board of Commissioners meeting.
“The state has made some changes to us, again,” said Peterson. “This has been going on; I looked at my presentations in 2018 and I told you then it was going to happen and now it’s here.”
Under the tailored plan system, individuals who have severe behavioral health, substance use and intellectual/developmental disabilities will have behavioral health, physical health and pharmacy benefits overseen by Trillium, Peterson said. It is whole-person care.
“We continue to manage the very, very high-risk individuals. We’ve been doing that for decades so that’s nothing new but managing their high-risk behaviors and their physical health is new,” Peterson said.
Individuals with moderate behavioral mental health, substance use or intellectual/developmental disabilities have been managed under standard Medicaid plans since July 2021.
The launch of the tailored plan system was delayed two years while the N.C. Department of Health and Human services oversaw the merger of the state’s managed care organizations including Trillium — a move intended to reduce the number of so-called Local Management Entities.
Peterson said when the state began reforming mental health management in the early 2000s, there were 41 management entities. Now there are four managed care organizations in North Carolina.
“We were one of the surviving entities because we do a really good job,” Peterson said. “They said how we function administratively, financially and with services and support was really top notch.”
Eighteen additional counties were added to Trillium’s service area earlier this year, Peterson said. The service area now consists of 46 counties extending from Guildford County to the Outer Banks.
Greene County is among those that were under EastPointe, one of two agencies that merged with Trillium. Sandhills Center is the second merged partner.
Taking over the management of 18 additional counties means the organization added 900 employees to its system and 1,200 providers, Peterson said. Trillium also has had to contract with every pharmacy in the 46-county region along with medical providers who see patients, he said.
Even though Guilford County, the third largest in the state, is now part of Trillium’s service area, its corporate headquarters remain at 201 W. First St. in Greenville.
To better manage operations, Trillium has divided its 46-county service area into five regions. Pitt County is located in the north central region, which encompasses Beaufort, Dare, Edgecombe, Greene, Hyde, Nash, Pamlico, Pitt, Tyrrell, Washington and Wilson counties.
The total population of the service area is 3.1 million.
The organization services 51,000 tailored plan members and 163,000 Medicaid Direct members and 287,000 uninsured members.
“Ask your legislators to put more money into this because that money goes dry really quickly,” Peterson said.
In fiscal year 2022-23, when Trillium had a 28-county service area, the organization served 43,571 people in fiscal year 2022-23 — 32,929 people received help for mental health issues, 12,526 for substance abuse and 7,456 for intellectual/developmental disabilities.
Peterson said the numbers don’t add up to 43,571 because some individuals are receiving more than one service.
The organization’s budget in 2022-23 was nearly $653.5 million for services.
In Pitt County, Trillium served 5,275 people. The breakdown is 3,940 for mental health services, 1,420 for substance use, and 1,143 for intellectual/developmental disabilities.
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