State lawmakers are poised to consider scrapping the longtime pilot program NorthSTAR, which provides mental health care to lower income residents in seven North Texas counties.
Critics say NorthSTAR short-changes itself on federal and state funding and cuts corners on care. Advocates say everyone gets seen, no waiting lists as is the case in other parts of the state.
The Texas Sunset Commission says Dallas, Collin, Ellis, Hunt, Kaufman, Navarro and Rockwall counties need to scrap the low-income mental health program that’s been in place since 1999, and it its place, craft a program based on the way the rest of the state delivers mental health services.
Dr. John Burris is the CEO of Metrocare, which provides mental health services for low-income Dallas County residents under the NorthSTAR system. And he says Burris says the rest of the state has now combined primary care and mental health treatment for Medicaid recipients into one program.
“If you make a company, like a managed care organization responsible for all aspects of someone’s health then you tend to get better outcomes.”
In the seven North Texas counties of NorthSTAR, patients must navigate two completely separate healthcare systems – one physical, one mental. Burris says advancements promised by NorthSTAR just didn’t happen, primarily because of the way it set up its funding mechanism.
But NorthSTAR has a fan in Matt Wolfe, policy director at NAMI Dallas, the local chapter of the National Alliance on Mental Health.
“There are a lot of things in our system that some folks want to jettison that could be models for the entire state.”
Wolfe cites no waiting list. He says other mental health care regions in the state have made progress, but some still have to wait to be seen. And NorthSTAR has what he calls a “no wrong door” policy. Patients can choose providers and change them if it’s not a good fit. He says a lot of North Texas mental health advocates are worried about what’s to come.
“People that have been involved in NAMI for decades, let alone the last 15 years have very clear memories of the way things were prior to NorthSTAR and prior to when NorthSTAR started actually working pretty well. They don’t want to see those things lost, and they’re very frightened that they would be.”
The Texas Sunset Commission says state auditors cannot properly evaluate the outcomes or efficiencies of the NorthSTAR program because of the way it records its data – different from the other state-monitored mental health programs. It also says NorthSTAR loses out on millions of dollars in federal funds because it ‘blends’ Medicaid money with indigent care funds. Officials say the seven North Texas counties are missing out on about $40 million a year in available federal mental health funds by not adopting the Medicaid primary and mental health managed care model the rest of the state has.
Dallas County Commissioner Theresa Daniel co-chairs the county’s Behavioral Health Leadership Team. She says no one intends to upset care for low income NorthSTAR enrollees or throw out the good things about NorthSTAR.
“Keep the good parts of what’s going on in North Texas, continue those. Keeping in mind that what we’re trying to do is have more connectivity with other parts of Texas so we can have same data sets that are comparable and things like that.”
Metrocare’s John Burris says people should be excited about changing the system.
“With so much going on that’s very positive in the rest of the state around mental health care and behavioral health care, what a great time to try to tap into some of that.”
The seven counties have until March 10 to present a new plan for mental health services to state health officials. Any changes will have to be approved by the state Legislature.