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."

*****************************  

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:    
Join from a PC, Mac, iPad, iPhone or Android device:
    Please click this URL to join. https://zoom.us/j/94922635037
 
Or One tap mobile:
     +19292056099,,94922635037# US (New York)
     +12678310333,,94922635037# US (Philadelphia)
 
Or join by phone:

Dial(for higher quality, dial a number based on your current location):

US: +1 929 205 6099  or +1 267 831 0333  or +1 312 626 6799  or +1 646 518 9805

Webinar ID: 949 2263 5037   

International numbers available: https://zoom.us/u/abORGuxsY

Click here for virtual meeting instructions

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: 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.

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… )

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

See also Michigan CMH Facts and Figures 

Making Sense of the Political Landscape... Part 2

Michigan: Budget negotiations and radical changes to DD service delivery

May 25. 2017

Where to start? The Michigan legislature is considering a radical change in 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 is 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. 

This intent of the Governor was spelled out clearly more than a year ago by the governor’s proposed budget for Fiscal Year 2017:

“…the FY17 executive budget recommendation includes section 298 of the Michigan Department of Health and Human Services Budget - a proposed change without any initial research or analysis that would transfer management responsibilities of all Medicaid behavioral health dollars ($3 billion) from the current publicly managed PIHP system to the privately managed Medicaid health plans by the end of FY17. This change would significantly harm an already underfunded system of care for Michigan's most vulnerable citizens.”

The plan that was proposed in 2016 was met with almost universal opposition from people receiving services through the Community Mental Health system, advocates, providers, and CMH agencies throughout the state. This was enough to halt the plan in its tracks, form various committees and workgroups to study the problem and submit reports to the legislature for consideration of this year’s budget negotiations.

The plans set forth by the Governor and the legislature for future fiscal years have changed in the details, but not in their intent. Privatization is the goal and the way to reach this goal has been laid out in proposed legislation. Many, many words, letters, emails, and phone calls have been exchanged trying to make sense of these proposals and assure that the people affected by them are heard and that their views are taken into consideration. Whether that will be the case remains to be seen.

The budget negotiations and the news about them from Lansing are overwhelming and confusing. Part of the problem for me and for many families of people living with severe disabilities is that real life keeps intervening. In my case, it mostly has to do with my older son’s struggle with seizures. I have decided to start with the present and work backwards to find ways to explain what is going on with the state and how it is affecting people at the local level.

In an article in the Ann Arbor News, “Lawmakers say mental health cuts put Michigan counties in a bad spot” by Ryan Stanton, 5/23/17, local legislators discuss the harmful effects of past actions by the state legislature and current proposals that make it increasingly difficult for local agencies to meet the needs of people with DD, mental illness, and other vulnerable populations:

"...Cuts at the state level in recent years already have created a crisis for community mental health service providers across Michigan, putting counties in a bad spot, [legislators] argued Monday night, May 22, during a legislative forum hosted by Washtenaw County's Office of Community and Economic Development.

"GOP lawmakers in Lansing are now considering further changes to how mental health services are provided in Michigan, and Democrats fear it could essentially lead to privatization of community mental health by 2020.

"Rep. Adam Zemke, D-Ann Arbor, said a lack of state general fund support for mental health is having devastating consequences, and counties are asking local taxpayers to dig deeper into their pockets to fund vital services.”

In past years, while Medicaid was the main source of funding for mental health services, dollars from the state’s General Fund could be used to pick up the slack for people who were not eligible for Medicaid but were nonetheless in need of services for medical care, job support, psychiatric care, and programs to prevent homelessness and incarceration. Recently, available General Fund resources have been shrinking drastically:

“Washtenaw County Community Mental Health's state general fund allocation has dropped from $6.5 million in 2014 to $2.7 million as of 2017.

“As a result, county officials say, critical treatment and services for highly vulnerable citizens have been reduced or eliminated, and WCCMH  is currently wait-listing people who are uninsured or underinsured.”

State Senator Rebekah Warren, D-Ann Arbor, voted against the Senate budget plan that calls for privatization of community mental health programs by 2020:

"'We were being sort of sold a promise that they will be able to deliver more care for more people with less money and I'm not exactly sure how they think they can do that, but that's kind of the promise.'"

Washtenaw and other Michigan counties are considering ballot measures for increasing local property taxes to pay for the lack of state general fund dollars and potential decreases in federal Medicaid funding for crucial services. This seems to be a stopgap measure to fund services, but is not a longterm solution. Legislators continue to seek tax cuts even as the demand for services for vulnerable populations increases along with the public’s demand for infrastructure improvements that have been neglected for years.

Michigan: Important information for Washtenaw County DD adults using "self-determination"

This is an email from a parent who asked me to pass on this information to anyone who receives services from the Washtenaw County Community Mental Health agency using Self-Determination arrangements. To learn more, a contact phone number and email is provided below:

This email contains some very important information for individuals and their families who are receiving community living support services (CLS) using a self - determination (SD) arrangement in Washtenaw County. Was your CLS budget reduced in May of 2015? Are you currently not receiving an adequate level of CLS services? Are you paying out of pocket for transportation, CLS services, community activity, or training expenses?

If yes, you are probably aware that in 2015, CMH changed the way in which they determine the self - determination budget. Instead of basing the SD budget on the individual's needs, they have essentially "capped" the SD budget and are forcing everyone to fit into a budget based solely on the number of CLS hours. CMH previously determined individual needs in the Person Centered Plan (PCP) and then authorized them in the Individual Plan of Service (IPOS.)

There is no longer "individualization". Instead the number of hours determine the budget, not the needs for transportation, training, or community activity. Although you may not feel a huge impact at the present, in the future if you or your loved one needed additional supports, such as double staffing due to an injury, there would be no additional funds or method to accommodate the need using self-determination. This method of calculating self- determination budgets is contrary to federal law and just plain wrong.

You do not have to accept this. If you did not file an appeal in May of 2015, you can still join other families in Washtenaw county who are fighting CMH to revert to the former, correct way of determining the SD budgets based on individual needs and medical necessity.

There is currently a lawsuit against Washtenaw CMH, not for monetary damages, but to force them to follow the law and perform the budgetary process correctly. This may greatly impact us and our loved ones in the future, You can join the lawsuit at no expense to you or your loved one.

For further information please call 734-665-7303 or email washtenawsd@icloud.com.

Thank you for taking the time to consider helping all the 150+ families in Washtenaw County who are affected by this.

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

From The DD News Blog:

See also, Michigan Medical Necessity Criteria for Medicaid-funded services.  

Take note of the last paragraph: "A PIHP may not solely deny services based solely on present limits of the cost, amount, scope, and duration of services. Instead, determination of the need of services shall be conducted on an individualized basis."

The MI Dept. of Health and Human Services offers guidance on self-determination policy on this Website.

See also Self Determination Policy from 2012 from the MI Dept. of Community Health (now the MI DHHS).

Washtenaw County deal to lessen impact of mental health cuts

From MLive.com:

"New deal to lessen impact of Washtenaw mental health cuts", by Ryan Stanton, 1/21/16: Supported employment programs to stay with WCCMH, skill building programs to be contracted out.  

Kelly Belknap, the county's chief financial officer, explains the financial implications of a compromise on mental health cuts:
 
"County officials are trying to close a $2 million-plus gap in the CMH budget, citing state cuts in mental health funding as the reason.

"While a number of cuts, including job eliminations, still are proposed under the new plan, they're viewed as less severe now.

"But the savings don't quite close the gap, so the labor unions are asking for $1.2 million in transitional funding to carry CMH through the end of 2016.

"This will allow them time to reorganize and restructure, so the savings that are needed will become structural starting in January 2017." ...

[County Commissioner] Rabhi offered his own take on the mental health cuts the county is forced to make, taking a shot at state leaders.

"'When you have tax cuts for the wealthiest Michiganders, and a lack of investment in our infrastructure and public services, those tax cuts roll downhill, and the budget cuts that happen roll downhill," he said. "And at the local level, where the rubber hits the road, where the services are important, this is where those cuts then come.'

"Rabhi mentioned the Flint water crisis, calling it another consequence of running the government like a business and putting money before people. He said the state is putting pressure on local government to drive down costs and pay workers low wages, and he considers that an unacceptable way to serve citizens."
 

Washtenaw County CMH Town Hall Presentation - 1/20/16

From WCCMH Customer Service:

Washtenaw County Community Mental Health

Join us at 5:30pm for a presentation on the programs and services
that Washtenaw County CMH has to offer and learn about all of the
exciting changes that have taken place over the past year as we
transitioned into Washtenaw County Community Mental Health.

Town Hall Presentation
January 20, 2016 5:30 p.m.
Washtenaw County Learning Resource Center
4135 Washtenaw Ave., Ann Arbor 48108

For more information please contact Customer Service:
customer-service@ewashtenaw.org or 1-877–779-9707

Sally Amos O’Neal, MS, LBSW
Director of Customer Service
Washtenaw County Community Mental Health
555 Towner St.
Ypsilanti, MI 48197
734.544.6807 desk
734.544.6732 fax

Michigan: Washtenaw County's New Community Mental Health Agency and PIHP

As of October 1, 2015, the Washtenaw Community Health Organization (WCHO) ceased to exist as the county's community mental health agency. Washtenaw County Community Support and Treatment Services (CSTS) has become the new Washtenaw County Community Mental Health (WCCMH). The agency is now under the control of the Washtenaw County Board of Commissioners, although the agency may seek to become an independent mental health authority in future years. 

WCCMH provides mental health 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.

This is the list of current WCCMH Board members with contact information. The Board meets on the third Friday of the month from 9:30 to 11:30 a.m. at the Learning Resource Center at 4135 Washtenaw Avenue in Ann Arbor. This is a link to a schedule of Board and committee meetings. The new Board is learning about the intricacies of the State and local CMH system - this is a good time for families and local organizations to attend Board meetings, introduce yourself to the Board, and learn more about how the service delivery system works in Washtenaw County.

Links to WCCMH information:

• WCCMH Programs and Services
• Customer Services  
• Recipient Rights
• Grievances and Appeals

The Prepaid Inpatient Health Plan (PIHP) is now the Community Mental Health Partnership of Southeast Michigan (CMHPSM). The PIHP, one of ten in the state, is a regional administrative entity that distributes Medicaid funds to its local partners, the Community Mental Health agencies for Washtenaw, Lenawee, Livingsston, and Monroe Counties. The reorganization of PIHPs and the reduction in number of PIHPs from 18 to 10 has been a somewhat easier transition for our region because the same counties participate in the PIHP as did under the old system. 

These are links to information about the CMHPSM and some of the services it provides:

• Board of Directors
• Board Meetings, Agenda, and Minutes
• CMHSPM Staff
• CMHSPM Regional Provider Network