By Beth Lawrence


Jackson County Board of Commissioners approved a resolution asking the N.C. General Assembly to stop slashing funding for mental health services at its Sept. 3 meeting.

The resolution was passed following a presentation to the board by Shelly Foreman of Vaya Health.

Vaya’s board of directors passed a resolution asking legislators to stop cutting funds, and its representatives visited local boards and councils in the region to ask that they do likewise.

Foreman said the cuts impact the most vulnerable residents of Jackson County.

“For all counties it’s a huge concern in our state,” Commissioner Gayle Woody said. “It’s easy to look at (the issue) and say, ‘It’s so big; what can we do?’ We can take small steps, and we can advocate.”

Vaya is a managed care organization that coordinates mental health treatments and other services for patients who are on Medicaid, under-insured, or lack health insurance using state funds.

Services are available to residents with mental health issues, developmental disabilities and substance abuse disorders.

“What we know is that if you are Medicaid eligible you really have a good health plan,” Foreman said. “Unfortunately, if you are a person who has no insurance, if you’re underinsured, there is no entitlement to services. It’s based strictly on the funds we get from our counties and from the General Assembly.”

In the past, Vaya and other MCOs across the state, have been able to use Medicaid savings – money that was saved by effectively managing money paid out from Medicaid benefits – to reinvest in the services they provide. For Vaya, that investment in services was nearly $20 million.

But since 2015, when cuts began, MCOs have had to use the money to cover non-Medicaid services that would have been paid for with money from the state.

The state General Assembly has cut $48 million in funding to Vaya. This year, the proposed reduction is another $18 million over the next two years.

Each MCO received a different level of funding cuts.

“These funding reductions really have eroded the funding we have on hand,” Foreman said. “With the funding reductions, what we have not been able to do is to do a great expansion of services because the General Assembly has cut those funds, and we have not been able to continue to cut that money out of our existing providers.”

Foreman told the board that Vaya had made cuts to its staff, restructured departments and cut other expenditures to deal with reductions in state funding.

She said that Vaya is at the point where it cannot make further staff reductions or use its fund balance to mitigate impacts caused by funding reductions.

Vaya examined the situation and made decisions based on: the need to support clients currently receiving treatment, maintain crisis services, continue access to outpatient therapy, keep providing housing for clients receiving housing assistance and continue to meet N.C. Department of Health and Human Services performance requirements.

With those topics in mind, Vaya opted to implement a moratorium on new client services.

The moratorium will apply to persons without Medicaid looking to start treatment through Vaya and anyone who has lost Medicaid coverage.

Vaya provided new services to more than 600 Jackson County residents in the first quarter of the year, Foreman said.

Current clients will continue to receive “medically necessary” support.

Vaya will continue to help Jackson County residents who are experiencing a mental health crisis and are not covered by Medicaid.

State-funded substance abuse recovery programs including opioid maintenance, intensive outpatient services and outpatient counseling and therapy will not be affected.

The plan is a stop-gap measure to cope with funding shortages until Vaya knows for certain how the state’s budget will impact it and other MCOs across North Carolina.

If needed, Vaya will reexamine services that could withstand cuts without greatly impacting its clients.

Gov. Roy Cooper and Republican legislators have been in a standoff over the state budget since late June.

Cooper vetoed a $24 billion budget that did not expand Medicaid and did not fund services that he felt would improve the lives of the state’s average residents.

“It doesn’t do enough for public education; it doesn’t cover people with healthcare drawing federal dollars down to expand Medicaid, and I don’t think it squares with the values of North Carolinians,” Cooper said when asked about the stalemate during a recent visit to Southwestern Community College.

Since then, legislators have attempted to work around the veto by sending piecemeal budget bills to Cooper, some which he has signed and others that he has vetoed.