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Colorado violating Medicaid mandate by not providing mental health services to children, lawsuit alleges

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CO HHS is being sued for not providing long-term residential MH/BH programs to members seeking treatment in ERs.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


The suit was filed against the head of the sate Department of Health Care Policy and Financing

Colorado is violating a Medicaid Act mandate by not providing certain mental health services to eligible children at home or in their community, which in some cases has led to teenagers experiencing “unnecessary institutionalization,” a federal lawsuit filed Friday alleges.

The lawsuit was filed in U.S. District Court of Colorado against Kim Bimestefer, the head of the state Department of Health Care Policy and Financing, on behalf of three unnamed teenagers and their families, including one with a history of suicide attempts and self-harm who was in a metro Denver emergency room for about a month.

“Colorado has been ignoring their duty to provide mental health services to the children of Colorado for too long,” attorney Robert H. Farley Jr. said in a statement. “We hope this lawsuit will force the state to find a solution for providing care to all of Colorado’s children and youth who need it.”

Marc Williams, spokesman for the Department of Health Care Policy and Financing, declined to comment on the lawsuit, citing pending litigation.

The suit is also seeking class-action status on the behalf of people under the age of 21 who qualify for Medicaid and have been diagnosed with mental health or behavioral disorders and who have been recommended to receive Intensive Home and Community-based services.

The plaintiffs in the suit include a 16-year-old girl who was in an emergency room between July 31 to Aug. 24 because the state has been unable to find a long-term residential program in the state to help her get treatment. Another is a 13-year-old boy who has been hospitalized since March 9, according to the news release.

The third is a 13-year-old girl who is at home, but needs servers to help with her behavioral disorders. The teenager has been in a psychiatric hospital three times since March 22.

Updated 1 p.m. Sept. 3, 2021 This story has been updated to correct how long the 16-year-old was in a metro Denver emergency room. A news release contained incorrect information.

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NCDHHS Announces Medicaid Managed Care Regional Behavioral Health I/DD Tailored Plans- Bladen County Included

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The winners were announced last week, and will be live Sept 1.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



The North Carolina Department of Health and Human Services announced the selection of seven organizations to serve as Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans). Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/developmental disability or traumatic brain injury may be eligible to enroll in a Behavioral Health I/DD Tailored Plan.

Following a competitive selection process, the following organizations were awarded a contract to serve as regional Behavioral Health I/DD Tailored Plans:

• Alliance Health

• Eastpointe

• Partners Health Management

• Sandhills Center

• Trillium Health Resources

• Vaya Health

• Cardinal Innovations Healthcare*

*While Cardinal Innovation Healthcare was awarded a contract, it is anticipated they will not operate a Behavioral Health I/DD Tailored Plan at launch due to the consolidation with Vaya Health. 

Behavioral Health I/DD Tailored Plans will provide integrated physical health, behavioral health, long-term care, pharmacy services and will address unmet health-related resource needs for qualifying North Carolinians under one plan. These plans will provide the same services as NC Medicaid Standard Plans with additional specialized services to serve individuals with significant behavioral health conditions, including those utilizing 1915(c) Home and Community-Based Services waivers and those utilizing State Funded Services. 

“NCDHHS looks forward to working with the awardees to make this innovative design a reality for the thousands of North Carolinians who will benefit from a whole person centered, well-coordinated system of care,” said NCDHHS Secretary Mandy K. Cohen, M.D. “Today moves us closer to that goal as we begin to implement this important program design.” 

At launch, Behavioral Health I/DD Tailored Plans will operate regionally, offering robust care management to approximately 200,000 individuals estimated to enroll. An additional unique feature of Behavioral Health I/DD Tailored Plans is the combination of Medicaid and state funding to support enrolled populations. 

The contract award covers counties in each catchment area as of July 26, 2021, as well as realignments approved by Secretary Cohen effective Sept. 1, 2021. Given additional county requests for disengagement, NCDHHS anticipates county alignments for Behavioral Health I/DD Tailored Plans will be significantly different at launch. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require DHHS Secretary’s approval. The list below indicates the anticipated county alignments at go-live. 

“We will work closely with LME/MCO’s to assure a smooth transition to Behavioral Health I/DD Tailored Plans while they continue to oversee the crucial services currently provided through the LME/MCO’s” said Deputy Secretary of NC Medicaid, Dave Richard. 

Only entities operating as LME/MCOs were eligible to apply to become Behavioral Health I/DD Tailored Plans. The first Behavioral Health I/DD Tailored Plans contract term will last four years. The Department has the authority to award no more than seven and no fewer than five regional Behavioral Health I/DD Tailored Plan contracts and may not award any statewide contracts.

Under Medicaid Managed Care, Standard Plans and the Eastern Band of Cherokee Indians (EBCI) Tribal Option launched on July 1, 2021, followed by Tailored Plans on July 1, 2022. 

For information specific to Behavioral Health and I/DD Tailored Plans, please visit the Behavioral Health I/DD Tailored Plans page

More information about the transition to NC Medicaid Managed Care can be found on the Medicaid website at


Projected County Alignments at Tailored Plan Launch for July 1, 2022

This list reflects projected county assignments based on disengagements requested or approved. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require approval by the NCDHHS Secretary.

Alliance Health: Cumberland, Durham, Johnston, Orange, Mecklenburg and Wake. 

Eastpointe: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne and Wilson.

Partners Health Management: Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union and Yadkin.

Sandhills Center: Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham. 

Trillium Health Resources: Bladen, Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell and Washington.

Vaya Health: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Swain, Transylvania, Vance, Watauga, Wilkes and Yancey.

Pending: Chatham, Halifax, Stokes and Warren. 


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Virginia launches new behavioral health services for Medicaid members

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Virginia now covers three news services to try and help members avoid inpatient stays for mental health.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



RICHMOND, Va. (WAVY)– New state-funded behavioral health services will give Medicaid members in Virginia greater access to community-based care.

The new services, which began on July 1, will give Medicaid members alternatives to inpatient hospitalizations and offer supports for those discharged from an inpatient facility to reduce readmissions.

The services were developed through a collaboration between the Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Medical Assistance Services (DMAS) with support from hundreds of stakeholders.

The services covered by Medicaid will include:

  • Assertive Community Treatment (ACT): Adults with serious mental illness receive care through a single team that works closely together to support the individual and is available 24/7.
  • Mental health partial hospitalization program: Adults and youth receive intensive services during daytime hours for five or six days per week while continuing to live in their homes.
  • Mental health intensive outpatient program: Adults and youth receive short-term, focused therapy and counseling both individually and with members of their support system two to three times weekly.

Virginia Medicaid members interested in the new services should contact their managed care organization or their behavioral health provider for more information.

An additional set of six new services will launch in December 2021.

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Oregon Will Use Medicaid Funding For Mental Health Emergency Response


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Oregon is improve $10M to provide mental health crisis response.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Oregon Legislature recently approved a bill that will help fund mobile mental health crisis teams around the state.

The bill allocates $10 million dollars of federal funding to be distributed across the state for crisis intervention centers.

Jackson County Representative Pam Marsh co-sponsored the bill. She says these crisis teams would complement police presence in terms of public safety during emergencies.

“What we’re trying to do is explore the idea that different kinds of professionals can be involved in responding to those 9-1-1 calls where there’s not a danger of violence or a need for someone to intervene in the way that law enforcement can intervene,” said Marsh.

Some of these professionals would be social workers, nurse practitioners, and mental health workers. They would address issues such as mental health crises and suicide threats.

Groups in Southern Oregon have been advocating for this bill in recent years. Marsh believes recent cases of people in mental health crises being killed during police encounters have led more Americans to rethink public safety methods.

“I certainly know that the Rogue Valley has been interested in this, and has been for a very long time,” she said. “We know that communities across the country woke up and started looking at these questions last summer. How many communities will actually come forward to put together a proposal? We’ll find that out in the grant process.”

Communities can apply for grant money to be used to assess existing resources, provide behavioral healthcare training, or develop and implement crisis intervention services. State Medicaid offices will be responsible for coordinating the mental health units.


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Vaya, Cardinal merge to take on Medicaid transformation

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The consolidation of North Carolina behavioral health providers continues in advance of the tailored plan launch next year.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Two of North Carolina’s largest managed care organizations recently announced they will consolidate in preparation for the state’s transformation to Medicaid managed care. 

Vaya Health and Cardinal Innovations have already begun transition efforts, with Vaya assuming responsibility for coordinating services and supports for Cardinal Innovations members once consolidated. Together, the organizations will work toward a seamless transition focused on integrated, compassionate care for individuals with mental illness, substance use disorders and/or intellectual and developmental disabilities.

Vaya Health currently manages services for individuals in 22 counties in Western North Carolina. If approved by the N.C. Department of Health and Human Services and county representatives, the consolidation will expand Vaya’s operations to encompass benefits for the individuals and counties served by Cardinal Innovations. The proposed consolidation marks the fourth such endeavor for Vaya, having successfully led previous mergers with New River Behavioral Healthcare in 2007, Foothills Area MH/DD/SA Authority in 2008 and Western Highlands Network in 2013.

Vaya’s experience with transitioning members through consolidation efforts will be especially beneficial as the state’s public health care system is undergoing a significant shift. The first phase of N.C. Medicaid Transformation will launch on July 1, 2021, with five commercial health plans poised to manage integrated health benefits for the majority of Medicaid enrollees. 


As part of the second phase of transformation to BH and I/DD Tailored Plans, which are expected to launch in July 2022, Vaya and Cardinal Innovations have been preparing to evolve their operations to offer fully integrated care for people with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability or a traumatic brain injury.

According to a press release, the consolidation of the two organizations will enable a stronger health plan to serve individuals who receive care through North Carolina’s public health care system. It will also bring needed stability to members in counties served by Cardinal Innovations. 

“We believe that when we work together to meet the needs of our communities, we all benefit,” said Brian Ingraham, Vaya Health President & CEO. “Our number one priority throughout this transition will be to support members, providers and counties and avoid any disruption in care. We remain committed to offering a successful public service option as a Tailored Plan. It is a privilege to have the opportunity to strengthen the public model, support our county partners and serve even more North Carolinians on their journey toward health and wellness.”

“The passion and commitment of Vaya staff in serving our members and communities is beyond compare,” said Rick French, Vaya Health Board Chair. “The Board of Directors is pleased to expand that work to ensure Cardinal Innovations health plan members continue to receive quality services and supports.”

“We believe in our mission to improve the health and wellness of our members and their families,” said Trey Sutten, Cardinal Innovations CEO. “It has become increasingly clear that in order to deliver on that mission, we need to consolidate with a strong organization that has a history of meeting member and community needs and can stabilize the disruption caused by Medicaid Transformation and county realignments. I have known Brian and the Vaya team for years, and know that our members, providers and communities are in the best possible hands.”

Leadership for the two organizations will be working closely with DHHS as well as local and state government representatives to ensure a successful transition. The boards for each organization will establish a joint steering committee to guide the development of a transition plan that puts member, provider and county needs at the forefront of planning efforts. 

Vaya leadership will be visiting with each county to hear their concerns and learn about the unique needs of each community. Consolidation of the two entities under Vaya Health leadership is expected to be completed by June 30, 2022.


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Virginia May Have to Foot the Bill for Commonwealth Center’s Mistake

MM Curator summary- an incorrect facility type designation lead to $11M in inappropriate payments for a Virginia behavioral health facility.




The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



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State Faces Medical Challenges

Group’s improper accreditation could cost Virginia more than $11 million. 

RICHMOND-A mistake by the Commonwealth Center for Children and Adolescents (CCCA) could cost Virginia more than $11 million. CCCA is a 48-bed mental health facility located in Staunton. Last year, the center served 1,079 children. In 2020, that number was near 1,000.
The Virginia Department of Medical Assistance Services (DMAS) labels CCCA as a psychiatric hospital, and it does provide essential psychiatric services to young Virginians. However, the facility is accredited as a behavioral health organization, and has been since 1990. CCCA officials thought such an accreditation was sufficient to bill Medicaid for the services it provided, but recently discovered their error. 

During its last session, the Virginia General Assembly convened a Children’s Inpatient Services Workgroup that uncovered the incongruity. 

The U.S. Department of Health and Human Services requires that all DMAS facilities be “Medicare certified” or accredited as a psychiatric hospital with The Joint Commission. If the facilities, such as CCCA, are not properly accredited, they can’t be enrolled with DMAS. And that’s important because DMAS administers Medicaid services.

Virginia Department of Behavioral Health and Developmental Services (DBHDS) Commissioner Alison Land explained the problem to the Joint Subcommittee on Mental Health Services in the 21st Century during its meeting Dec. 21. 

The department has a plan to make CCCA compliant with federal regulations. If it fails to do so, however, the state government may be liable for bills it improperly processed. Virginia may also be on the hook for between $11 and 20 million in repayments to the federal government. 


Who Pays for Medicaid?

In describing the accreditation snafu to the subcommittee on Monday, Land called the situation “pretty critical, because those are the only pediatric beds we have.” In other words, CCCA is located in Central Virginia, but it’s a resource for children struggling with their mental health from around the state. It’s the only resource they have. 

Children must be pre-screened for admission to CCCA by a community health board, which decides whether the child is “in crisis” in their current environment. If so, CCCA can provide support for children who have threatened or attempted suicide; displayed aggressive or assaultive behavior or exhibited a need for evaluation and medication management. 

According to DBHDS Chief Public Relations Officer Meghan McGuire, approximately 60% of CCCA patients are Medicaid-eligible upon admission for a temporary detention order. 

These children come from low-income backgrounds. Medicaid is a program funded jointly by the state and federal government to ensure people without sufficient financial means can still access necessary medical care. 

Since 1990, Virginia has been contributing 50% to the cost-share for Medicaid patients at CCCA. The federal government covered the other 50%. Now, since it appears CCCA was not properly accredited as a Medicaid enrollee, legislators are wondering whether the federal government’s half needs to be paid back. 

According to Land, CCCA stopped billing Medicaid on June 2, 2020. The group notified the Centers for Medicare and Medicaid Services of the issue on Dec. 14. DBHDS has a 12-month plan to address the accreditation issue and potential revenue shortfalls. If needed, DMAS will be working with federal regulators to pay back money owed. That money will be due by Dec. 14, 2021.


Mental Health Services Budget Already Slashed

Luckily, while DBHDS sorts out the paperwork, there will be no interruption of services at CCCA. “We were doing an inpatient, acute level of care at CCCA and continue to do that, so we just need to get this right from a billing perspective,” Land said during Monday’s subcommittee meeting. 

However, CCCA predicts a $2.8 million revenue shortfall from the 12-month suspension in Medicaid billing. The accreditation process itself will also cost nearly $1 million. The facility will spend $718,000 on one-time capital improvements and operational modifications to meet requirements of a psychiatric hospital. It will also hire two staff members at a cost of $170,000 to guide the process. Land said DBHDS will absorb these staffing costs within its existing operating plan. 

All these additional expenses come in a context of funding for mental health services being reduced dramatically in the past year. Multiple departments saw budgets cut due to the pandemic. State Senate Finance Committee Legislative Analyst Mike Tweedy explained these cuts during Monday’s meeting. 

In the governor’s proposed 2021 budget, he removed $442 million from the state’s Department of Health and Human Resources. The General Assembly restored $224 million during the special session, but that still represents a $218 million cut. Specifically, community-based mental health services saw more than $52 million cut, Tweedy said.

Many of the programs that the joint subcommittee listed as top priorities during its last meeting on Dec. 9 were among those facing budget cuts. These included jail diversion programs, pilot programs to discharge geriatric patients with dementia from state mental health hospitals and the STEP-Virginia program.

Future of Deeds Commission in Virginia

The Joint Subcommittee on Mental Health Services in the 21st Century wants to restructure the mental healthcare system in Virginia. It’s been working as part of the Deeds Commission to fulfill that goal for seven years. But next year, the Deeds Commission expires. 

So during the Dec. 21 meeting, legislators on the call also discussed what comes next for the subcommittee. The consensus was that the work needs to continue, but finding funding for staff the subcommittee needs is a primary obstacle. 

“Four years is great, but you know, the work goes on forever. This is not an easy subject, and that’s because it’s complex and the issues constantly have to be considered and reconsidered to get the right approach,” said Sen. Creigh Deeds (D-Charlottesville), for whom the commission is named.

After some discussion, Del. Marcia Price (D-Newport News) made a motion to extend the commission for one year and to revisit the question of sustainable funding in the future. The motion passed. 

Ashley Spinks Dugan is a freelance reporter for Dogwood. You can reach her at



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Larry Hogan announces that Medicaid reimbursement increases will go into effect January 1

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Maryland will begin paying BH and LTC providers more January 1 via a rate increase of 3.5% and 4%, respectively.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.






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Behavioral health and long-term care Medicaid reimbursement rate increases are set to go into effect on Jan. 1.. They were initially set to go into effect on July 1. The rate increases were passed through legislation in 2019.

Governor Larry Hogan announced the change on Thursday. Reimbursement rates will affect private health care providers who provide services to Marylanders on Medicaid.



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The changes to long-term care reimbursement will include nursing facilities, Rare and Expensive Case Management (REM), Development Disabilities Administration (DDA) targeted case management for certain individuals and private duty nursing. The Medicaid reimbursement rate for each will increase by 4 percent.

Behavioral health programs included in the bill will see a 3.5 percent increase in reimbursement. This includes behavioral analysis, adult residential and community-based substance use disorder treatment (SUD), mental health services, behavioral health targeted case management for children and adults, the 1915i community-based services program and therapeutic behavioral services.

The costs associated with the changes will be split between the state’s general funds and federal Medicaid funding.