THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, September 25, 1995 TAG: 9509220004
SECTION: FRONT PAGE: A6 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 53 lines
Virginia Mental Health Commissioner Thomas Kelly has backed off a plan to mandate a managed-care program for the Medicaid-dependent mentally ill of Southeastern Virginia. Good.
Managed care is seen as the antidote to soaring medical and hospitalization costs. Federal, state and local governments and private-sector employers favor managed care over the fee-for-service option.
With Governor Allen's blessing, Commissioner Kelly pushed for a pilot managed-care program in Southeastern Virginia that would entrust the fate of Medicaid-dependent mentally ill to a for-profit private enterprise overseen by a new, centralized state bureaucracy. He pushed the plan despite cries of dismay from the mentally ill and their families and local mental-health agencies.
The pilot program, affecting 25 percent of Virginia's mentally ill, would have abruptly limited the role of local volunteer Community Service Boards. Virginia has 40 CSBs. They function at the grass roots, surveying community mental-health needs and apportioning scarce dollars to aid as many needy recipients as possible. Commissioner Kelly's plan largely cut CSBs out of the mental-health picture. Its proposed radical shift of power from the communities to a Richmond-based bureaucracy would have depreciated the decentralized system now in place and working well.
The Kelly plan portended a rise in localities' mental-health costs - for health services, support and housing historically borne by state government.
Some 10,000 mentally ill Virginians in need of assistance are still waiting because of insufficient funds. Critics argued plausibly that the Kelly intention to turn care over to private operators could worsen the situation, contrary to the Allen administration's contention that savings achieved by managed care would eliminate the waiting list. But the critics feared that many of the mentally ill would be shortchanged by a private managed-care company to pay administrative expenses and generate profits. The Virginia Hospital Association and the Virginia Managed Care Association were among groups expressing reservations about the plan.
The state Mental Health, Mental Retardation and Substance Abuse Board responded to public concern by asking Commissioner Kelly to produce a compromise. The commissioner reports that a draft proposal will be ready soon. May it be prudent. No new, centralized bureaucracy, for example, and no diminishment of the responsibilities and authority of the citizen-volunteer Community Service Boards. by CNB