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Medicaid plan and now we are talking dollar amounts that can make a difference. A big showstopper for the Medicaid plan is the county match for the new money. He does not think the plan will work unless the State comes up with a way to redo the formula. Chair Jacobs said that he hopes the Board, the LME Board, the Manager, and the OPC Director will keep track of legislative changes that we think will improve this system. Commissioner Brown asked Tom Maynard if he was involved with agencies at the State level and he said yes and that they have been fairly successful. Commissioner Carey said that he agrees with the County Commissioners being involved with changing the Medicaid plan but that the counties are over-burdened right now and could not provide a match. He heard that there is a slight possibility that the federal government may increase the portion of Medicaid it covers and reduce the percentage that the State is required to cover. John Link made reference to the timing of the divestiture of the public side of OPC and said that we should take every single second of the three years and do this slowly and prudently. Because once we know the local cost that could be offset by Medicaid, this is one way to persuade the other County Commissioners. He said that we need to find a way, during the interim of three years, to continue the good programs. Tom Maynard said that there is no need for people in the independent program to feel threatened. There are other programs that are very worried, and he does not see a good answer for them. These programs need to be addressed. Chair Jacobs asked if we could track these programs in writing. Tom Maynard asked about the programs that are working now and if we need to fix them. The UNC contract is a big problem because there is inappropriate use. He asked the Board what they thought he should focus on most urgently. John Link said that two critical issues are to thoroughly understand the potentials of case management and coordination of services, and to stretch the definition of what case management services for complex services only means. He thinks that 90% of the cases are complex. Tom Maynard said that there are a fair amount of clients who may have serious disorders but can be successfully treated by a single provider. A complex case is one that requires multiple services. Coordination is the issue. Commissioner Brown asked about the potential for managed care companies coming in and how we can defend ourselves. Tom Maynard said that the State says that you have to accept all willing and able providers. There can be certain services that can be defined as needing different elements. Commissioner Brown said that this has been done in other states with terrible consequences and we should learn from this. Tom Maynard said that we could go with open competition but this is a critical issue. Commissioner Brown asked about what the State requires and who is going to judge if you use a non-profit or a for-profit. Tom Maynard said that it is a very critical issue as to who is going to decide whether this is done right. This has not been resolved. Commissioner Brown said that it seemed to her that county governments provide these services all the time without a conflict of interest. Commissioner Gordon does not know the State ground rules or how we would like to change them. She said that we have decided we wanted to manage services and the question is could the county also provide services. She asked if it was possible to break apart management and services. Tom Maynard said that he did not know if it was possible, but, as part of the State plan, we need to decide what the Board is ok with and what it wants to fight about. He said that this plan has been very muddled and unclear about how the finances would work.