Mental health advocate named to subcommittee

Laurie Coker's reputation as a persistent, passionate local advocate for behavioral-health issues, including making numerous trips to the General Assembly, has caught the eye of legislators.

Coker has been appointed to a 24-member subcommittee focused on governance of local management entities, which oversee behavioral-health providers and services. She is director of the N.C. Consumer Advocacy, Networking and Support Organization.

The subcommittee is scheduled to hold four meetings, each three hours long, on Jan. 24, Feb. 13, March 12 and April 9.

Rep. Nelson Dollar, R-Wake, chairman of the committee, said he nominated Coker because she "brings unique experience and perspective to this effort." He said he based his opinion in part on Coker's regular attendance at the legislature's Joint Health and Human Services oversight committee.

"Laurie is a very active advocate," Dollar said. "Through her correspondences, she has brought a lot of good ideas, insight and perspective to these issues."

Coker said she views her appointment "as a door finally being opened in the General Assembly that lends legitimacy to our advocacy. The fact a consumer advocate, and a consumer, is being included is good for the whole process."

Dollar said the goal for the subcommittee is to identify and recommend solutions to potential governance problems and challenges as 11 local management entities (LMEs), including CenterPoint Human Services locally, make the transition to managed-care organizations (MCO) as part of a controversial Medicaid waiver program.

Also participating on the subcommittee will be legislators and representatives from the N.C. Division of Health and Human Services, LMEs, country commissioners, providers and governance experts.

The primary goal of the waiver — scheduled to go into effect statewide Jan. 1 — is combining the management of Medicaid and state funds at the community level. The change is intended to reduce costs and add more accountability and consistency to mental-health reform.

The waiver allows LMEs to operate with fewer restrictions on their management of the mental health, developmental disability and substance-abuse providers and services they oversee.

CenterPoint's financial stability was a key issue in its first and second applications. The cost of becoming a waiver program was estimated at $4 million, of which nearly half was projected to go toward hiring 103 additional employees — expanding CenterPoint's workforce to 189.

However, many advocates, including Coker, are concerned that counties would lose their authority over MCOs if recommendations submitted by the N.C. Council of Community Programs are enacted.

The council, led by CenterPoint chief executive Betty Taylor, wants to have the MCOs treated as a public authority, with greater independence from county governments, to improve their chances of succeeding and attracting top managers.

Other proposals by the council include:

• Allowing only the N.C. Department of Health and Human Services to have MCO oversight;

• Removing limitations on executive salaries and use of fund balances;

• Limiting the liability of top executives and board directors; and

• Giving MCOs the power to sue.

"The scope of governance, how MCO boards are informed by their administrations and by stakeholders — their transparency and accountability matters now more than ever," Coker said.

Dollar declined to say which proposals would be addressed during the sessions.

"We will put a narrow focus on determining which changes are feasible and warranted in the Medicaid waiver transition," Dollar said. "Whatever the subcommittee recommends to the legislature likely will have wide board approval."

Coker and other local advocates have butted heads with Taylor over CenterPoint's responsiveness to local needs. Some local advocates and providers say they are leery of commenting publicly on CenterPoint for fear of rubbing Taylor the wrong way, potentially hurting providers' revenue streams.

Taylor said in a statement that Coker would be "an excellent consumer representative. She is knowledgeable, articulate and passionate."

Coker said she pledges to be "a mouthpiece for consumer advocates in our state who have paid dearly in receiving harsh criticism for expressing valid concerns about behavioral-health governance, service access and service quality."

"Because I'm not a provider, I can speak free of conflict of interest on the hard issues. Getting to have that voice in this setting is very rewarding."