Notes on the Washtenaw County CMH Board Meeting of 3/25/19

When I report on meetings, it is usually from the perspective of people with developmental disabilities and their families, so I may leave out details that would stand out more to people with other disabilities or mental illness. The CMH packet of materials that is available with the agenda before each Board meeting has much more information than what I cover and is a good resource for keeping up with current issues in the CMH system. 

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The Washtenaw County Community Mental Health (WCCMH) Board of Directors met at the administration building at 555 Towner St. in Ypsilanti, MI, rather than its usual meeting place at the Learning Resource Center at 4135 Washtenaw Ave, Ann Arbor, MI.

Minutes for the last meeting of the board can be found with the agenda and packet of meeting materials.

A detailed financial report, Attachment #2, is available. There was a discussion of methodology to determine the state Medicaid rate reimbursement for services provided by CMH. The problem with the formula used is that it apparently does not take into account all the variables that cause expenses to be higher in some places than others. Washtenaw County, for example, has a higher cost of living than other areas, but that is not accounted for in the rate of reimbursement. Also, the caseload of people served by WCCMH continues to rise while it has been falling in the state overall. 

There is continuing concern about the inability of PIHPs (regional administrative agencies that pass on Medicaid funds to local CMH agencies) to save a sufficient amount of funding in reserve to provide financial stability to the CMH system.

Trish Cortes, the Executive Director of the WCCMH, said in her report to the Board, that local agencies have been getting some traction with the Michigan Department of Health and Human Services and that the state is acknowledging the problem of insufficient revenues. A midyear adjustment is being considered.

Department of Health and Human Services (DHHS) budget hearings on Behavioral Health [Community Mental Health services including services for DD] were scheduled for March 21, 2019 before the Senate Committee on Health/Human Services. Jeff Irwin is a state Senator from Ann Arbor who is on this committee.

House Health and Human Services Committee budget hearings will be held April 11, 2019 at 1:30pm or after session, in the House Approps Rm, 3rd floor Capitol.

It is important for legislators to hear from provider agencies, consumers, and families about the impact of insufficient mental health funding. If there is no relief, it is possible that WCCMH and other CMH agencies will be in the position of being unable to provide mandated services to consumers. 

This is from an email from Alan Bolter, Associate Director of the Community Mental Health Association of Michigan (CMHAM) on DHHS Budget Hearings: 
 
“Over the past few weeks, Bob [Sheehan] and I have had several encouraging meetings with the administration and legislators and believe there may be an opportunity to make some progress on our funding challenges. We believe the DHHS budget hearings would be a perfect opportunity for our members to back up the message lawmakers are hearing from CMHAM. With that said, we strongly encourage you to participate in either or both of the upcoming hearings, especially if you have a member from your community on the committees.”

The following is the message from CMHAM to legislators on budget issues:

1. Medicaid rates set to match demand and costs: Set the Medicaid rates to the state’s public mental health system (the process that provides over 90% of the funding for this system) to reflect the actual and projected growth in demand for and the real costs of providing the services associated with Michigan’s Medicaid mental health benefit.

2. Medicaid rates to include contribution to risk reserve: Include, in the Medicaid rates to the state’s public mental health system the federally required contribution to risk reserves at a level sufficient to allow for the fiscal soundness of the public mental health system,

3. Allow the public mental health system to hold sufficient risk reserves: Allow the state’s public Medicaid mental health/specialty health plans (the Prepaid Inpatient Health Plans; PIHPs) to hold risk reserves of the size that would be held by any risk-bearing organization. With the earmarking of the risk reserve contribution in the rates (see 2 above), allow the CMHs to retain and reinvest any Medicaid savings that they generate through efficiencies and effective clinical practices.

4. Free up local dollars to meet unmet non-Medicaid needs, by halting the inappropriate drain of local dollars to fulfill state Medicaid obligations: eliminate the Local Match Draw Down requirement (section 928); assume the appropriate state role in ensuring the soundness of the state’s Medicaid mental health system by halting the demand that counties close the Medicaid gap caused by the systemic underfunding of Michigan’s public mental health system. 

5. Restore General Fund dollars to the public mental health system: Restore the lion’s share of the State General Fund dollars cut from the CMH budget to ensure that persons, not covered by Medicaid, have access to needed mental health services.

If you as a family member are testifying before a legislative committee or sending in written comments, you may have other concerns or want to express some of the same concerns in your own words. Advice from CMHAM: If you plan on attending, you should plan on bringing around 20 copies of your testimony and arrive at least 10 minutes early to fill out a card...

These are members of the house and senate committees considering appropriations for the Health and Human service budget: 

State House Health & Human Services Committee -- Whiteford (C), Green (MVC), Inman, Allor, Yaroch, Glenn, Huizenga, VanWoerkom, Hammoud (MVC), Hoadley, Love, Brixie, Cherry. 

State Senate Committee on Community Health/Human Services -- Sen. MacGregor (Chair), Sen. Bizon (Vice Chair), Sen. Schmidt, Sen. LaSata, Sen. MacDonald, Sen. Barrett, Sen. Hertel (Minority Vice Chair), Sen. Irwin, Sen. Santana

Community Mental Health Partnership of Southeastern Michigan (CMHPSM) Regional Update

[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.]

The CMHPS recently commissioned an evaluation of their Chief Executive Officer Jane Terwilliger. The results were not good. She has been CEO of the PIHP for four years and before that was the Executive Director of the Monroe County Community Mental Health Authority. There were many complaints about her job performance. The agency staff were especially upset that she has discontinued holding staff meetings. Directors on the Board from the four counties were the most critical of her performance.

Jane Terwilliger’s contract was extended for six months, but the CMHSP board has put conditions on her employment for immediate improvement with time requirements for changes. If these do not occur, her contract may be terminated. 

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Well, folks, that’s about all the excitement I can take from one more WCCMH Board meeting. The next meeting is April 19, 2019 4135 Washtenaw Ave, Ann Arbor LRC Room Michigan 9:30-11:30am .