Michigan's Plan for Dual Eligibles: Comment on Stakeholder Input

The Michigan Department of Community Health (MDCH) scheduled many forums and meetings on the proposal. There were a large number of participants in the process and a high degree of interest among groups affected by the plan. One of the barriers to access to these public forums, however, was that information was primarily available to people who have Internet access and are comfortable using computers to receive information and submit comments. People who are elderly, as well as those who have physical and cognitive disabilities, have more problems accessing and relaying information on the Internet than the general population. Some Community Mental Health agencies managed to get out the word about the meetings and the proposal through print mailings, but I did not see any statement by the MDCH that this was required or encouraged.

At various times participants in state forums and work group meetings were told that certain subjects would not be part of the discussion, presumably because the MDCH and the state Medicaid agency had already made up their collective minds on these aspects of the Dual Eligibles plan. Some of these topics were among the most controversial parts of the plan including:

• At the first meeting for work group members on November 9, 2011, a statement was made that the work groups would not be considering the “entities” that the state would choose to administer the plan, even though many of the participants viewed the selection of these entities as crucial to whether the plan could succeed and whether individuals served by the plan would have any influence over the “entity” making decisions that could significantly affect their lives.
• The idea of allowing beneficiaries to opt into the plan was dismissed at the outset by the state in favor of passive mandatory enrollment followed by the option to opt out of the plan.
• Also ruled out of the discussion was the idea of the state taking a less radical approach to integrating care such as proposing a pilot program to test ideas before full implementation of the proposal.

 Participants in the public meetings did express views on these topics, but the state cannot claim to have encouraged extensive stakeholder participation while at the same time it was attempting to limit discussion of some of the most controversial aspects of the proposal.