2nd Town Hall Meeting on Washtenaw County DD Services - 5/7/15

This was a 2nd meeting to answer questions about services for people with developmental disabilities provided by the Washtenaw County Community Mental Health (CMH) agency.  The subject of the meeting was the review of Community Living Services provided by CMH and pay rates for people using Self-Determination. The meeting was attended by about 50 people at St. Luke Lutheran Church in Ann Arbor on 5/7/15. 

Handouts included:
 
The Washtenaw County Behavioral Health Task Force Report Frequently Asked Questions
 
Community Living supports Frequently Asked Questions

Self-Determination: Frequently Asked Questions on pay rates

[The Washtenaw Community Health Organization (WCHO) is currently the name of the CMH agency for Washtenaw County. This will be changing in October 2015 when the agency is reorganized and becomes a CMH agency controlled by county government.]

For further clarification on how changes may affect you or your family member, contact your supports coordinator or other members of the team assisting you with CMH services.

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This was mostly a question and answer session, with a lot of questions about the budget for the WCHO that has a $3.8 million deficit out of a total of over $80 million. 

The WCHO has given assurances that the amount, duration, and scope of services to individuals will not be cut. However, from the last meeting it was clear that the Individual Plans of Service (IPOS) will be reviewed to assure that Medical necessity criteria are being applied. Services can be reduced if the WCHO can justify it on the basis that they do not meet criteria for medical necessity. [This has always been true for Medicaid services. One question to ask is what has changed, if you are being told that a service no longer meets the medical necessity criteria?]

Question: If this is a budget problem, where is the budget being cut? Answer: There have been staff changes and many positions will be left open. Presumably, costs may be cut by finding services that are determined to not be medically necessary. The WCHO advises people to work with their clinical team and their fiscal intermediaries to handle changes. 

Self-Determination direct care providers will receive lower rates set by the PIHP (Prepaid Inpatient Health Plan) [PIHPs are regional administrative agencies that pass on Medicaid funds to local CMH agencies] - the CMH Partnership of Southeastern Michigan. Previously,  administrative fees, workers compensation, and other charges were supplemented with other funds, but this will no longer be the case.

Question: Is the Message that Self-Determination is being eliminated? WCHO: No, the agency is still offering this as an option. [The main concern, however, is that a reduced pay rate could make it more difficult to hire and retain workers] Individuals may choose to go back to a more traditional way of providing services through the CMH with less individual control of how or by whom services are provided. 

Medicaid Funding:
 
Ironically, the improving economy leads to less federal funding for medicaid because federal Medicaid matching funds decrease. CMH has done better when the economy is poor.  

There are 33,000 Medicaid enrollees in Washtenaw County. Capitation is the part of funding available that is conditioned on a set amount per person.

Healthy Michigan is Michigan’s version of Medicaid expansion under the Affordable Care Act. It covers people with incomes at or below 133% of the federal poverty level ($16,000 for a single person or $33,000 for a family of four). this means that there are a lot more people covered by Medicaid, many of whom have needs for mental health services, but the rate paid is lower under Healthy Michigan than that paid for people already qualifying for regular Medicaid. This results overall in less funding for people needing mental health services, but more people needing these services.

Comment: If we spend less now, less funding will be available in the future to the extent that it is based on current spending. WCHO: The IPOS process will not change.

Comment and Question: Are Cuts expected in future years? Are we going toward a system that gives a given sum of money to families ($20,000/year?) to spend as they choose?

Question: When rate changes for Self-Determination were contemplated, why wasn’t the community brought in? Answer: Decisions were made in public meetings of the PIHP with time allowed for public comment. No special announcements were made. 

Complaint: The rate change is a done deal, that we are being informed of, but we were not included initially in making the decision.

Question: Who is the leadership for the WCHO and why were we not being well-represented when decision to lower rates was decided? [The higher cost of living in Washtenaw County should be taken into account.] Are the people making the decision elected?  Answer: The WCHO was represented by the Executive Director and others hired by the WCHO board. The Board is not elected. [It does include people with disabilities and family members of people with disabilities.]

Question on “Goods and Services” for Self-Determination: Can unused Goods and Services money be used to fill in the gaps? Answer: WCHO is not sure. 

[FYI: “The purpose of Goods and Services is to promote individual control over, and flexible use of, the individual budget by the HSW beneficiary using arrangements that support self-determination and facilitate creative use of funds to accomplish the goals identified in the individual plan of services (IPOS) through achieving better value or an improved outcome. …A Goods and services item must be identified using a person-centered planning process, meet medical necessity criteria, and be documented in the IPOS [Individual Plan of Service]” This is from the Michigan Medicaid Provider Manual, page 979 of the PDF file that is available on-line. I have been told never to click on print when looking at this document. It is 1,840 pages long.]

Question on the Children’s Waiver: This is a state-run, fee-for-service waiver, with the funding coming from the state. So why is the rate for those worker’s being reduced? Answer: The WCHO uses General Fund dollars [these are state funds that are not designated for a specific purpose such as education, transportation, corrections, etc.] to supplement the rate if it is different than what the state allocates. General Fund dollars now available for the WCHO is less that $1million, a very small amount compared to what is needed to maintain services to people relying on general fund dollars.
 
WCHO Board and Committee Meetings for 2015

CMH Partnership of Southeastern Michigan meeting information

Corrections and comments welcome!