Guilford County officials were extremely upset recently to find out that, in a final act by former NC Department of Health and Human Services Director Kody Kinsley, much of the power that Guilford County has to manage its mental health and developmental health services was robbed from it in a secret and underhanded move that all but did away with the county’s ability to control its efforts in those areas.
Guilford County has now filed a lawsuit against Kinsley and against the administrative management entity that the county was forced to join several years ago in a shotgun style marriage arranged by the state. That entity now controls the fate of county services and the say on how federal funds meant for Guilford County’s mental and behavioral services areas are used.
On January 7, the county put out a press release titled as follows: “Guilford County Denounces Secretary Kinsley’s Appointment of New Trillium Advisory Board.”
The press release went on to state that Guilford County officials expressed “profound disappointment in Kody Kinsley’s final act as North Carolina’s Health and Human Services Secretary before leaving office on December 31, 2024: appointing a new Trillium LME/MCO Governing Board. This move significantly limits transparency and public oversight, setting a dangerous precedent for the management of federal behavioral health funds in North Carolina.”
The statement from the county went on to say that Kinsley’s decision leads to unfair treatment of 46 North Carolina counties, nearly half of the counties in the state, including Guilford.
Guilford County’s press releases almost always come out during the day; however, this one, which was sent out Tuesday night, stated that the appointed board has drawn widespread criticism for its lack of proportional representation of elected officials.
Local Management Entities/Managed Care Organizations in North Carolina – also known as “LMEs” and “MCOs” – manage Medicaid and state-funded behavioral health services for people with mental health issues, substance abuse problems and intellectual and developmental disabilities.
This story really starts almost two decades ago when Guilford County’s administration of mental and behavioral health benefits was conducted in-house by a well-run and well-respected county department called The Guilford Center. The Center was run by the also well-respected Billie Martin Pierce, and, by all accounts, the arrangement worked well for decades and help reached the people who needed that help.
However, state officials – in what’s now considered to be a major debacle – in the name of efficiency, took those duties away from Guilford County and similar centers in other counties and forced the counties in the state to become parts of larger management entities.
Some experts contend that this move was one reason that mental health and drug addiction issues in North Carolina have reached such a dangerous level.
After the forced mergers, many problems began to arise and it has all been essentially downhill in the area of mental health from there; and now, due to the recent move by Kinsley, the current situation is that Guilford County is largely at the mercy of a mental health administrative board that not only is calling almost all the shots without Guilford County having representation, but the board is also, according to county leaders, not being at all transparent as to how the money is being spent or how decisions are being made.
It’s obvious that things have become very bad – since the county has filed suit against the former secretary of NC Health and Human Services as well as against Trillium, the management entity that administers funds for mental health and behavioral health care in Guilford County.
Guilford County’s strongly worded January 7 statement points out that the affected clientele is some of the state’s most vulnerable residents and also that LMEs and MCOs serve as “a critical link between these services and the communities they support, ensuring access to care and responsible use of public funds.”
Trillium’s governance got its start in 2023 when the state merged Eastpointe LME/MCO with Sandhills LME/MCO. Guilford County had been part of Sandhills management entity and had been fairly satisfied with the representation it had on that board prior to the merger with Trillium.
When consolidation began, the newly merged entities and incoming leadership called for increased transparency and accountability from Trillium’s management team. Apparently, county officials never got it.
Guilford County, along with other counties in the catchment area, raised concerns at the time about Trillium’s lack of adherence to the Budget and Fiscal Control Act. Specifically, those concerns pertained to the “delegation of contracting authority by the CEO without documented approval from the governing board.”
According to Guilford County leaders, repeated attempts to obtain public records were denied, and that led to a growing frustration with Trillium’s management. Those frustrations culminated, Guilford County’s press release contends, when Trillium’s administrative staff “secured legislative lobbyists, without approval from their governing board, to disband and reorganize said board charged with ensuring transparency and oversight.”
This “maneuver,” as the county leaders call it, was done through the addition of a conference report to Senate Bill 425 – an omnibus health and human services bill.
The revisions to SB 425, Guilford County leaders maintain, were ”introduced quietly and without consultation” – despite the fact that they transferred significant decision-making power to Trillium’s CEO, drastically diminished county representation and allowed the CEO to circumvent public accountability.
Chairman of the Guilford County Board of Commissioners Alston has been railing against Guilford County’s treatment in this regard since the merger began years ago, and, this week, he described what went on as a “deliberate and calculated attempt to undermine local governance established by State Statute and consolidate power.”
Alston added: “Trillium’s leadership has systematically removed safeguards meant to ensure transparency, equity, and the responsible use of taxpayer dollars.”
Guilford County isn’t the only county that’s pissed about the power grab.
Former Eastpoint and Trillium Board member and Robeson County Commissioner Wixie Stephens stated publicly, “The addition of these revisions via a conference report without disclosure to legislators or affected counties was a blatant disregard for transparency and due process. The people we serve deserve better. I am so disappointed in how this transpired without open debate or discussion.”
The lawsuit Guilford County filed against NC Department of Health and Human Services Secretary Kody Kinsley and Trillium LME/MCO seeks a permanent injunction on SB 425 changes to restore local control of public mental health funds and protect counties’ marginalized communities.
Alston said: “Guilford County has a long history of leadership in behavioral health innovation, from establishing the original county-run Guilford Center to creating state-of-the-art facilities such as the Adult Behavioral Health Crisis Center and collaboratively working with the former Sandhills Center LME/MCO to establish a 24/7 Juvenile and Adolescent Behavioral Health Crisis Center. These programs exemplify Guilford County’s commitment to delivering comprehensive care while maintaining public accountability.”
In response to Trillium’s highly sketchy actions, Guilford County is advocating for:
- Proportionate representation of elected officials on the Trillium governing board to ensure community needs are prioritized.
- Adherence to the state’s governance laws such as the Budget and Fiscal Control Act that’s meant to uphold financial integrity and promote transparency.
- A thorough review of the legislative process that enabled these governance changes in order to guard against similar actions in the future.
“Trillium’s ongoing disregard for transparency and local governance combined with Kody Kinsley’s efforts to remove existing statutory due process undermines the very foundation of public trust,” Alston said on Tuesday. “This is about protecting our communities and ensuring equitable, effective and accountable management of behavioral health services.”
The latest announcement of oversight membership consists of individuals selected with only two publicly elected representatives – one who doesn’t even represent the citizens served in the Trillium Catchment area.
Guilford County has called on state leaders, counties and residents to join in advocating for reforms that prioritize transparency, equity and the well-being of those relying on mental health and substance abuse services.
There has been a lot of negative back and forth between Guilford County and Trillium for years.
Just over a year ago, Alston and his fellow eight county commissioners suddenly discovered that Guilford County hadn’t been granted a single seat on the Trillium governing board that oversaw the administration of its mental health and behavioral health services.
Even though Guilford County was assigned to the new management entity, the county was to have zero say in the decision making.
In that shuffle, meant to bring efficiencies from economies of scale, the state had dissolved Guilford County’s former mental and behavioral health administrator, Sandhills Center, and subsumed the Sandhills counties under Eastpointe Human Services – and then merged that management entity with Trillium Health Resources.
That created one giant administrative entity run by a board with no representation from Guilford County.
When the Guilford County Board of Commissioners held a work session in December of 2023, Alston and other commissioners were extremely disturbed to find out that the new 22-member board that oversaw the large new management entity didn’t include one single seat for Guilford County.
Guilford County had had solid representation on the Sandhills Inc. board before the state, in its wisdom, dissolved Sandhills.
Under the new behemoth entity, Guilford County was left out of the mix even though it’s by far the biggest county in the group and even though it’s been paying out about $10 million each year for the administration of its behavioral health services.
Alston said at that time, of a discussion with Kinsley, “I told him, ‘With all due respect, we need three seats on the board.”
In the end, Guilford County got two seats on that board; however, the latest upheaval removes Guilford County’s representation entirely and the battle will now head to the courts.
Lol, love Skip’s comments! Guess he now knows how many county citizens feel with his and commissioners spending/wasting our tax dollars. Karma is hell. I’m glad Skip is ticked off and feels screwed. Hope there is more to come for him and his bandits.
At a time when the Federal Government is attempting to pull the “rug” from the American people with this latest round of Executive Orders, it should be no surprise that Cooper`s outgoing Administration would do the same to North Carolina citizens.
I am glad Skip is pissed off, only because this is a real gripe for Guilford County. This was a real underhanded move by the Cooper administration. Mental health and addiction services are very important and Guilford should have adequate representation in getting those services and there should be transparency in how the entities charged with that task operate. I hope Skip and other interested parties can make some progress on this. And, how about some of our elected representatives? Guilford County deserves better.
Why are federal dollars going to NC for mental health services? To any state actually? As a supporter of the Tenth Amendment, the NC Department of Health and Human Services should figure out a way to pay for services without federal money.
Hope something good can come of the lawsuit. Know a person who got sucked into the grips of Trillium, and is still waiting to see anything that benefits anyone except Trillium. Experienced and heard too many war stories for the past two years. Just wait until the real war begins after January 31st when people may unknowingly try to receive medical services from providers who didn’t contract with Trillium, and their fees/charges will have to be paid out of pocket. Yet Trillium will still receive Federal and State funding for individuals who won’t receive any benefits when choosing out-of-network providers.
Ahhh, the power struggle continues. Skip feels scorned, just like voters in Guilford County.
Karma is a wonderful thing!
Trillium’s actions “says” a significant amount about how Guilford County (also Greensboro) government is viewed &
“Skippy’s management!
Tell me something new about the dealings within and without the State mandated LME’s. For sure it is big business going after any monies they can get their hands on (and misuse as they see fit).
I am a retired MH/SA counselor and was working in Western NC counties when all these changes came.
The LME got the money and first thing was build a huge building for themselves and left us Provider Clinicians working in old buildings with many defects, sometimes with lights that didn’t work—HVAC failures—limited funds for supplies (LIKE TP!). We also got a ton of paperwork for the peons at LME to look over.
So big announcements came that huge grants had been obtained. We cheered but not for long because the LME got new carpet, all new office furniture, new PC’s and a whole fleet of automobiles (for going where by whom?).
Folks seeking help, treatment for their diagnoses, got the short end of the stick!
This is called Journalism 101.