Michigan State Budget Updates as of 7/1/22

This information is from an email from the ARC Michigan Government Affairs Update for July 1, 2022. See The ARC Michigan Website for the Government Affairs newsletter and email archives.

The $76.5 billion 2023 State Budget has been passed by the legislature and signed by the Governor.

From the ARC:

The agreed upon budget for the Michigan Department of Health and Human Services came in at $33.4 billion – slightly less than the Executive Recommendation but more than the House and Senate recommendations. The following are some notable inclusions:
   •    $3 million GF/GP to continue the Michigan Crisis and Access Line (MiCAL) statewide -- a behavioral health crisis intervention and support call center and also provides primary coverage in regions where a regional national suicide prevention 988 lifeline center does not provide coverage and for statewide secondary coverage for 988

    •    $5 million to reimburse Community Mental Health Services Providers (CMHSPs) for the cost of court-appointed public guardians

    •    $41 million to increase capacity at Hawthorn Center

    •    $325 million in Capital Outlay for a new state operated psych hospital to eventually replace Hawthorn and Walter Reuther

    •    $165.6 million (Gross) for several new, private, one-time behavioral health facility capacity investments

    •    $16.8 million to expand opioid and behavioral health homes

    •    $34 million for various one-time behavioral health funding initiatives

    •    $10 million to expand the loan repayment program for behavioral health professionals

    •    $50 million for Clinical and CMHSP [Community Mental Health Services Program] Integration Readiness Initiatives – ostensibly would be needed should Senate Bill 597 and 598 – Senate Majority Leader Mike Shirkey’s behavioral health integration package – move forward in the future

    •    $2 million for the Arc Michigan to provide special education advocacy services for youth in foster care
...

"The budget also includes a continuation of the $2.35 an hour for Direct Care Workers (DCW) but does not increase the wage above and beyond the previous year’s increase other than a slight increase for DCWs in private residential facilities."

"According to Gongwer News Service, $7 billion remains on the balance sheet, ostensibly for further conversations in the coming months around tax cuts and supplemental spending measures."

 "The budget also invests heavily in education, including new investments in school mental health programs and $1.6 billion was included in the School Aid Budget for special education." 

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How these facts and figures will affect people with intellectual and developmental disabilities is not entirely clear, but I would keep my eye on that $7 billion and possible supplemental spending proposals.

Michigan: Radical proposals to change Medicaid services for IDD put our loved one's right to services at risk

This is from One Voice – A Michigan Parent/Family advocacy organization in support of individuals with Intellectual and Developmental Disabilities. 

Proposals from the Michigan Department of Health and Human Services (MDHHS) are not much different than the attempts by the previous administration to shift Medicaid funding away from Community Mental Health agencies to Medicaid Health Plans and to privatize services. Medicaid Health Plans would like to be in control of the Medicaid budget for people with developmental and other disabilities, but they have little experience with providing the social services, residential services, and other specialized programs necessary for the survival of the IDD population. 

Most disturbing to me is the desire to base services on the Supports Intensity Scale (SIS) questionnaire. Years ago, the state DHHS clarified that this assessment tool is not appropriate in all cases: “The SIS should be used to enhance and support the person-centered planning process. As with all assessments, the SIS is voluntary and should not be tied to determinations of medical necessity and the authorization of behavioral health services. Supports and services cannot be denied, reduced or discontinued if a consumer and/or guardian refuse to cooperate with the assessment process.” 

For my sons, who are profoundly intellectually and physically disabled, the SIS assessment misses the boat entirely. For one thing, it assumes that the only worthy goal is to provide supports so that everyone with IDD can live in the community just like everyone else who is not disabled. I can assure you that for my sons, "living just like everyone else", is a fantasy. Helping them to have a quality of life worth living entails acknowledging their extensive medical and physical needs that go far beyond what they are likely to ever find in "the community".

When my son Ian was assessed using the SIS at the age of 30, one of the questions asked was what supports are necessary to allow Ian to "date" like a typical 30-year old man. He cannot walk, talk, or do anything without total assistance. He is nevertheless a charming, lovely man, but we will never know what he thinks about "dating" or anything else in any specific way. An answer that indicated that "dating" might not be possible was not allowed. Indulging this fantastical way of thinking does not help Ian. Acknowledging that people with IDD have a wide spectrum of need and allowing for individual differences by providing a full array of services and residential options will help.

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Provided by One Voice –A Michigan Parent/Family advocacy organization in support of individuals with Intellectual and Developmental Disabilities Email us at: onevoicemi@gmail.com Bob Pierce, Chair of One Voice

ACT NOW To save our loved one’s supports and right to services. 

Radical changes are being proposed at the State level for Medicaid Services for our I/DD family members. Extraordinarily incomplete detailed information has been made available to the public. The announced timeline is to have the changes implemented in 2022! Here is a summary of our understanding and take on the issue. 

 MDHHS is moving toward a model that calls for Specialty Integrated Plans that combine behavioral and physical health plans under one umbrella that appears to most likely place Medicaid under private control.

Terms like “Most things stay the same” and “Ability to pick your plan (including a public-led option if you want)” are in Director Gordon’s public sales pitch for this revolutionary change.

The key to changes is the part about opening up the Mental Health Code. The Code currently says services are based on the Person Centered Plan (PCP). That Section will likely be removed, and services will be based on a Supports Intensity Scale (SIS) questionnaire. Questions can be misleading, and numbers manipulated to limit what services are legally protected. We cannot let the SIS dictate the needs of our loved ones.

Nowhere has anyone publicly detailed what is failing in our existing systems or how to improve these shortcomings. It is our belief that this is simply a plan to eliminate financial risk for the state, reduce support and services for our I/DD family and ultimately privatize Community Mental Health services.

Other states have implemented similar programs. Here are a few samples of press headlines that reflect the “success” of these changes:

North Carolina gets a “F” on how equally it treats mental and physical health issues – North Carolina Health News 1/15/19

Medicaid changes hit mental health services in state; payment cuts cited as providers shut – Arkansas Democrat Gazette 12/9/2019 

We must send a loud and clear message to Governor Gretchen Whitmer - NO Specialty Integrated Plans (SIPs) and NO opening of the Mental Health Code! Slow down this process now!! 

Please contact the Governor now! Time is of the essence. State Representatives, State Senators and your local County Commissioners need to hear our voices.

Governor Gretchen Whitmer

P.O. Box 30013
Lansing, Michigan 48909

517-373-3400
517-335-7858 (Constituent Services)

Governor Whitmer
https://govenorsoffice@mich.gov https://MDHHS-futureofbh@michigan.gov State Senator https://www.senate.michigan.gov/fysbyaddress.html

State Representative
https://www.house.mi.gov/mhrpublic/frmFindaRep.aspx

Washtenaw County Board of Commissioners
https://gisappsecure.ewashtenaw.org/public/BOC/

References:

https://www.arkansasonline.com/news/2019/dec/09/medicaid-changes-hit-mental-health-serv/

https://www.northcarolinahealthnews.org/2019/01/15/north-carolina-gets-a-f-on-how-equally-it-treatsmental-and-physical-health-issues/

Press release announcing the plan.
https://www.michigan.gov/som/0,4669,7-192-29942_34762-513879--,00.html

MDHHS Director Gordon’s slide presentation 

http://www.house.mi.gov/hfa/PDF/HealthandHumanServices/ DHHS_Subcmte_Testimony_MI_Behavioral_Health_System_New_Approach_12-4-19.pdf 

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See also, 

"Families providers ask tough questions on plans to integrate Medicaid mental health" by Jay Greene from Crain's Detroit

The DD News blog: Managed care and privatization create a crisis in Iowa

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.

Michigan 2018: Making Sense of the political landscape for people with disabilities, Part 1

Alan Bolter, Associate Director of the Community Mental Health Association of Michigan (CMHAM), gave a presentation on 11/15/18 at a Town Hall meeting of the Washtenaw County Community Mental Health Association. A Power Point of his talk, “Looking Back, Looking Forward and How to Make Sense of it All” is available on-line. Here is a sampling of the topics he discussed: 

The 2018 Election

Democrats flipped ALL state constitutional officers (first time since 1938 one party flipped all statewide offices in a single election)

• Governor – Gretchen Whitmer (D) 
• Lt. Governor – Garlin Gilchrist (D) 
• Secretary of State – Jocelyn Benson (D) 
• Attorney General – Dana Nessel (D) 

Democrats picked up 5 seats in each legislative chamber

Republicans retained their majority in the State House of Representatives by a margin of 58 – 52 (currently the margin is 67 – 43).

Republicans retained their majority in the State Senate by a margin of 22 – 16 (currently the margin is 27 – 11).

All three ballot proposals were approved by voters (marijuana, gerrymandering, easier voting)

U.S. Senator Debbie Stabenow won re-election.

Democrats picked up 2 Congressional seats. Democrats Elissa Slotkin (D-8th) and Haley Stevens (D-11th) won their congressional races flipping two seats previously held by Republicans.

Democrats have won majorities on all statewide elected education boards, including the State Board of Education.

This is the first time in 16 years that the Governor in Michigan will have legislative experience.

2019 Michigan Legislative Leaders

Senate Republicans

• Majority Leader: Senator Mike Shirkey 
• Majority Floor Leader: Senator Peter MacGregor 
• Appropriations Chairman: Senator Jim Stamas (appointed not elected) 

House Republicans

• Speaker of the House: Rep. Lee Chatfield (R-Levering) 
• Majority Floor Leader: Rep. Triston Cole (R-Mancelona) 
• Speaker Pro-Tempore: Rep. Jason Wentworth (R-Farwell) 

Senate Democrats

• Senate Minority Leader: Jim Ananich 
• Senate Minority Floor Leader: Stephanie Chang 
• Minority Vice Chair, Appropriations Committee: Curtis Hertel 

House Democrats 

• House Minority Leader: Christine Greig 
• House Minority Floor Leader: Yousef Rabhi 

Committee assignments will not be announced until late January/early February.

The 2018 Lame Duck Session

A Lame Duck session occurs when one legislature meets after its successor is elected, but before the successor’s term begins.

The Michigan Lame Duck session runs from November 27 - December 20 (4 weeks/12 session days.)

Why Lame Ducks are dangerous:

• The Legislative process is in fast forward 
• Condensed timeframe so things move quickly, in many cases little if any public participation of legislation (committee / public meetings) 
• Bills do not have to go through the committee process, can get referred right to House or Senate floor. 

Three most important numbers 56, 20 , & 1 (votes needed to pass a bill). 

Article IV, section 26 of the Michigan Constitution states: No bill shall be passed or become a law at any regular session of the legislature until it has been printed or reproduced and in the possession of each house for at least five days.

A bill’s intent can be completely changed in lame duck as long as it still amends the same section of law…

Possible Lame Duck issues

• FY19 supplemental budget 
• Republicans looking for ways to tie Governor’s hand with spending State 
• Budget Surplus fund 
• Minimum Wage & Sick Time changes (from legislation passed in September) 
• Auto No-Fault reform 
• School Safety Grants - $30 million in FY19 budget 
• Implementation bills for proposals 1-3? 

(to be continued… )

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See also Michigan CMH Facts and Figures 

Making Sense of the Political Landscape... Part 2

Michigan's Community Mental Health System: Facts and Figures

Alan Bolter from The Community Mental Health Association of Michigan (CMHAM) gave a presentation on 11/15/18 at a Town Hall meeting of the Washtenaw Community Mental Health Association (more about that later). He distributed a flyer with basic information about the Michigan Community Mental Health system. It describes what CMH agencies do, how they are funded, and who they serve. The flyer does not appear to be available on the internet, but if it does become available, I will provide a link to the complete document.

These are excerpts from the flyer with a few modifications to make it easier to understand in the way I am presenting it here: 

How Community Mental Health agencies are funded

• $2.319 billion from “Medicaid Mental Health” 
• $299 million from “Healthy Michigan” [Michigan’s Medicaid expansion under Obamacare] 
• $175 million from “Substance Use Disorder” 
• $192 million from Autism funding 

These funds go to Prepaid Inpatient Health Plans (PIHPs), behavioral health managed care entities. These are the regional administrative agencies that distribute Medicaid funds to local CMH agencies.] PIHPs are responsible for oversight and compliance (Federal & State), Administration, and Utilization Management.

These funds are passed on along with $125 million from the State General Fund [GF] to Community Mental Health Centers and their provider network covering all 83 counties. CMHs are responsible for service provision, coordinating the local service network, and ensuring compliance (Federal & State).

Who Community Mental Health serves

• Children with Serious Emotional Disturbance [examples: Obsessive-Compulsive Disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD)] 
• People with Substance Use Disorders [SUD] 
• People with Developmental/Intellectual Disabilities 
• Adults with Mental Illness 

Michigan is the only state that serves all 4 populations in a managed care setting.

How the Money is Spent

• 49% on People with Intellectual/Developmental Disabilities [45,000 people served] 
• 36% on Adults with Mental Illness [155,000 people served] 
• 9% on Children with Serious Emotional Disturbance [45,000 people served] 
• 6% on People with Substance Use Disorders [70,000 people served] 

Other pertinent information

The percentage of dollars spent on actual care in Michigan’s PIHP system has a statewide average of 6% spent on administrative Costs. This is a 94% “medical loss ratio”, an indication that Michigan Medicaid dollars are spent very efficiently for the actual care of the people served.

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Community Mental Health Association of Michigan (CMHAM) is a trade association representing the 46 Community Mental Health Boards, 10 Prepaid Inpatient Health Plans, and more than 90 provider organizations that deliver services to adults with Mental Illness, children and adolescents with emotional disturbances, persons with Intellectual/developmental disabilities, and those with substance use disorders in every community across the state. 

From the Section 298 Team: More opportunities for public input in mental health reform

Total eclipse

August 30, 2017

From the Michigan Department of Health and Human Services, Section 298 Team:

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Dear stakeholders,

Over the last two years, the Michigan health care community has been engaged in a statewide discussion on improving the coordination of physical health and behavioral health services. This discussion is known as the Section 298 Initiative. This initiative is based upon Section 298 in the Public Act 268 of 2016. Under Section 298, the Michigan Legislature directed the Michigan Department of Health and Human Services to develop a set of recommendations “regarding the most effective financing model and policies for behavioral health services in order to improve the coordination of behavioral and physical health services for individuals with mental illnesses, intellectual and developmental disabilities, and substance use disorders.” MDHHS submitted a final report with recommendations for the Michigan Legislature on March 15, 2017.

The Michigan legislature approved a revised version of Section 298 as part of Public Act 107 of 2017. Under the revised Section 298, the Michigan legislature directed the Michigan Department of Health and Human Services to develop and implement up to three pilots and one demonstration model to test the integration of physical health and behavioral health services. The department will be working with stakeholders across the Michigan health care community to develop and implement the pilots and demonstration model over the next few years.

Under the revised Section 298 language, the Michigan legislature also directed the department to recruit a project facilitator to assist with the development and implementation of the pilots and demonstration model. The department has designated the Michigan Public Health Institute as the project facilitator for the Section 298 Initiative. The Michigan Public Health Institute will provide support to the department with supporting stakeholder discussions and managing the development and implementation process. Jo Anna Trierweiler will serve as the main project facilitator, and Jane Pilditch will serve as the co-facilitator.

The department will be working with the project facilitator to announce the next phase of the Section 298 discussion in September 2017. The next phase will focus on (1) the development of the structure of the pilot(s) and demonstration model and (2) the development of the evaluation process. The department will be also be contracting with one of Michigan’s research universities to support the evaluation process. The department will provide additional information about the next phase of the Section 298 Initiative in the near future.

We look forward to continuing to work with you on improving the coordination of physical health and behavioral health services for Michiganders. If you have any questions about this email or the Section 298 Initiative, please send an email to MDHHS-298@michigan.gov.

Sincerely,

The Section 298 Team
Michigan Department of Health and Human Services

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Background on the Section 298 Initiative

Michigan compromise budget for mental health: stalls complete takeover by medicaid health plans & funds pilot programs

In May 2017, The DD News Blog covered proposed radical changes to how services for people with developmental disabilities, mental illness, and substance abuse disorders will be delivered and who will be in control of the Medicaid dollars that pay for those services. The intent of proposed legislation was the eventual privatization of mental health services by “integrating” mental health and medical Medicaid services under the control of Michigan’s private Medicaid Health Plans.

The final budget compromise has at least stalled the complete privatization of the mental health system. The compromise preserves the current ten Prepaid In Patient Health Plans (PIHPs), regional administrative agency that distribute Medicaid funding for Mental Health services. There will also be as many as four pilot programs to test whether privatization, i.e. handing over control of Medicaid funding for mental health services to Michigan’s Medicaid Health Plans, can lower costs and expand services.

These are excerpts from an article in Crain’s Detroit Business, “Budget deal advances plan to test Medicaid mental health integration” by Jay Greene, 6/20/17.

“The budget deal allocates $2.8 million the first year to the fiscal 2017 budget to plan the pilots, and $3.1 million for fiscal 2018, which starts Oct. 1, to fund the pilots themselves. The $5.9 million funding includes $2 million in general state tax funds.

“The implementation of the pilots will be overseen by the state Department of Health and Human Services, which must hire by Aug. 1 an experienced project facilitator. The manager must establish performance metrics and pilot plans.”
…
“Over the past 18 months, Michigan's 11 Medicaid health plans have lobbied legislators and the public to try a semi-privatized approach. They contend they can run an efficient $11.6 billion integrated delivery system, save the state several hundred million dollars of administrative money and plow back the savings into expanded services. There are an estimated 350,000 people in the state's Medicaid program with mental illness, developmental and intellectual disabilities, and substance abuse problems.

“But mental health advocates, providers and families object to Medicaid HMOs taking over the system — even to test an integrated approach with which more than two dozen states are experimenting. They believe health plans have insufficient experience at overseeing complex populations and argue that private profit motivations of the health plans will trump public service.”
…
“[State Senator Mike] Shirkey, chair of the Senate health policy committee, has told Crain's the Medicaid HMOs will not be able to keep any savings. They must reinvest any savings into expanded services.

“Bob Sheehan, CEO of the Michigan Association of Community Mental Health Boards, said he is concerned that the budget language allows Medicaid health plans to contract outside of the several dozen established community mental health agencies and provider networks.

“‘Making the local community mental health (agency) only one of many providers in the pilot communities will immediately drain dollars from the community's mental health safety net ... leaving it unable to fulfill its statutory safety net role,’ Sheehan said Tuesday night in an email to Crain’s.”

Implementation of the pilot programs will include the following:

• That any changes made to a Medicaid waiver or Medicaid state plan to implement the pilot project must only be in effect for the duration of the pilot project.
• That the project is consistent with the stated core values as identified in the final report of the Section 298 workgroup in Public Act 268 of 2016.
• That updates are provided to the medical care advisory council, behavioral health advisory council and developmental disabilities council.

Will Michigan legislators listen to constituents on mental health funding proposals?

Michigan Public Radio aired an interview on 6/7/2017 with Gail Marsh, the mother of an adult daughter with Down Syndrome, and Bob White, the father of two adult sons on the autism spectrum. Both parents have been involved in “Section 298” workgroups and affinity groups for more than a year. These groups were formed after the Governor’s budget proposed to shift mental health Medicaid funding from public Community Mental Health (CMH) agencies to private health plans that currently administer Medicaid medical health plans. They were a response to the strong opposition that met the Governor's proposal. 

People with developmental disabilities are one of the populations served by the mental health system in local Community Mental Health (CMH) agencies.

From the Michigan Radio website, "Parents 'afraid to die' because of fear mental health care system won’t take care of their children" by Stateside staff and Josh Hakala, 6/7/17:

“Tomorrow, state lawmakers are expected to release their final budget for fiscal year 2017-18 for the Department of Health and Human Services.

“That budget will reveal if Republicans have chosen to shift control of mental health funding – which amounts to nearly $2.5 billion in annual Medicaid payments – away from public mental health organizations, and transfer it to private insurers.
...
"Listen to the full interview … to hear more about their children and how they rely on mental health services as well as Marsh's examples of how privatizing ‘doesn't work’ and why White describes it as a form of ‘outsourcing.’"

Here is part of the interview with Gail Marsh on how the legislature has so far ignored much of the public input from the “Section 298 Initiative”. Start listening at about 12 minutes and 30 seconds into the interview. [Note that in this discussion, “integration” of care is about integrating funding for medical and behavioral health services under one administrative roof - the private Medicaid health plans.] The stakeholder workgroups and affinity groups overwhelmingly supported maintaining a public system to provide behavioral health services which include the social services and supports necessary to maintain people served in community settings.

Gail Marsh recently testified at a Michigan House appropriations subcommittee where she heard references to a State Senator’s comment that, “We’ve been dancing around the concept of integration for too long and the legislature needs to force things to happen.”

Here is her response in the interview:

“…I told them, the reason we’ve been dancing around total integration for so long is because it’s not what people want …The job they’ve been hired to do …is not to force unwanted things on their constituents, but to listen to the people who elected them. So, both the House and the Senate…have dismissed the recommendations of the workgroup and the stakeholder affinity groups, which were to maintain a public behavioral healthcare system.”

• Listen to the whole interview here.
• Link to  background information on “Section 298 Initiative” 
• Minding Michigan, is Stateside’s ongoing series about mental health issues is Michigan.
• So far, I have not seen news on whether the budget proposals for MI Health and Human Services have been acted on.

FYI: Background information on Michigan's infamous Section 298 regarding funding of CMH services

May 25, 2017

This is background information from the Michigan Department of Health and Human Services with links to reports and the text of the proposed FY18 budget. Opinions vary on the intent of the initiative and whether it will be a benefit to the people served:

Background on the Section 298 Initiative

The Section 298 Initiative is a statewide effort to improve the coordination of physical health services and behavioral health services. The initiative started with the publication of the 2017 executive budget, which sparked a statewide discussion on the best approach for coordinating physical health services and behavioral health services. In order to facilitate this discussion, the Lieutenant Governor called an initial meeting of stakeholders, which resulted in the formation of the original 298 Workgroup. This workgroup met five times from March 2016 to June 2016 and produced a final report. This final report included final language for Section 298, a set of “core values” for the initiative, and a set of “design elements” for future discussions.

The Michigan Legislature used the recommendations from the original 298 Workgroup to create a Section 298, which was approved as part of Public Act 268 of 2016. Under the new Section 298, the Michigan Legislature directs the Department to develop a set of recommendations “…Regarding the most effective financing model and policies for behavioral health services in order to improve the coordination of behavioral and physical health services for individuals with mental illnesses, intellectual and developmental disabilities, and substance use disorders.”

The Department convened a new 298 Facilitation Workgroup to assist with the development of the report. The Department and the 298 Facilitation Workgroup have also hosted a series of Affinity Group meetings across Michigan to inform the development of the recommendations. 1,113 Michiganders participated in this process during 45 separate meetings. The Affinity Group meetings included individuals, families, providers, payers and advocates. The Department and the 298 Facilitation Workgroup used the input from these discussions to inform the development of the recommendations.

The Department ultimately submitted two reports to the legislature. The first report was an interim report that was submitted on January 13, 2017. The interim report focused on recommendations for policy changes. The second report was a final report, which was submitted on March 15, 2017. The final report includes the initial policy recommendations and incorporates recommendations on financing models and benchmarks for implementation.

Michigan: Action Alert from CMH Board Association

May 25, 2017

The following is an Action Alert from the MACMHB regarding budget negotiations that affect Community Mental Health services for people with DD and other vulnerable populations:

Action Alert from the Michigan Association of Community Mental Health Boards

May 2017

As you know, both the House and Senate have passed their FY18 budget recommendations. Now legislative leaders will come together to mold their two separate budgets into one compromised budget bill for FY18. These discussions will begin to heat up again this week and should be finalized sometime over the next three weeks.

Now is not the time to ease up, we must have a strong finish to our advocacy efforts. Thanks to your help our last two ACTION ALERTS generated over 2000 emails to House and Senate offices – we need to do even better with this next one!!

REQUEST FOR URGENT ACTION: Please contact your House and Senate members urging them to make sensible changes to the final 298 boilerplate language. Timing is critical, we have roughly three weeks to put pressure on lawmakers as they finalize the FY18 budget. We are asking that you reach out to your lawmakers between now and June 2, urging them to remove the Senate language in Section 234 and to not include health plan run pilot programs in the final version of section 298.

We also need you to ask that the members of your Board of Directors, your staff, and your community partners make those same contacts – SIMPLY FORWARD THEM THE ACTION ALERT. These contacts are critical, legislators must hear from us in order to counter the efforts by others opposed to the public management of the state’s publicly sponsored behavioral health and intellectual/developmental disability services and supports system.

Below are quick talking points: 

REMOVE LANGUAGE – Section 234 of the Senate DHHS budget, specifically language referring to total Medicaid benefit and financial integration by 9/30/20, which would transfer all Medicaid resources to Medicaid Health plans.

This language predetermines the outcome of the process without any input from pilots or other measurables and completely ignores the 298 workgroup process and the will of the people.

INCLUDE LANGUAGE – Ensure that the policy and management role for Michigan’s Medicaid behavioral health and intellectual/developmental disability services and supports system remains public.

Concerns Regarding a Health Plan Run Pilot 

• Health Plans do not have a good track record managing behavioral health services 
• Mild/moderate services track record 
• Duals initiative 
• Less money available for services 
• Higher overhead cost 

What are we trying to accomplish? 

What are we measuring? Outcomes/metrics? 

Click the link below to log in and send your message:
https://www.votervoice.net/BroadcastLinks/3lZEXfKTU-pwR2WYUbnwpg 

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This is from an email I received with the names of specific legislators who will be making decisions as to changes in proposed wording for the FY18 budget:

Senate-Health and Human Services
Appropriation Sub-committee

Dave Hildenbrand (R), Full Appropriation Committee Chair, 29nd Distric-Conference Committee

Jim Marleau (R) 12th District-Conference Committee

Vincent Gregory (D), Minority Vice Chair, 11th District-Conference Committee

Peter MacGregor (R), Vice Chair, 28th District-Conference Committee ?

House-Health and Human Services
Appropriation Sub-committee

Laura Cox (R), Full Appropriation Committee Chair, 19th District-Conference Committee

Edward Canfield (R) Committee Chair, 84th District-Conference Committee

Sue Allor (R) Majority Vice-Chair, 106th District-Conference Committee

Pam Faris (D) Minority Vice-Chair, 48th District-Conference Committee

Michigan : DHHS wants to hear from you about the services you need and want

This is a flyer from the Michigan Department of Health and Human Services:

TELL US WHAT YOU WANT!

The Michigan Department of Health and Human Services (MDHHS) is asking people with mental illness, emotional disorder, developmental or intellectual disability, or substance use disorder, and their family members, what supports and services they need/want!

This is a follow-up to the Lieutenant Governor’s workgroup on the 298 boilerplate that was in the Governor’s budget recommending privatizing behavioral health services. The boilerplate was changed, but MDHHS needs to write a report to Legislators about suggestions for improving the service system.

To collect information a survey was developed. MDHHS is hosting group meetings to ask people the survey questions. Meetings are scheduled for:

October 4, 2016
From 1-4 pm

October 5, 2016
From 6-9 pm

at 

The Hannah Center
819 Abbot Road
East Lansing, Michigan 48823
(517) 333-2580

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For those wanting to comment on a proposal but unable to attend the meeting can access a questionnaire… and then send (email or USPO) the completed questionnaire to:   MDHHS-298@michigan.gov

To obtain the Word version of the survey go to the Affinity Group webpage and scroll down to "Questions for eligible populations and families". You can then fill in the survey answers using the Word document and return it by email or regular mail.

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Background information: 

The 298 Initiative

[Section 298 was the notorious proposal inserted into the Governor's 2016 budget bill in March 2016. It had language in it that would have handed over Medicaid funding for behavioral health, including Community Mental Health funding for DD, to Medicaid Health Plans. This change to privatize the funding of services was placed in the budget bill without hearings or input from people affected by the proposal. It was withdrawn and the 298 Initiative was created to make recommendations to the Michigan legislature regarding funding and services for people with DD and other disabilities.]

"The Section 298 Initiative is a statewide effort to improve the coordination of physical health services and behavioral health services in Michigan. This initiative is based upon Section 298 in the Public Act 268 of 2016. Under Section 298, the Michigan Legislature directs the Michigan Department of Health and Human Services to develop a set of recommendations “regarding the most effective financing model and policies for behavioral health services in order to improve the coordination of behavioral and physical health services for individuals with mental illnesses, intellectual and developmental disabilities, and substance use disorders...”

Follow the links on the 298 Website for more information.

Metro Detroit Town Hall meetings on Mental Health Funding and Services

From the the Detroit Free Press, 9/22/16:

“A series of town hall meetings about mental health funding and services in Michigan is kicking off Thursday, with the first of three meetings in metro Detroit to be held in Oakland County.

"Each event is to have a panel of state legislators from their respective counties to hear from advocates, community mental health leaders and citizens concerned about mental health reform. Other town halls are scheduled for venues in Macomb and Wayne counties.

"Specifically, organizers hope to have people express their concerns about properly funding more and better mental health services to their policymakers and to oppose efforts in Lansing to shift Medicaid funding for mental health services to private HMOs."

Earlier this year the Governor proposed in his budget bill to drastically change the way Mental Health services are funded and delivered in Michigan. The proposal would have allowed for the privatizing of Medicaid spending on Mental Health, handing funding over to private Medicaid Health Plans.  This created an uproar that was enough to have the Governor withdraw his proposals for this year, but it could come up again in January, after the Michigan Department of Health and Human Services delivers a report on reform proposals to the legislature.

The first town hall is tonight (Thursday, 9/22/16) at 7 p.m. in the Beaumont Hospital Administration Auditorium, 3601 Thirteen Mile in Royal Oak. Two more Town Halls are set for or 7 p.m. Sept. 28 at the Macomb Intermediate School District, 44001 Garfield in Clinton Township and 10 a.m. Oct. 15 at UAW Region 1A, 9650 Telegraph Road in Taylor.

Comments are limited to five minutes. These events are sponsored by organizations listed on the flyer. Send written comments to freda.cummins@gmail.com . Call 248-203-1998 for more information.

See the Flyer for these events