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.

**********************************

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. 

**************************

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.