Cardinal rules: state lawmakers want to hand over control of Medicaid spending--until they look at the pay chart.

• Author: Otterbourg, Ken
• Position: POINT TAKEN

If you pay attention to the news, it sometimes seems hard to find a story about North Carolina politics where the word "bitterly" isn't placed directly in front of "divided" when describing the state of things in Raleigh.

Thankfully, there's one issue most Democrats and Republicans can agree on before returning to their name-calling and brinkmanship: Cardinal Innovations Healthcare Solutions is a major headache.

Cardinal is a local-management entity, a wonderfully Orwellian term for an operation that coordinates spending for disabled North Carolinians, as well as manages Medicaid and other public funding for mental health and substance-abuse services. There are six other entities in the state, but Cardinal is the biggest with 850,000 clients in the Piedmont. It plans to get even bigger, if it ever gets the greenlight to absorb Eastpointe Human Services and its 280,000 clients in eastern North Carolina.

These organizations are creatures of the state, in one sense no different from a regional water authority. There are lots of lines of accountability, which means, at least in theory, they answer to everyone, which means, of course, just the opposite in practice. Cardinal is the brashest of the bunch, more ambitious than its peers, and more willing to poke a stick in the eye of the bureaucrats and politicians who no longer like the way Cardinal is using its government-issue toolkit to control spending and provide services to North Carolinians. A few months back, for example, the N.C. House voted 109-0 to place closer oversight on these management entities, including the salaries for their top executives. While the bill would cover all these LMEs, Cardinal is the target, after news reports last year that CEO Richard Topping made [dollar]635,000 in base salary, or about four times the pay of Gov. Roy Cooper. Cardinal has been a little tone-deaf in other areas as well, moving its offices from Kannapolis into the swanky NASCAR Plaza in Charlotte.

Not to be outdone--or outshone--State Auditor Beth Wood released a performance audit in May that takes Cardinal to task for potential mission creep, excessive salaries, employee bonuses and some eyebrow-raising spending on conferences and travel. Wood says the behavior "erodes the public's trust in Cardinal's ability to deliver quality health care to a vulnerable population."

It's important to note that Cardinal manages public spending of nearly [dollar]700 million a year, so the questionable outlays on...