Washtenaw County: Notes on the WCCMH Board Meeting for 5/17/19

I apologize for the use of so many acronyms, but I have tried to make sure to explain what they stand for at least one time for each. This is typical of administrative meetings where the acronyms fly fast and furiously. Their use is an understandable convenience for the people involved, but when they go unexplained, they add to the confusion of innocent bystanders.

Washtenaw County Community Mental Health (WCCMH) Board meetings are usually held on the third Friday of the month from 9:30 to 11:30 a.m. at the Learning Resource Center (LRC), 4135 Washtenaw Ave, Ann Arbor, MI 48108. Board materials for the 5/17/19 meeting are posted on line.

The current financial status report included a discussion of the continuing problem with the mysterious “migration” of consumers [clients of WCCMH] from regular Medicaid that covers DABS - people who are Disabled, Aged, and Blind - to the Healthy Michigan Plan (HMP). HMP is Michigan’s version of Medicaid expansion under Obamacare. Medicaid reimbursement rates to CMH for services are much lower for the HMP than for regular Medicaid. Later in the meeting, this came up again - when someone who has “migrated” to the HMP is re-identified as a DAB, there is no retroactive compensation to CMH for lost funding. Also, when someone is part of the HMP, they are limited to 3 years on that plan and a work requirement has been added for many of its beneficiaries. 

During the Executive Director’s report, an observation was made that 20 years ago CMH decided to “philosophically” oppose group homes in favor of supported living in one’s own or family’s home with an emphasis on “self-determination”. There are still group homes - my sons live in one of them. In my opinion, having decisions based on a philosophical argument from a public agency rather than on individual need is a mistake that is detrimental to people with DD and their families. “Self-determination” as a method of delivering services, can be helpful to people with DD, even for people with severe intellectual disabilities who are under guardianship, but often it is not. It sometimes amounts to a shift in responsibility, from the public agency to the family, for finding and supervising services. Adding these administrative burdens to the already relentless task of caring for someone with a severe disability can be crushing. “Self-determination”, in the usual meaning of having control of one’s life, is not always achievable, especially for someone with severe intellectual or behavioral disabilities.

The Community Mental Health Partnership of Southeast Michigan (CMHPSM) is the regional administrative agency that passes Medicaid funds from the state and federal government to a four-county area in Southeast Michigan. The CMHPSM is improving its administrative functions and is seeking a permanent Executive Director. It is also dealing better with personnel issues than had been previously reported. 

A presentation was given on the Direct Care Worker crisis by CMH staff and Scott Brown from Renaissance Community Homes. A Power Point presentation  accompanied a report called “Deconstructing the Direct Care Service Crisis” concerning a proposal to implement recommendations made three years ago by a legislative workgroup to improve wages and working conditions for direct care workers that was largely ignored by the state. The presentation emphasized how the crisis undermines care and support to CMH consumers and is imposing extraordinary costs on provider agencies causing many of them to go out of business.

I will be discussing these proposals in a future blog post.

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At the June meeting of the WCCMH, there will be a discussion of services for people with developmental disabilities: 

June 21, 2019 
4135 Washtenaw Ave, LRC Room Michigan 9:30-11:30am
Ann Arbor