Washtenaw County Community Mental Health Board

Having been to many Community Mental Health meetings over the years, I can say that some are more entertaining than others depending on the range and relevance of topics covered. Anyone wanting to understand how this part of local government works can find out more by attending the CMH Board meetings and following their activities.

Your local Community Mental Health Agency funds programs and services for people with developmental and other disabilities. Administrative decisions are ultimately the responsibility of the CMH Board of Directors.  The Washtenaw County Community Mental Health (WCCMH) Board meets on the 3rd Friday of every month. Board materials are available before each meeting and minutes are posted after they have been approved: 

WCCMH Board meetings 

9:30 a.m. on the 3rd Friday of every month 

Washtenaw County LRC 

4135 Washtenaw Avenue

Ann Arbor, MI 48108 

Materials for Board meetings, past and present, are available at the Agenda Center on  the Washtenaw County Website. 

When you download the agenda, it has all the items for that meeting included in one packet of materials.

Here is the Calendar of Washtenaw County Boards and Committee Meetings.

WCCMH Board members

2017 Election results: Washtenaw County millages supporting special ed and Community Mental Health win and other news

Both Washtenaw County millages won by a wide margin in yesterday’s election.

In other news, the Michigan legislature seems to be losing its mind depending on how you feel about guns in schools and protecting wildlife.

According to a Detroit Free Press article, “Michigan bills would allow concealed guns in schools, churches” by Kathleen Gray, 11/7/17:

“In the wake of mass shootings in Las Vegas and Texas that left dozens of people dead or injured, a Michigan Senate committee approved bills Tuesday that will allow gun owners to carry concealed weapons in gun-free zones such as schools, churches, day care centers, bars, dorms and stadiums.”

…”The bills taken up in the Senate Government Operations Committee passed on a party-line vote with Republicans supporting the three-bill package and Democrats opposing it. The bills would also close the open-carry loophole, effectively barring gun owners from openly carrying their weapons in gun-free zones.” This was a concession to school districts that claim that seeing people carrying weapons in school upsets students, parents, and staff to the point where they sometimes have to shut down.

Emily Durbin, Michigan chapter president of Moms Demand Action, responded:

”Two days after the latest shooting, we’re here not having a conversation about keeping guns away from domestic abusers, increasing background checks or banning bump stocks," she said. "Instead, we're urgently discussing what the gun lobby wants and that's a desire to have more guns in more places, no questions asked."

Governor Rick Snyder vetoed a similar bill in 2012, four days after a gunman slaughtered 20 children in an elementary school in Newtown, Connecticut.

“SB 584-586 — could come up for a vote in the Senate on Wednesday, and will likely pass the chamber, where Republicans hold a 27-11 majority.” 

***************************
In addition,..."The state House of Representatives, in a voice vote and without debate, …passed a resolution urging the state Natural Resources Commission to establish a sandhill crane hunting season in Michigan." ---“‘Ribeye of the sky?' House recommends sandhill crane hunt in Michigan”, by Keith Matheny, Detroit Free Press, 10/18/17.

This has little to do with developmental disabilities, but a lot to do with how government fails to address important issues and sometimes seems to just want to aggravate the opposition for no particular reason. I doubt there has been a groundswell of support from hungry citizens who can’t wait to sample sandhill crane breast meat.

The Phyllis Haehnle Memorial Audubon Sanctuary near Jackson, Michigan has documented the successful repopulation of Sandhill Cranes in Michigan from near extinction to abundance throughout the Mississippi flyway. Since 2009, however, the fall population count has leveled off in Michigan and the birds reproduce in low numbers. The birds are protected under the federal Migratory Bird Treaty Act, but farmers can apply to the U.S. Fish and Wildlife Service for special permits to eradicate birds damaging their crops.

Is a Sandhill Crane hunt necessary, or could we all show a little restraint in the protection of native bird species?

Elections Matter: VOTE November 7th, 2017

Washtenaw County, Michigan, has two important issues on the ballot affecting people with disabilities and people with mental illness.

Voting Information

The Ann Arbor League of Women Voters website can provide you with the information you need to vote. Enter your address and zip code and follow the links to check on your voter registration, the exact wording of ballot issues, and more.

Millage Elections

A mill is a property tax of one tenth of a cent ($0.001) or one-thousandth of a dollar of taxable value. A tax rate of one mill raises $1 per $1,000 of taxable value. The taxable value cannot be higher than 50% of the State equalized value (true cash value) of the property.

[For easily distractible people, who need to know more about this now, here  is a link to a paper from the Michigan Senate Fiscal Agency.]

Washtenaw Intermediate Special Education Millage 

This is a proposal to renew a special education millage for another 8 years. See the Ann Arbor News report on the millage election:

“The millage would provide about $15.2 million in 2018 to fund special education services provided by Washtenaw County's public schools. Because this is a renewal of the existing millage, there is no additional cost to taxpayers.

“In all, Washtenaw County schools spend $124 million each year on special education services for more than 6,500 students, according to a presentation on the millage request from the WISD.”…

Washtenaw County Community Mental Health and Public Safety Preservation Millage

This is an NPR program by Jorge Avellan on 11/2/17 about the CMH millage: “Washtenaw County Voters To Decide Community Mental Health And Public Safety Proposal On Nov. 7th”

NAMI (National Alliance on Mental Illness), Washtenaw County supports the CMH Millage

NAMI Washtenaw County supports the Community Mental Health and Public Safety Preservation Millage on the November 7, 2017 ballot. NAMI WC focuses on mental health issues and their intersection with public safety, but we also support the complete millage, including the need for reliable funding for public safety operations and the need to rebate funds to communities which have their own public safety agencies.

Washtenaw County faces several crises among people with mental illnesses who are not eligible for Medicaid and who are unserved as a result of state budget cuts. State funding for Community Mental Health (CMH) has dropped by 60%, from $6.5 million to $2.7 million. CMH has lost 70 staff members. CMH has discharged 350 people and has turned away others seeking help. CMH cannot use other funds to make up for the cuts.

Here are the results from these cuts to the CMH budget:

1. CMH cannot respond to the demands from the deadly and growing mental health crisis from suicides and opioid use.

2. Lack of CMH services has resulted in costly hospital stays. Other services in the community have been stressed because they cannot serve such serious problems.

3. We see its effects of budget cuts on the homeless population.

4. People with mental illnesses are being incarcerated in the County Jail unnecessarily.

The millage will raise $5.86 million to fund:

1. Better coordination with the Sheriff’s Office and services which will divert people with mental illness from unnecessary jailing and harm.

2. Four specific types of service

• Crisis services: including the suicide and opioid epidemics 
• Stabilization services: for those who do not currently qualify for services— 
• Prevention services: including mental health awareness, prevention, and early intervention programming with community partners, including schools, law enforcement and other first responders, and health care providers. 
• Jail Services: Including mental health and substance abuse assessment and treatment inclusive of counseling and psychiatric services and prisoner re-entry. 

....Call or email NAMI WC at 734-994-6611, office@namiwc.org. Our website: namiwc.org

Michigan : Washtenaw County events and news

The first event coming up this month is sponsored by Intentional Communities of Washtenaw (ICW), a non-profit group that is organized to help provide housing and services to people with DD:

Learn About the New Washtenaw CMH Strategic Plan

Speaker: Trish Cortes, CMH Director

Tuesday, January 10, 2017

7 - 8:30 P.M.

Washtenaw ISD at 1819 South Wagner Rd., Ann Arbor, MI 48103 (Between Liberty and Scio Church Roads)

Washtenaw Community Mental Health is the county agency that funds most Community Living Support (CLS) services for persons with disabilities. This month, the ICW program will provide family members with the latest information about changes at the agency and at the state level that will affect our loved ones. 

Our speaker will be Patricia Cortes, CMH Director. Trish holds a Bachelors degree in Nursing and a Master degree in Community Health Nursing from the University of Michigan. She has held a variety of positions with Washtenaw County since 2000 including Mental Health Nurse,Health Service Supervisor, Program Administrator - Developmental Disabilities, Program, Director of Health Service Innovation, and Director of Community Support and Treatment Services (CSTS) prior to becoming CMH Director. She has established and maintained countless internal and external partnerships in the community. She recently has led the process of developing the CMH Strategic Plan. 

Our monthly meetings are open to the public and offer a great opportunity to learn more about ICW and to meet other families with similar challenges. 

We hope to see you there.

Al Blixt, Board Chair
Intentional Communities of Washtenaw 

================================

St. Louis Center in Chelsea, MI is a "caring residential community for people with intellectual and developmental disabilities". It is sponsoring a program for special needs families on "Securing the Future":

Securing the Future 

for Special Needs Families 

Protect, Provide and Prosper 

Thursday, February 16, 2017 

7:00 - 9:00 pm 

St. Louis Center 

16195 W. Old US Hwy. 12, Chelsea MI 48118

Family Welcome and Orientation Center 

Many families with special needs children or adults have a difficult time navigating the future for their loved ones, and advanced planning can ensure a positive quality of life for years to come. Our advisors can help special needs families by explaining the ins and outs of saving and investing to ensure long term success. Please join us for an opportunity to ask our distinguished panel about financial investments, special needs trusts, and guardianship issues to obtain the answers you seek while planning for the future. 

Speakers: Dan Johnson, Investment/Financial Advisor, Northwestern Mutual, Southfield, MI.....Joshua R. Fink, Guardianship - Attorney, *Fink & Fink, Pllc*, Ann Arbor, MI;..... Daniel R. Shirey, Special Needs Trusts *Kitch, Drutchas, Wagner, Valitutti & Sherbrook*, Detroit, MI.

Please contact Joe Yekulis, PR Director, at SLC at 734-475-8430 

for more information or to register. 

To learn more about St. Louis Center, visit our website www.stlouiscenter.org 

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

The "Village" at St. Louis Center

Groundbreaking Marks New Era for St. Louis Center (9/29/16)

After several years of planning and fundraising, the St. Louis Center finally celebrated a groundbreaking ceremony for St. Louis Guanella Village with about 275 of their closest friends on Thursday, September 29, 2016. The “Village” is considered an “intentional community,” with the construction of four new children’s homes immediately for children with intellectual and developmental disabilities. The “Village” will also include other segments of homes and townhomes for people with I/DD and their families. In spite of the rain soaked evening, supporters came from far and wide to enjoy a fine selection of hors d’oeuvres provided by Food Art, Inc. and speeches from key supporters and local dignitaries. Development Director Peggy Cole was moved that the time had finally arrived to sink shovels into the ground. “We owe this moment to our many supporters who see St. Louis Center as a bright light that is leading the way for others. We have many hard working committee members who share our dream of the St. Louis Guanella Village, and have worked to make this happen.”... 

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

For more information on St. Louis Center's Guanella Village see the website:

"New housing built in the Village will guarantee the provision of the full continuum of care for aging people with I/DD and will provide housing and care opportunities for them and their families."

Advocacy Alert for Washtenaw : Townhall meeting, 2/29/16 at 5:30 pm

This is a last minute notice that came to me by way of Intentional Communities of Washtenaw.

*************************
ADVOCACY ALERT
Town Hall for Education & Advocacy
Monday, February 29th.

This is an urgent message for all of us concerned about persons with developmental disabilities including residents of Intentional Communities. Please read it carefully and take action to oppose the changes that are being proposed including attending the town hall meeting on Monday.

There are some fairly terrifying aspects of the proposed 2017 Michigan budget, specifically Section 298 - which eliminates Prepaid Inpatient Health Plans (PIHP's) in our state and puts the money into the HMO's [Medicaid Health Plans].

Michigan is the only state that is completely managed care and has integrated care for persons with mental illness, intellectual/developmental disabilities, and substance use disorder services into one system. According to a 2015 Public Sector Consultants report Michigan is pioneering advances in care that is innovative, cost-effective and evidence-based.

However, despite Michigan's many successes in behavioral health care, 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.

Washtenaw County Community Mental Health wants to educate our consumers, families, and stakeholders on the proposed changes of Boilerplate 298 and provide materials to help flood our legislator's inboxes and mailboxes with statements and stories on the importance of Mental Health Services.

Please help spread the word about this town hall.
When: February 29, 2016 at 5:30pm
Where: St. Luke Church-4205 Washtenaw Ave.,
Ann Arbor, MI

Questions? Contact Community Mental Health.
Call 734.544.3050 or email customer_service@ewashtenaw.org

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."
 

Michigan: Washtenaw County's Mental Health Mess

The Ann Arbor News featured a long article about the decrease in funding for Community Mental Heatlh (CMH) services in Washtenaw County: "Analysis: Where has all the money gone? Washtenaw County's mental health mess" by Ben Freed, 11/15/15.

Kudos to Ben Freed for figuring this out and analyzing  a mess similar to the results of Humpty Dumpty falling off the wall in the nursery rhyme.  Freed has unscrambled the egg and now I am trying to understand and translate his analysis, so that us ordinary people dealing with the mental health system can at least have a clue as to what happened.

The CMH system provides services primarily to people with developmental disabilities, mental illness, and drug abuse problems. For individuals who are eligible for Medicaid and are developmentally disabled, Washtenaw County CMH still has a responsibility to provide them with all services that are deemed medically-necessary through a person-centered planning process that results in an Individual Plan of Services (IPOS). Most people with developmental disabilities fall under this category. This has not changed, but many other people who were previously covered by CMH who do not fit that category, have found themselves with greatly reduced services or none at all. This is bound to affect the entire system.

What Happened?

Washtenaw County's mental health services budget was $80 million in fiscal year 2012 and has fallen to $66.7 million in Fiscal Year 2016. 

Where has the $14.3 million gone? Freed breaks it down into several categories to account for the lost funds.

$3.86 Million: The WCHO deficit

The Washtenaw Community Health Organization was formed in 2000 in partnership with the University of Michigan and was designated the Prepaid Inpatient Health Plan (PIHP) for a four county area as well as the CMHSP (or what had previously been called the CMH ) for the County. The PIHP is a regional administrative agency that distributes Medicaid funding to the counties belonging to its affiliation and the CMHSP provides the services. 

Within the WCHO, Medicaid funding and the number of people served would fluctuate over the course of a year and deficits in one county, usually Washtenaw, would be plugged by surpluses in other counties. This practice was not hidden and it was the accepted way of balancing the budget.  Sometimes infusions of state funding would also fill the gaps. 

By 2014, it became clear that the gap had reached unmanageable proportions and a Washtenaw County Behavioral Task Force recommended dissolution of the WCHO and a takeover by Washtenaw County government to provide better oversight and monitoring of CMH. There were also changes in state funding and the PIHPs that eventually led to substantial changes:

“A new organization, the Community Mental Health Partnership of Southeast Michigan, was formed to take over PIHP duties from the Washtenaw Community Health Organization, which was eventually phased out as an entity in 2015. Its county functions were absorbed by the CSTS [Community Supports and Treatment Services], which took on the name Washtenaw County Community Mental Health.”

Cuts in services to offset the deficit have been the source of controversy and have led to devastating results for some County residents.

$8.5 million: Medicaid and carry over

Medicaid funding accounts for 80% of the Washtenaw CMH budget. Medicaid funds can only be used for certain services for Medicaid-eligible individuals and cannot be used for other services or for those who do not qualify.

Here is where you have to watch the bouncing ball to understand what is going on with Medicaid:

If the economy improves, as it has in the last couple of years, fewer people qualify for Medicaid and funding to CMH goes down:

“As of June 2015, there were 3,333 fewer total Washtenaw County residents on Medicaid than the previous June—that number includes all Medicaid enrollees, not just mental health patients. In FY 2015, Washtenaw County received about $1.4 million less than was budgeted for that year and in the coming year the county's Medicaid payout will be down by $2.5 million.”

In previous years, any Medicaid money that was not used up could be rolled over into the next year’s budget: 

In 2012, the WCHO had $8milliion to carry over to its next fiscal year. “By FY 2014 the carry forward had shrunk to $6 million and four months into the following fiscal year, it was gone. This year there is no carry forward money to help supplement the Medicaid dollars. At the same time, community living support costs grew from $10.4 million in FY 2010 to more than $22 million by FY 2014. Core provider costs had grown from $25.8 million to nearly $30 million over the same time period.”

Also, “Three of the four counties in Washtenaw County's PIHP region did not receive enough Medicaid dollars to fully fund their programs in FY 2014 and the $1 million surplus from Lenawee was distributed to help the other three support their deficits.”

$2.2 Million: The State of Michigan

Although the State Budget Office tells us that the state's total mental health budget - including the Healthy Michigan Plan (Medicaid expansion) - grew by 9 percent to a total of $2.8 billion in 2015, local CMH agencies are struggling with financial problems not addressed by the state or exacerbated by state funding decisions.

Michigan introduced its Healthy Michigan Plan (Medicaid expansion), in 2014, and more than 600,000 people signed up who had previously not had Medicaid coverage:

“Because enrollment was higher than expected, the state had less money to pay per patient than they had previously estimated. Approximately 15,000 people enrolled in the program in Washtenaw County, but the per-patient rate was adjusted down by $10 per month mid-year by the state.” This resulted in $1million less revenue than expected for Healthy Michigan Plan CMH consumers that will carry over into 2016.

Then, “with the new federal funding coming into mental health services, the state also took the opportunity to cut general fund allocations to county mental health agencies across the state.” Because this money had been used to fill in gaps for County residents who did not qualify for Medicaid or were on the borderline of qualifying, services that were once provided with general fund money, are the most adversely affected by the state’s decision.

As a result, “’You're starting to see those people in the ER, you're going to start seeing them in the justice system, people who had been under our care,’ Cortes said. ‘These are people we've been serving for more than a decade.’”

“…Washtenaw County's general fund allocation for FY 2012 was $8.36 million. In FY 2016 it is $2.8 million, but the state is also taking on about $1.9 million payments to state hospitals that previously came from the general fund allocations.”

What happens next?

There are state-level discussions going on to request an increase in general fund dollars for county CMH agencies. Washtenaw County Board of Commissioners has stepped up to continue funding of the county’s vocational training program. The County has also added a “structural $400,000 allocation to mental health from its general fund that will be paid for through the anticipated increases in taxable value in the county.”

“…St. Joseph Mercy Hospital and University of Michigan Health System have each pledged more than $100,000 to Community Mental Health and the Washtenaw County Health Plan is adding an additional $150,000. Those funds will all go toward direct services for people not covered by Medicaid.”

In addition, “The county is also in negotiations with the unions about maintaining staffing and pay levels for county employees”.

The article also covers the programs that are likely to be most affected by the changes in Washtenaw County and the services that will likely be dropped. 

Read the full article here...

Another article, "What the mental health funding cuts mean for one woman's struggles" by Ben Freed, 11/15/15, follows the day-to-day changes in the life of a woman with severe mental illness whose services have been reduced or eliminated.