Washtenaw County: Citizens for Mental Health & Public Safety

Glenn Nelson, Co-Chair of Citizens for Mental Health & Public Safety (CMHPS), informed the WCCMH Board at the 2/15/19 meeting of his organization's new Website. According to the Website, CMHPS "...is a group of concerned citizens advocating that the money allocated to the City of Ann Arbor from the November 2017 Mental Health and Public Safety Millage be used for public safety and mental health services for the residents of Ann Arbor." [The millage funding is specifically directed to benefit people with mental illness and local communities and not people with developmental disabilities, most of whom are covered by Medicaid-funded mental health services.]

That sounds pretty straightforward. That was the purpose of a 2017 millage (property tax) initiative that passed with overwhelming approval: "...to improve the treatment to people with mental health needs, provide increased financial support for mental health crisis, stabilization and prevention, and for continued law enforcement services provided by the Washtenaw County Sheriff’s Office, and for local governments which have their own police force..."

There is some controversy over how Ann Arbor is choosing to spend millage funds:

In July 2017 the Ann Arbor City Council passed a resolution to spend its revenue of $20 million over 8 years as follows:

• 40% for affordable housing, which we support so long as this includes supportive services.
• 20% for bicycle and pedestrian safety, which we recognize is an important component of public safety.
• 40% for climate change actions, which we oppose because these are not related to mental health or public safety.

I am all for initiatives that address climate change, but this looks like a highjacking of funds meant to improve mental health services by a project that is not directly related to mental health issues. Addressing climate change funding in competition with funding for mental health services is not a good precedent.

[Update: After learning more about the millage and agreements reached in order to get it passed, I have come to realize that some of the millage funds are to reimburse cities and townships who do not contract with the county sheriff's office for policing and have their own police departments. Much of the millage funding goes to the Washtenaw County Sheriff's office to improve public safety, but towns and cities that do not have a contract with the Sheriff's  department get a reimbursement from the millage to spend as they see fit. Ann Arbor is not obligated to spend funds on mental health services and it is up to the the local government to decide how they will spend the reimbursement.]

Get the facts and follow the controversy on the CMHPS Website. Look for updates and new information.

Washtenaw County: Notes on Community Mental Health Board Meetings

I often attend Washtenaw County Community Mental Health  (WCCMH) board meetings. My interest in CMH is primarily to follow policies and changes in services for people with intellectual and developmental disabilities (IDD). People with mental illness are by far the majority of people served by the agency and the subjects covered at the board meetings reflect that. I will attempt to cover topics of interest to the whole population served by WCCMH, but it is best to review the agenda and minutes for Board meetings to get a broad idea of topics discussed. 

For those interested in funding for mental health services, there are detailed financial reports tracking revenues and expenditures included in the agenda for each meeting.

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Introduction: The Washtenaw County Community Mental Heath agency provides services to adults with a severe and persistent mental illness, children with a severe emotional disturbance, and individuals with a developmental disability, residing in the county. The WCCMH is a department of the Washtenaw County Board of Commissioners . 

The WCCMH Board of Directors meets on the third Friday of the month. Agenda and minutes are available on-line before each meeting at the Washtenaw County LRC (Learning Resource Center) at 4135 Washtenaw Ave., Ann Arbor, MI 48108. The location for meetings is sometimes changed because of scheduling conflicts or for other reasons. Check the agenda before the meeting for changes.

WCCMH Board meetings are usually scheduled from 9:30 to 11:30 a.m. with a time set aside at the beginning of each meeting for comments from the public.

The WCCMH belongs to the Community Mental Health Partnership of Southeast Michigan (CMHPSM) along with CMH agencies from Livingston, Lenawee, and Monroe Counties. The CMHPSM is one of ten PIHPs (Prepaid Inpatient Health Plans) in Michigan. PIHPs are regional administrative agencies that pass Medicaid funds from the state to local CMH agencies. 

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Rather than giving a full account of the February 15th, 2019 WCCMH Board Meeting, I will touch on subjects that are frequently discussed in addition to topics of interest specific to this meeting.

There always seems to be a funding crisis of some kind within CMH agencies. For example, in the 2/1/19 Year-To-Date Financial Status for Washtenaw CMH, Medicaid shows a deficit (expenditures exceeding revenues) of $2.2 million and the Healthy Michigan Plan (Medicaid expansion under Obamacare) shows a deficit of $930,000. 

Before you start hyperventilating, there are some key points to understand about funding for CMH. The state requires local CMH agencies to fund medically necessary mental health services to all Medicaid-eligible individuals - waiting lists are not allowed. At the same time, budget deficits are prohibited while the state has an obligation to adequately fund local CMH agencies. When the state underfunds the CMH system, deficits grow and local agencies, along with regional PIHPs, are stuck in the middle with conflicting mandates to fund all necessary services and to budget their revenues and expenditures without deficit spending. Conflicts between the state and local agencies are common. There are occasional adjustments to funding from the state that partially alleviate these problems, but permanent fixes to the system are necessary to bring stability.

Recently, the WCCMH filed a lawsuit against the state for not providing sufficient funds for the agency to meet its obligations to the people it serves. [More on this later]. 

"Systemic Underfunding of Michigan's Mental Health System"

This is a document from the Community Mental Health Association of Michigan (CMHAM), an organization for CMH Boards of Directors. These are key points that CMHAM makes to explain the dilemma of underfunding:

• There is a growing demand for mental health services not reflected in funding to the public system such as addressing the opioid crisis and preventing suicide.
• There is insufficient Medicaid funding to meet community demand and real costs of care, including  the funding approach being based on two year old data, thus not reflecting current and emerging needs and costs. Two examples were brought up at the meeting. The Medicaid funding to pay for a mandate to expand state autism services to children and adults up to age 21 is not yet based on actual costs of the program. People with intellectual and developmental disabilities (IDD) are funded at a higher rate than those without intellectual disabilities, even though there are people with severe physical disabilities without ID who have equally high needs.
• The state’s public Medicaid mental health system was underfunded by $133 million in Fiscal Year 2017. During that period, the public system spent over 99% of the funds that it received on mental health services with 6.1% spent on administration. During that same year, the private Medicaid managed care plans took in profits of over $136 million, while spending only 89.8% on medical services with administrative costs 40% higher than the public system. 
• The public system is unable to retain savings of sufficient size to ensure fiscal stability.
• The State General Fund (non-Medicaid) support for the public mental health system and its ability to meet increasing community demand has fallen off dramatically. Due to cuts in this source of funding, $7.50 per person per year is available, to the public mental health system, to provide mental health care to the 8 million Michiganders without Medicaid coverage.

In addition, there has been a statewide and somewhat mysterious “migration” of disabled individuals covered by basic Medicaid and identified as DAB (Disabled, Aged, and Blind) to other categories including those covered by Healthy Michigan, the state’s version of Medicaid expansion under Obamacare. The reimbursement rate for people covered by Healthy Michigan is significantly lower than reimbursement for people identified as “DABs”. This "migration" has led to a statewide reduction of revenues for mental health services. 

Washtenaw County Mental Health and Public Safety Millage

In November 2017 voters passed the Washtenaw County Mental Health and Public Safety Millage by a wide margin. WCCMH continues to plan for how funds available for CMH will be spent. Citizens for Mental Health and Public Safety have a new Website with information on the millage and controversies regarding how the money will be spent. [a millage is a local property tax initiative approved by voters in a millage election]

State News

Robert Gordon will head the Michigan Department of Health and Human Services. 

There is a staffing crisis at State Hospitals that will have to be dealt with. Also, a large number of long term state employees of DHHS have left and will have to be replaced.

Confusion reigns.

WA State Senate: Arguments for and against eliminating special wage certificates for PWD

Sub-minimum wage certificates allow employers to hire people with disabilities for less than minimum wage when disabled employees are not able to work at full capacity equal to their non-disabled peers doing the same job. Special wage certificates are often used to support people in center-based work programs (sheltered workshops) that may also provide an array of other services in addition to employment. When these programs are eliminated for people with more severe and complex disabilities, against their will and over the objections of their families, they often end up working fewer hours or not at all, spending more time at home watching TV or other unproductive activities. The alternative, "supported employment" in competitive integrated work settings, can be very costly and is not always desired by or as satisfying for the person with a disability. 

The video is from a hearing in the Washington State Senate about Senate Bill 5753 proposing to eliminate sub-minimum wage certificates. The arguments, pro and con, are laid out by two Senators with opposing views. Make sure that you listen long enough to hear the testimony of Senator Walsh that starts at around 3 1/2 minutes.

Valentine's Day 2019 - La Vie En Rose

U.N. World Autism Awareness Day 2017 reveals hostility to families caring for people with severe autism

In a new blogpost from the National Council on Severe Autism (NCSA), "Autism Fantasies v. Autism Realities at the United Nations", 2/13/19, Lisa McCauley Parles discusses her experience speaking on behalf of her autistic son and others like him at the 2017 U.N. Autism Awareness Day:

"Two years ago, when I was asked to speak at The United Nations for World Autism Awareness Day I was honored. When I saw that the topic was 'The Road to Independent Living,' I wondered if the organizers were familiar with my work focusing on individuals with severe autism. But after I was told they were looking for a variety of perspectives, I eagerly accepted the invitation. As I sat in the great hall listening to other speakers I was surprised, saddened and then truly angered. 

"Though I have worked in the area of autism advocacy for decades, I had never encountered such direct hostility toward families and guardians struggling to help and protect their severely disabled loved ones...

"As parents were portrayed as controlling enslavers my anger grew. When a speaker proclaimed that guardianship is 'the equivalent of slavery and genital mutilation' it boiled over. On that day at the U.N. I was overwhelmed by the intense need to tell our stories, to organize families, researchers, providers and others and to bring facts and reality forward."

..."World Autism Awareness Day is this Tuesday, April 2, 2019. Will the public and world leaders again be fed a narrative that ignores our population with severe autism and vilifies parents? Let's hope not. The launch of the NCSA is a critical step towards effective advocacy for the needs of individuals with severe autism and their families. For more information, see ncsautism.org."

Lisa McCauley Parles is an attorney based in New Jersey. She is a member of the board of NCSA.

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See also "Parent-Blaming and Autism: Tragically Trending Again", by Jonathan Mitchell, 2/7/19

Washtenaw County, MI: Special Needs Planning

This is an announcement for a presentation on planning for the future of your DD adult. I have heard Joelle speak several times and I am impressed by her knowledge of and personal experience with people who are developmentally disabled:



The Special Needs Planning Toolbox 

Wednesday, March 20, 2019 
6:30 p.m. to 8:30 p.m. 

Washtenaw Intermediate School District 

1819 South Wagner Road, Ann Arbor 

RSVP by March 15 to Megan Kiser: kiser@mielderlaw.com, (734) 352-6950, or online at mielderlaw.com

Help your child transition to adulthood and independence with information on:

• Planning ahead to secure government benefits 
• Options for supplementing government benefits 
• Creating goals for independent living 

Presented by: Joelle Gurnoe-Adams 

Joelle focuses her practice on special needs and estate planning, trust administration, guardianship, and conservatorship, and advising families who have a loved one that is elderly or has a disability. She received her Bachelor’s degree from the University of Michigan and her Juris Doctorate with honors from Wayne State University Law School. Joelle has received several honors for her work including Washtenaw County Human Services Communication Skills Award, the Mark Weiss Endowment for Public Interest Achievement, and Bergstrom Child Welfare Law Fellowship.

Wayne County, MI, Advocates for IDD: Workshops on Medicaid, employment, and housing

This is an announcement of events in Wayne County, Michigan, from parent/advocate Ed Diegel:

During the last several election cycles I heard only Barack Obama mention that in addition to providing Medical services to the needy, Medicaid also provides funding for the intellectually and developmentally disabled, the mentally ill and persons suffering with substance abuse. Furthermore, in my state district during the 2018 election,  the Michigan Republican Party flooded the district with fliers suggesting that extending Medicaid would only extend Medicaid fraud, inferring in effect that all Medicaid recipients are lazy and fraudulent. 

My friends, it is you and I who are responsible for allowing politicians and our friends and neighbors to harbor the idea that Medicaid is BAD. We need to do a much better job of being honest and effective and speaking out about the tremendous benefit to our individuals and communities that this program delivers. In addition there are issues being discussed in Lansing and Washington that have potentially severe impacts across the board and specifically on funding and on group home and workshop settings that need our attention.

Community Opportunity Center together with STEP and MALA is sponsoring the legislative issues and advocacy training workshop described below. Persons ready to speak up are encouraged to sign up for the workshop. Position papers of current issues, tips on effective lobbying and legislator town hall and in district coffee schedules will be provided.

Two workshop dates are available. Please see the following for detail:

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You Are Encouraged To Attend A Family Advocacy Training Session

Sponsored by: Community Opportunity Center and Services to Enhance Potential

Two Sessions Offered:

February 12, 2019 5pm-8pm

February 16, 2019 10am-2pm

Location: Community Opportunity Center
14147 Farmington Rd., Livonia, MI 48154

Educating legislators about the importance of Medicaid funding and about the needs and circumstances of our loved ones is essential if we wish to influence legislation and funding sources for their benefit. Issues related to housing and employment are under review and new legislation has been created at the federal level, which may have an impact on services our loved ones receive. For this reason, COC and STEP would like to meet with interested families and other support persons to discuss these issues and create an advocacy group, which in turn can share information with local, state, and Federal legislators regarding the impact of these legislative changes. 

If you wish to attend one of these sessions and to learn more about these issues, please contact Joyce Franks at, 734-422-1020 or jfranks@cochomes.net by Friday February 8, 2019. 

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Thanks, I hope to see you at the session. It's up to us to spread the word!!! 

Ed Diegel,

Advocates for Persons with Developmental Disabilities in Wayne County.
ddadvocates@gmail.com

Washtenaw County: Approaches for Dementia Care for Adults with IDD

2/4/19

St. Louis Center in Chelsea, Michigan, is a residential community for people with intellectual and Developmental Disabilities. A presentation focusing on dementia care will be held on Wednesday, February 20, 2019. 

See the SLC website for other St. Louis Center programs and legacy projects.

Securing the Future for Families with Special Needs

Protect, Provide and Prosper

Approaches for Dementia: Origins, Present Status, and Future Directions

WEDNESDAY, FEBRUARY 20, 2019 | 7-9 PM

St. Louis Center Family Welcome and Orientation Center

16195 W. Old US Hwy. 12,
Chelsea, MI 48118

In this presentation we will examine how the Montessori Method, originally developed to educate children, evolved into an effective method for working with persons with dementia. Initially focusing on activities for persons with dementia, the process of translating the Montessori Method to a geriatric population with memory impairment (Montessori-Based Dementia Programming®) will be detailed. Persons with dementia, like all persons, wish to be treated with respect, dignity, and equality. They want purpose and meaning in their lives, to be in control of their lives, to feel safe, and to be able to contribute to their communities and to society in general. This focus now is being expanded to persons without dementia, including family members and staff members, and persons with developmental disabilities, because the Montessori Inspired Lifestyle® is, basically, a way of living a good life as a human being.

SPEAKER:

DR. CAMERON J. CAMP, PH.D originally developed the use of the Montessori Method as an intervention for use with persons with dementia. He is a noted psychologist specializing in applied research in gerontology, and currently serves as Director of Research and Development for the Center for Applied Research in Dementia. 

Dr. Camp gives workshops on designing cognitive and behavioral interventions for dementia internationally. These interventions are all designed to reduce challenging behaviors and increase the level of functioning and quality of life of persons with dementia. He has co-authored three college textbooks and published over 150 peer-reviewed articles and book chapters. Dr. Camp is a Fellow and past-president of Division 20 (Adult Development and Aging) of the American Psychological Association, a Fellow of the Gerontological Society of America, and a Charter Member of the Association for Psychological Science. His research has been funded by grants from the National Institutes of Health, and the national Alzheimer’s Association. He is recipient of the American Psychological Association Award for Distinguished Professional Contributions to Applied Research.

For more information or to RSVP contact PR Director Joe Yekulis at joey@stlouiscenter.org or 734-475-8430