Washtenaw County Community Mental Health Meetings

 Washtenaw County Community Mental Health (WCCMH) Information

From the Website: 

"What is Community Mental Health?

"Washtenaw County Community Mental Health is one of several community-based mental healthcare organizations in Michigan. We provide mental health services to adults with a severe and persistent mental illness and children with a severe emotional disturbance, and services to individuals with an intellectual and/or developmental disability, residing in Washtenaw County. We have locations in Ann Arbor and Ypsilanti. Please read our Programs and Services page to learn more about what we offer, and feel free to call us at 734-544-3050 to talk more about Getting Started."

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WCCMH Board Meetings are Bi-monthly from 9:30 a.m.-11:30 a.m.

The next meeting is scheduled for November 18th, 2022

WCCMH Board members are encouraged to participate in person to count towards a quorum. All others are welcome to attend this meeting virtually.

In Person:  Learning Resource Center-Michigan Room
4135 Washtenaw Ave, Ann Arbor, Michigan (near US 23 and Washtenaw Ave.)

Virtual via Zoom:    
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Meetings schedule

View the WCCMH 2022 Board and Board Committees meeting schedule revised 11-3-22 

Agendas are available prior to the meetings. Minutes are available following WCCMH Board approval.

View Most Recent Agendas and Minutes

WCCMH Board Members, revised 5-9-22

Washtenaw County CMH Board hears from families and people with developmental disabilities, 6/21/19

On 6/20/19, Kerry Kafafian, a parent who is spearheading a project called “Home Grown Community” in Washtenaw County, sent out an email encouraging families to attend the Washtenaw Community Mental Health Board meeting on 6/21/19. Earlier, Kathy Homan from the Washtenaw Association for Community Advocacy had sent out an email reporting that a CMH Board member at two CMH committee meetings had suggested that CMH tell the state that the county would no longer provide Community Living Supports (CLS) or Applied Behavior Analysis (ABA) for people with autism in order to eliminate a $10 million deficit in the CMH budget.

The DD community is mentioned infrequently at CMH Board meetings and this seemed to be a good time to let the Board know about the importance of the services needed by people with DD and their families.

The Friday 6/21/19 Board meeting was attended by 25 to 30 (in my estimation) family members and people with disabilities who spoke to the Board during an extended period for public participation. It was an amazing turnout, considering that many of the families involved are under a great deal of stress. They cannot do something as simple as grocery shopping without making arrangements to have a responsible adult caregiver available to their disabled family member. The Board meetings are held from 9:30 to 11:30 a.m., an inconvenient time, especially for people who work, making it even more difficult for families to attend. There were many people who could not make it on Friday but who nevertheless wanted to address the Board.

Some parents spoke of their children being exposed to abuse and neglect in other settings outside of their own homes and many spoke of the difficulty in hiring Medicaid-funded support staff at poverty level wages. One parent told of how the CMH system has moved the chains and bars from institutions to his home, where he cannot find staff to take care of his son with extreme behavioral difficulties. Others were very happy with the services their loved ones were receiving and said that they were life sustaining for their families and liberating for their disabled family members. They did not want the services discontinued. Parents also expressed how sleepless nights and relentless caregiving responsibilities had pushed them to the brink of exhaustion and beyond. Another called the contemplation of removing services as reckless and irresponsible and another mentioned that there was no end in sight to caregiving responsibilities for people with lifelong disabilities. Another said that using our loved ones as pawns to get more money from the state was reprehensible. 

Board members expressed appreciation for all who attended; some described their own struggles with mental illness themselves or with their family members. In response to questions, the Board said they had joined a lawsuit against drug companies that have made huge profits on selling opioids. Washtenaw County is also involved in a lawsuit against the state for chronic underfunding of services that the local CMH is mandated by law to provide. The board member who had made the suggestion to cut services to force the state to pay for them apologized for his insensitive remarks. No decisions have been made yet on how to deal with the CMH budget deficit.

Attached is a calendar showing CMH Board and committee meetings for 2019. They all include a time for public participation. Anyone can submit a written statement to the Board at any time. I do not have specific information for sending written or electronic materials to the Board, but Customer Services at 734-544-3050 or 877-779-9707 should be able to give you that information. Their hours are from 8:30 a.m. to 5 p.m.

Jill Barker
Ann Arbor, MI

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This is a definition of Community Living Supports from the Michigan Medicaid Provider Manual, a huge document (never make the mistake of trying to print the whole thing). CLS is a service provided under various Medicaid Waivers and State Plan benefits for people with disabilities:

"Community Living Supports (CLS) facilitate an individual’s independence, productivity, and promote inclusion and participation. The supports can be provided in the beneficiary’s residence (licensed facility, family home, own home or apartment) and in community settings (including, but not limited to, libraries, city pools, camps, etc.), and may not supplant other waiver or state plan covered services (e.g., out-of-home nonvocational habilitation, Home Help Program, personal care in specialized residential, respite)."

2019 Calendar of CMH Board and Committee Meetings

WCCMH Board Members

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  

Washtenaw County: Notes on the WCCMH Board Meeting for 4/19/19

Washtenaw Community Mental Health Board meetings are usually held on the third Friday of the month from 9:30 to 11:30 a.m. The timing alone may explain why there are so few members of the public who attend the meetings or take the opportunity to speak to the Board during the time set aside for public participation. Most of the attendees are Board members, WCCMH staff, or people who have been invited to talk to the Board on specific topics. 

At the WCCMH Board meeting on April 19, 2019, there were at least half a dozen members of the public who made comments during public participation, many of whom had participated in state House budget hearings on 4/11/19 in Lansing. Those hearings can be viewed on Michigan House TV. 

The April 11th Agenda for the House Appropriations Subcommittee on Health and Human Services included an Overview of the FY 2019 - 20 Executive Recommendation for Behavioral Health and State Hospitals by the DHHS (Department of Health and Human Services) and Public Testimony on the DHHS Budget Recommendation. Public comments begin at around 1 hour and 10 minutes into the video. There were a number of commenters from Washtenaw County, most speaking about the benefits of services for people with severe mental illness and a few representing people with developmental disabilities. A provider of services who is also a parent, said that Monroe CMH is far behind in reimbursing providers like himself for services and that this has a domino effect on families, clients, and employees. Some spoke against the privatization of mental health services and others bravely spoke of their experiences with severe mental illness and surviving seemingly hopeless situations, including childhood sexual abuse.

The agenda and other materials for the 4/19/19 Board meeting are available on the Washtenaw County website. The public part of the meeting was cut short for a closed session to discuss pending litigation that challenges the State’s underfunding of Community Mental Health agencies. As I understand it, these agencies are put in the position of having to either cut services that they are mandated to provide or to violate mandates against budget deficits that they are unable to cover with funding reserves because they have been depleted by underfunding. In current state budgets, there has been a slight increase in general appropriations that can include spending on services to people who are not eligilble for Medicaid.

A notable development is that Jane Terwilliger has resigned as the Executive Director of the 4-county Community Mental Health Partnership of Southeast Michigan (CMHPSM). This followed the results of a survey that was highly critical of her performance. The COO (Chief Operating Officer) is now heading the organization and there will be a search for a new Executive Director.

Another part of the meeting focused on Board Committee structure and planning for services funded by the 2017 Washtenaw County millage to improve mental health services and safety. As I have said before, my interest is usually in subjects connected with services to people with intellectual and developmental disabilities. If you are interested in how the WCCMH is funded and spends available resources, the Agenda package includes detailed financial information on this subject.

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 .

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.