THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, September 15, 1995 TAG: 9509130141
SECTION: CHESAPEAKE CLIPPER PAGE: 2E EDITION: EAST
SOURCE: BY NOREEN FARRELL NICKOLAS, CORRESPONDENT
LENGTH: Long : 133 lines
Irean McCoy's large, brown eyes well up with tears when she talks about how her life will change if Chesapeake's Coastal Club House closes.
``If I stay home it begins to look like the walls are closing in on me,'' McCoy said. ``I don't know what I would do without the club house.''
McCoy, 65, an epileptic, was diagnosed with depressive disorder 20 years ago. Since then, she has been attending the psycho-social rehabilitative program run by the city's Community Services Board.
Five days a week, a van picks her up and drops her at the center on Great Bridge Boulevard, where she sells coffee and snacks and socializes with others who understand her special problems.
Before she joined the program, McCoy rode the bus to pick up her medication.
``One time I had a seizure, got lost and someone called the police,'' she said.
Now someone from the center makes sure she gets to and from her appointments.
State officials have proposed that some outpatient mental health services be included in an Allen administration pilot program that requires Medicaid recipients in Hampton Roads to join a health maintenance organization or HMO. That program is scheduled to begin Jan. 1.
Allen's plan, drafted to cut costs, will turn over the management of mental health services to a managed-care organization, which won't provide services, but will oversee the program through contracts with mental health care providers. The community-services boards would deliver services for the first year. But eventually, contracts could be awarded to private providers.
For Allen's plan to work, local mental health advocates say, services will have to be cut.
``Managed care becomes managed costs,'' said Martin Phillips, Chesapeake's mental health director.
In its effort to make a profit, the managed care organization may look at services like the Coastal Club House and decide to cut back on the number of visits a member is allowed. They may even decide that it should not be considered a covered benefit at all, he said.
``Services will not be cut,'' insisted Timothy A. Kelly, commissioner of the Department of Mental Health, Mental Retardation and Substance Abuse Services. ``The psycho-social programs are the most cost-effective thing we do.''
In addition to saving money, the goal of the governor's plan is to improve accountability, efficiency and the care provided, he said.
``If there is a reduction in care, the program will be a failure,'' Kelly said.
Chesapeake's Community Services Board, which is appointed by the City Council, provides and manages service to more than 5,000 residents. Of those, 1,500 are Medicaid recipients.
The board has a six-week waiting list for residents seeking psychiatric treatment.
Under Allen's plan, officials predict that the city could be forced to increase its $700,000 budget for mental health services. Otherwise, the mentally ill will have no place to go except to juvenile detention programs and the City Jail.
``We have written state officials and have asked them to move carefully and cautiously, because there are some in our current population who would not be covered and this would place a greater burden at the local level,'' City Manager James W. Rein said.
In its present form, the Allen plan would create a two-tier system, Phillips said. Whereas Medicaid patients receive care, others who can't afford treatment could be dumped into state hospitals or on the street.
``The person losing is the person who is medically indigent - the person who cannot get Medicaid, doesn't have insurance or not enough insurance,'' said Candace Waller, executive director of the Chesapeake Community Services Board.
But Kelly said the pilot program will not shift the burden of servicing non-Medicaid patients to local governments.
Non-Medicaid patients who need services will continue to be served by the community services boards supported by a combination of state funds, federal grants, local matching funds, direct client fees and insurance reimbursements, he said.
The state's 40 community services boards have been running mental health services for 25 years.
``One of the most important things we (community services boards) provide is a safety net,'' Phillips said.
Residents who don't have coverage are treated on the basis of their ability to pay, he added.
``Even if they don't have the ability to pay, we don't just stop treating them. An MCO can't do that,'' he said.
It is this mission, Waller said, that makes the community services boards less competitive.
``As long as we continue to serve people based on their ability to pay. My cost will be more expensive for people who can pay,'' Waller said.
With a $3.6 million operating budget, the city's Mental Health Services Department offers a number of inpatient and outpatient services, as well as residential, day and emergency services.
The Coastal Club House's $500,000 cut provides social activities, transportation and a job placement program for 110 members.
``Our objective is to get people to work,'' said Dwight Hendricks, program director.
For members who are unable to hold down a job, Hendricks said the center provides a safe place where they can come and not be looked down on because they are depressed, talk to themselves or are hearing voices.
Families of the mentally ill worry that Allen's plan could undermine the progress their loved ones have made.
``It (the Club House) has been a life-saver for both of us,'' said Bruce Matthews, 67. His wife Carol, 66, who was diagnosed with bipolar disorder, has been a member for six years.
Carol Matthews has been in and out of Eastern State Hospital many times, her husband said, but the program at the Club House has kept her out of the hospital for almost five years.
Hampton Roads' nine community services boards, together with other mental health advocates, have submitted their own proposal. In their plan, the community services boards would continue administrating mental health services but would contract with a managed care organization for their data collection and analysis expertise. Information gathered by the MCO would be used by the boards to improve the efficiency of the programs offered.
Kelly said their proposal does not provide safeguards for managing the mental health care system efficiently.
``It's like the fox guarding the hen house,'' he said. ``There must be a separation between the provider of care and the manager of care.
``Sometimes a program is not working, and management has to make tough recommendations. If providers are making the decisions, they will be hesitant to drop the program.''
A detailed report on Allen's plan will be presented to two General Assembly subcommittees by state officials on Oct. 2.
Meanwhile, some directly affected by the proposed changes are not leaving the future of the programs to chance.
``I'm praying hard every day and every night,'' McCoy said. ``I hope he (Allen) opens his heart and helps keep this program.'' ILLUSTRATION: Staff photo by STEVE EARLEY
Irean McCoy, an epileptic who was diagnosed with depressive disorder
20 years ago, works in the snack bar of the Coastal Club House.
by CNB