Key Legislative Contact Information for Michigan Dual Eligibles Project

If you have unanswered questions and concerns about the Michigan's project to integrate dual eligibles, you can do more than just send your comments to the project Website. Contact the key legislative committees of the Michigan legislature and your own state senator and representative as well as the Governor.

Michigan State Senator correspondence can be sent to:

State Capitol, P.O. Box 30036, Lansing MI. 48909-7536
 
Michigan State Legislators correspondence can be sent to:
 
State Capitol, P.O. Box 30014, Lansing MI. 48909-7514
 
Michigan House Committees:

Health Policy Chair: Rep. Gail Haines, Room N-167 Capitol Bldg.  gailhaines@house.mi.gov 

Community Health Chair Rep. Matt Lori, Room N-993, Anderson Bldg. mattlori@house.mi.gov   

Human Resources Appropriations Chair Rep. Dave Agema, Room N-1093, Anderson Bldg. daveagema@house.mi.gov 

Appropriations Vice Chair Joe Haveman, Room N-1194, Anderson Bldg. josephhaveman@house.mi.gov

Michigan Senate Committees:

Appropriations Committee – Sen. Roger Kahn, Room S-324, Capitol Bldg. senrkahn@senate.michigan.gov 

Health Policy Chair Sen. Jim Marleau, Room 1010, Farnum Bldg. jimmarleau@senate.michigan.gov 

Families, Seniors and Human Services Chair Sen. Judy Emmons, Room 1005, Farnum Bldg. senjemmons@senate.michigan.gov 

Dept of Community Health – Chair Sen. John Moolenaar, Room 715 Farnum Bldg. senjmoolenaar@senate.michigan.gov  

Dept of community Health - Vice Chair Sen. Bruce Caswell, Room 720, Farnum Bldg. senatebcaswell@senate.michigan.gov 

Dept. of Human Services – Sen. Mark, Room S-324, Capitol Bldg. senmjansen@senate.michigan.gov

Michigan Senate Leadership:

Appropriations Senate Majority Leader – Sen. Randy Richardville, Room 106, Capitol Bldg. senrichardville@senate.michigan.gov 

Senate Majority Floor Leader – Sen. Arlan Meekhof, Room S-8, Capitol Bldg. senameekhof@senate.michigan.gov 

Michigan House Leadership:

Speaker of the House - Rep. James Bolger, Room H-164, Capitol Bldg.  jasebolger@house.mi.gov
 
Majority Floor Leader – Rep. Jim Stamas, Room 153, Capitol Bldg. jimstamas@house.mi.gov 

Governor Rick Snyder - P.O.Box 30013, Lansing, MI. 48909, (517) 373-3400 Rick.Snyder@michigan.gov
 
Attorney General Bill Schuette, G. Mennen Williams State Office Bldg., P.O. Box 30212,  Lansing MI. 48909 (517) 373-1110  MIAG@michigan.gov
 
Michigan Dept of Human Services – Dir. Maura Corrigan, 235 S. Grand Avenue, P.O. Box 30037,   Lansing MI. 48909 (517) 373-2035
 
Michigan Dept of Community Health – Dir. Ogla Dazzo, Captiol View Bldg., 201 Townsend Street, Lansing MI. 48913 (517) 373-3740 moyer1@michigan.gov

Questions on Michigan "Dual Eligibles" Project from Stakeholders

This is from the Michigan Association of Community Mental Health Boards Executive Board and includes the complete list of questions from stakeholders mentioned in the last blogpost:

Integrated Care for Dual Eligible Beneficiaries in Michigan
 
The following is a list of Stakeholder questions and concerns as discussed at the MACMHB Executive Board Meeting August 5, 2011. Several forums were held in July offering the opportunity “to learn about and offer input into the state’s plans for integrated care for dual eligibles in Michigan”, however we were engaged late in the process and those who facilitated the regional meetings did not offer answers to our questions.
 
The questions pertain to three areas.
 
Changes to Consumer services and treatments:

• Who makes the final decision as to which treatments and services are “inappropriate” and/or “too costly”?
• Will Habilitative Services be continued to the extent necessary to maintain functioning level and skills and for how long?
• Will Payers have the final approval over the PCP process and its content regardless of the individual beneficiary’s opinions?
• Will the existing Supports Coordination system be continued and for how long?
• What services will be available for those who “opt out”?
• Has there been a real effort to ask Stakeholders for their opinions and what they want?
• At what point will the CMHSP system no longer be used to deliver MI and DD services?
• Will any real consideration be given to allowing regional health homes managed by CMHSP county partners?

Participating Payers:

• Will anyone address the exorbitant reserves and extravagant Executive salaries and benefits of the large carriers?
• Will anyone address the extreme administrative cost rates that result from these large executive employment packages and insure that Medicaid dollars will not be used to feed increases to these already high costs?
• Would it not be worthwhile to compare the participating carrier administrative costs ratios with those of the present CMHSP system already serving these beneficiaries?
• Since these Participating Payers have apparently been promised a share in any “cost saving” realized by the plan, what prevents them from gutting services and treatments in order to protect and insure they attain their share of the profits?
• Assumed “Cost Savings” based on an improved treatment model for co-morbid conditions could take years before the individuals actually attain improved health and the system realizes the savings. What is the assumed source of additional funding in the interim? Will the Payers be required to use their reserves to cover this shortfall?
• Has anyone questioned the logic and/or reasonableness of creating such huge monopolies charged with overseeing both commercial healthcare and tax payer funded Medicare/Medicaid dollars?
• Who is responsibility for identifying fraud and abuse and what is the anticipated accountability process?

 DE Plan Governance Steering Committee:

• Why is there no Stakeholder participation in this committee?
• If the committee is charged with governance and oversight, it would follow that part of their responsibility is to insure the stated goals of improving healthcare and cutting costs are included in its charge. What happens when those two objectives are in conflict? Which of the goals
• will take priority?
• Decisions on or approval of treatment routines and service opportunities could not only alter the quality of life of these beneficiaries but also decide who lives or who does not. Who ultimately makes the final decisions for the most severe segment of this population?
• Will the most severe therefore be determined too costly to support in any meaningful manner? This is one of the most important questions as these individuals are the most severely impaired, most challenging to treat, and are considered the least able to contribute to their healthcare costs and/or healthcare needs

More on "Integrating Dual Eligibles" in Michigan

In July 2011, the Michigan Department of Community Health notified stakeholders about forums on the "Integration of Dual Eligibles". Dual eligibles are people who qualify for both Medicaid and Medicare. Most people with developmental disabilities become eligible for Medicaid when they turn 18 and their families' incomes are no longer considered in determining eligibility. Usually, people with DD qualify for Medicare in addition to Medicaid, when a parent who has been paying into Social Security retires, dies, or becomes disabled. 
 

Michigan is one of fifteen states that has a contract with the Centers for Medicare and Medicaid Services (CMS) to develop a model to "integrate dual eligibles". So far, it appears that the state's plan could radically change the way services are provided to this population. Because dual eligibles are a significant minority served by the mental health system, everyone who receives specialty services through community mental health may feel the impact of these changes.

Presumably, this is all about saving money. According to the Michigan Association of Community Mental Health Boards (MACMHB), "As a group, these individuals [dual eligibles served by the mental health system] have the most complex care needs of persons served by our system.  As a result, the Medicaid expenditures for the specialty services for these persons was $1.1M, almost 50 % of the total Medicaid expenditures for specialty mental health and developmental disabilities services statewide."

These figures would not be a surprise to anyone who knows this population well, just as most people would not be shocked to discover that it costs more to treat an aggressive cancer than it does to treat a sore throat or a broken arm. But we aren't necessarily dealing with people who have an intimate knowledge of what it is like to have a severe developmental disability, mental illness, or other condition covered by Medicare and Medicaid. As far as the state and the federal government are concerned, dual eligibles cost too much money and the costs must be reduced. The belief is that, “Providers will experience administrative efficiencies by working with a single administrative system and payer source [probably Blue Cross/Blue Shield or a similar entity] and instead of dealing with multiple entities for authorization and payment of services." The belief of many families and other advocates is that cost reductions are more likely to come from reducing services than from administrative efficiencies.

The State is required to include stakeholders in the development of this plan that will go into effect next year, but stakeholders were kept in the dark about it until recently. Even after four stakeholder forums with two more scheduled in August (see below), people who attended the forums and read the material distributed about the State plan are still scratching their heads wondering what this is all about. 

What is truly shocking about all this, is that the MDCH is either unwilling or unable to answer some very basic questions, such as those posed by stakeholders at the Michigan Association of Community Mental Health Boards Executive Board Meeting on August 5, 2011. Here are a few of those questions:  

Unanswered questions regarding changes to consumer services and treatments:

• Who makes the final decision as to which treatments and services are
  “inappropriate” and/or “too costly”?
• Will Habilitative Services be continued to the extent necessary to maintain functioning level and skills and for how long?
• Will Payers have the final approval over the PCP [Person-Centered Planning] process and its content regardless of the individual beneficiary’s opinions?

Unanswered questions about participating payers [most likely Blue Cross/Blue Shield or similar entity]:

• Will anyone address the exorbitant reserves and extravagant Executive salaries and benefits of the large carriers?
• Will anyone address the extreme administrative cost rates that result from these large executive employment packages and insure that Medicaid dollars will not be used to feed increases to these already high costs?
• Would it not be worthwhile to compare the participating carrier administrative costs ratios with those of the present CMHSP [Community Mental Health] system already serving these beneficiaries?

Unanswered questions about the Governance Steering Committee for the dual eligibles plan:

• Why is there no Stakeholder participation in this committee?
• If the committee is charged with governance and oversight, it would follow that part of their responsibility is to insure the stated goals of improving healthcare and cutting costs are included in its charge. What happens when those two objectives are in conflict? Which of the goals will take priority?
• Will the most severe therefore be determined too costly to support in any meaningful manner? This is one of the most important questions as these individuals are the most severely impaired, most challenging to treat, and are considered the least able to contribute to their healthcare costs and/or healthcare needs.

Due to feedback from families and other advocates, the state has added two additional meetings for stakeholders regarding the "dual eligible" proposal for integrated care: 

Greater Lansing

Date: Wed., August 24
Time: 1–4 PMVenue: Eagle Eye Golf Club (at Hawk Hollow), 15500 Chandler Road (directions)
(517) 641-4570
Directions

 

and

Detroit 

Date: Mon., August 29
Time: 1–4 PMVenue: Greater Grace Temple Banquet Hall, 23500 W. Seven Mile Rd., Detroit

(313) 543-6000
Directions

If you were unable to attend the previous forums, go to the project Website or call Dawn Wade (517) 484-4954 to register. It is critical that as many people as possible attend. Ask questions concerning aspects of the plan you do not understand or cannot reconcile with your needs. To the extent that you have unmet needs, that should also be expressed as the purpose is to obtain stakeholder input concerning needs. If your needs are currently being served and you fear they will not continue, or will be diminished, that is also a valid statement to express. 

If the state is unwilling or unable to answer basic questions about the dual eligible integration project, the results could be disastrous for this vulnerable and relatively powerless population. 

Written comments can be e-mailed any time to Integratedcare@michigan.gov. See the project Website here and follow the links for more information.

Medicaid funds plundered by nonprofits in New York

The New York Times features an article today called "Reaping Millions in Nonprofit Care for Disabled" By Russ Buettner. It is one of a series of New York Times reports on treatment of the developmentally disabled and how money is spent on their care.

This installment is not as heartbreaking as past stories of rampant abuse of people with disabilities in some of New York's state run group homes and facilities, but the plundering of the Medicaid system by  non-profits and the lack of oversight of their activities is a significant part of the corruption of the system of care. I'm sure this problem is not unique to New York, but New York is a big state and it does corruption in a big way.

According to the article, New York spends $10 billion a year for care of people with developmental disabilities with more than half going to private providers with  little oversight of their spending.

The story focuses on the Young Adult Institute Network run by the Levy brothers from Brooklyn. They both earned close to $1 million a year each as top executives at the Medicaid-financed nonprofit. Public money paid for luxury cars and homes as well as for a year's worth of living expenses in graduate school for one of their daughters. From 2007 - 2009 the brothers also received consulting fees of $50,000 a year from one of the organization's affiliates.

For people who have been around the disability business for a long time, there are many details in the article that strike a familiar chord:

• The organizations began to grow as a response to deinstitutionalization of people with developmental disabilities in the 1970s. As more money became available for community services, the organizations expanded, replacing parents who started the organizations with professionals skilled at fund raising. 
• The power of the organizations matched the power of government agencies in determining services and funding. According to the article,  "The providers and officials from the Office of Mental Retardation and Developmental Disabilities — now called the Office for People With Developmental Disabilities — met monthly to agree on new programs, expansion of existing programs and reimbursement rates. Then, together with the agency officials, they would lobby the Legislature and the governor’s office for the money...The providers became powerful advocates for the people in their care, and savvy strategists, alert to opportunities to increase financing."
• In the early 1980s the organizations got wind of a new state formula that greatly increased rates for people with vision problems. Suddenly, they reported large increases in the number of people who had trouble seeing." 'We called it the day everyone went blind,' said Mr. Castellani, the author of a book about the New York system of caring for the developmentally disabled. "

These and other financial shenanigans are covered thoroughly by the Times. Although there was little found to detract from the the good reputation that the Young Adult Institute has for providing quality care, there is also nothing that justifies the arrogance of the leaders of the nonprofit to exploit people with disabilities for their own enrichment.

The debt ceiling crisis according to Groucho

The Feds double standard on community living

Here is an interesting article by Sally Abrahms published in the AARP Bulletin for July/August 2011 on housing for homeless veterans.

"Homeless Veterans No More" describes a model program to house and provide services to about 40 formerly homeless veterans at the Gordon H. Mansfield Veterans Community in Pittsfield, Massachusetts. The veterans live in brand-new attached units in a development subsidized by the U.S. Department of Housing and Urban Development and the the Department of Veterans Affairs. Each veteran buys a limited-equity ownership in the development and pays about $7,000 in  rent per year with some of that refunded. In addition to earned income, they receive Social Security and veterans disability benefits

A non-profit organization, Soldier On, created the project and provides medical, mental health, and job training services on-site or at its transitional shelter building next door.

According to the article, of the 550 vets served per year by Soldier On, 88% have substance abuse issues and 84% have mental health issues. Most of these veterans not only were homeless, but they also have disabilities similar to non-veterans who are served through other federally-funded programs.

Compare this situation to non-veterans with disabilities who receive Home and Community Based Services (HCBS) through waivers that allow Medicaid funds to pay for services in the community. The same federal government that subsidizes and supports vets in the community described above is proposing to place similar communities off-limits for non-veterans with disabilities. The federal Centers for Medicare and Medicaid Services (CMS) characterizes these settings, especially larger congregate housing developments, as isolated, segregated, and not sufficiently integrated into the community to qualify as community based. In fact, for people with developmental and intellectual disabilities, CMS would not even call the Soldier On program a community, dismissing the idea that people with disabilities with common needs and interests might chose to live together for their mutual benefit.

If the programs and housing for homeless veterans were subject to the proposed rules from CMS and they had to rely on HCBS funding, they would suffer severe limitations:

• The Mansfield Veterans Community is located next door to the transitional shelter building where many of the vets receive services. Under the CMS proposed regulations, that would not be allowed because CMS has determined that a setting that is "in a building on the grounds of, or immediately adjacent to, a public institution; or a housing complex designed expressly around an individual's diagnosis or disability" is not sufficiently integrated into the community.
• Soldier On has received federal funding to build 60 homes on the campus of the VA Medical Center in Northampton, Massachussetts, a program that would not receive Medicaid funding or support under the proposed CMS rules. The VA Medical center has 85 psychiatric beds and a 66-bed nursing home care unit located on the Northampton campus, making it too institution-like for the CMS, regardless of whether residents could use the services provided there.
• Residents at the Mansfield Veterans Community have a great deal of personal freedom and independence, but there are rules they have to follow. They are accountable for their actions, such as for not paying their rent on time or having a drug or alcohol relapse. CMS proposals would only allow settings that do not impose rules on residents that could limit "daily life activities". It is questionable whether the restrictions imposed  on the veterans would be tolerated by CMS  if a disabled non-veteran needed and chose to live in a similar setting.

Of course there are differences in the population of homeless disabled veterans and people with developmental and intellectual disabilities, but there are a lot of similarities such as stigmatization by society, difficulty being accepted and integrated into the community, and numerous unmet physical and mental health needs.

In the case of people with developmental and intellectual disabilities, despite all the lip service paid to "self-determination" and "independence", the federal government and government-funded advocacy organizations believe that they know better than people with disabilities and their families what they should want and need. To unnecessarily limit options available is an impediment to creating a system of care that can truly meet the needs of this diverse population.

Michigan public forums on "Integrating Care"

The Michigan Department of Community Health is holding public forums on "Integrating Care for Dual Eligibles in Michigan".

Before your eyes glaze over, let me explain.

Dual eligibles are people who qualify for both Medicaid and Medicare. For an adult with developmental disabilities, this usually happens when a parent who has been paying into Social Security dies or retires. The disabled adult-child becomes eligible for Social Security and Medicare benefits. The vast majority of adults with developmental disabilities also qualify for Medicaid when they become 18 and the family's income is no longer counted in determining eligibility for Medicaid services. Medicaid pays for medical services as well as an array of mental health services provided through local community mental health agencies.

The Michigan Department of Community Health (MDCH) has contracted with the federal Centers for Medicare and Medicaid Services (CMS) to develop a plan to integrate care for people who are eligible for both Medicare and Medicaid. The ultimate goal of the project is to serve this population more efficiently by improving the quality of care and reducing costs.

The forums for public input on the project will be held in four different locations in the state. For those living in Southeast Michigan, the closest public forum will be in Southfield:

 1 - 4 pm on Wednesday, July 27, 2011
The Hilton Garden Detroit-Southfield
2600 American Drive
Southfield, MI

In addition to hearing a presentation from Michigan’s Medicaid agency, forum participants will be asked to describe what they like about the current system as well as issues that exist. They will also offer feedback regarding the state’s proposed approach for integrating care.

WHY ARE THESE FORUMS IMPORTANT? They are an opportunity for people with DD and their families to remind the state that there is a small but important minority of people who are included in this population of "dual eligibles" who are often overlooked in discussions about reform of our health care system.

This is from the Michigan Association of Community Mental Health Boards:

"Persons with specialty behavioral health needs [the latest term for mental health services] make up a significant part of the dual eligible population.  They represent more than 25% of the dual eligible population statewide.   They also represent a significant part of the persons served by the public mental health system.  In FY09, 54,396 of the persons served by the community mental health system were persons with dual eligibility, more than 25% of the total persons served.   There were 35,339 adults with SMI, 22 children with SED, 18,093 people with DD (6,010 of which were on the Habilitation Supports Waiver).   As a group, these individuals have the most complex care needs of persons served by our system.   As a result, the Medicaid expenditures for the specialty services for these persons was $1.1M, almost 50 % of the total Medicaid expenditures for specialty mental health and developmental disabilities services statewide."

Even if your family member is only eligible for Medicaid, changes in care for "dual eligibles" could significantly affect the delivery of all mental health services. We need to be part of the reform effort rather than victims of it.
 
More Information:

Agenda for the forums including discussion questions
 
Stakeholders may submit comments on integrated care eat any time to: Integratedcare@michigan.gov . 
 
For questions about the forums, contact Dawn Wade at at Public Sector Consultants, at dwade@pscinc.com or  (517) 484-4954.