Whether or not the state moves forward with its redesign efforts, care in Michigan will continue. That is why ongoing advocacy remains critical to ensure that all voices are at the table, and no matter who is in charge, is held accountable. Pull Up Your Chair & Let’s Start the Conversation.

If you are not at the table, you will be eaten

At the World Economic Forum in Davos last week, Canada’s Prime Minister Mark Carney used the writings of Václav Havel, the President of the Czech Republic to describe a ruptured world. In a ruptured world he said, power consolidates and those without voice absorb the consequences.  Carney said, if you are not at the table, you will be eaten.

He described Canada as a middle power. Michigan’s behavioral health providers occupy a similar position. Providers do not contract directly with the state, they do not control rate setting or interpret the rules. Yet they carry the burden of the systems when it succeeds and when it fails, in emergency rooms, courtrooms, schools, jails, and families’ living rooms. Providers are essential to the system’s function, but often peripheral to its redesign.

Earlier this month, the Michigan Court of Claims, in the Yates decision, allowed the state’s PIHP procurement process to proceed but must address the portions of the RFP that conflict with the Michigan Mental Health Code. Specifically, the Court found that the RFP bars Community Mental Health Services Programs (CMHSPs) from entering into financial arrangements necessary to carry out core statutory duties, including crisis intervention, recipient rights protections, preadmission screening, and other legally required services.

Plaintiffs argued that the RFP unlawfully stripped CMHSPs of their ability to coordinate care and maintain provider networks, despite explicit statutory mandates requiring them to deliver comprehensive behavioral health services regardless of an individual’s ability to pay. The Court agreed.

While the Court affirmed CMHSPs in current law, the law can be changed and updated to meet the needs of the community mental health system.

Havel and most recently Carney, warned that systems persist not because they work, but because people learn how to live within them, repeating accepted language, complying with ritual, and avoiding direct confrontation with contradiction. Over time, the system becomes adept at preserving itself while drifting further from its purpose.

While the MDHHS decides how it will address who holds authority, who bears risk, and who is accountable when care breaks down the path forward cannot be about winners and losers. A redesigned system must be one that addresses all the concerns of the state, PIHPs, CMHSPs, providers, consumers and families.

This includes,

Michigan has an opportunity not just to adjust its behavioral health system, but to transform it in a way that aligns law, funding, accountability, and care. Providers can’t afford to sit on the sidelines and accept the status quo. They must be part of a collective voice to redesign a better system.

Read further,

Soon, the Governor will propose her final state budget. With less funds to work with, the budget itself cannot undo the state’s procurement efforts, but it can influence timing, conditions, and implementation in ways that matter.

The most realistic pressure points to watch are boilerplate and line-item conditions. The Legislature can include boilerplate language directing MDHHS on how appropriated funds may be used, imposing reporting requirements, setting conditions precedent to spending, or requiring legislative notification or approval before certain steps occur. While boilerplate cannot amend substantive law, it can slow execution.

Delayed appropriations, partial funding, or restricted spending authority can compress implementation timelines. In a complex procurement like this, as we are already seeing, timing pressure alone can create practical barriers, particularly around transition planning and provider contracting.

At the same time the budget can be used to mandate oversight and install guardrails. This includes requirements for independent audits, readiness assessments, legislative reporting, or external reviews.

The Legislature cannot, through the budget alone, stop or prevent the procurement process from moving forward. And the Yates Decision already gave the state permission to move forward.

As the state moves forward in its budget process, we should all watch what is happening carefully. People are encouraged to meet and engage with their legislators, particularly those on the Appropriations Committee and if possible testify on key aspects of the budget that impact your agency.

The Data Reinforces the SUD Gap Is Structural

The Access to Behavioral Health Care in Michigan, 2022 Data Update underscores that how substance use disorder (SUD) care is financed within Medicaid is closely linked to whether people ultimately receive treatment. The report documents that within Michigan Medicaid, responsibility for behavioral health services is split across Medicaid Health Plans (MHPs), Prepaid Inpatient Health Plans (PIHPs), and fee-for-service payment, with PIHPs required to cover all SUD treatment and more severe behavioral health conditions. In 2022, this structure coincided with a 58% untreated rate among Medicaid enrollees with SUD, an increase from 2019, despite higher overall utilization and a growing population in need. The report does not assign fault, but the data suggest that fragmented payment responsibility and complex administrative pathways remain a significant factor shaping access to care. These findings reinforce provider concerns that access challenges are structural rather than clinical, and they point to a clear opportunity for systems change: aligning payment responsibility, accountability, and administrative processes with the realities of SUD care delivery to reduce friction, stabilize capacity, and improve access statewide. You can read the 2026 Altarum Report, here.

Mott Foundation pledges to disburse $2 billion in next decade

The Charles Stewart Mott Foundation has announced plans to disburse $2 billion in grants over the next decade, with more than 60 percent of the funds focused on its hometown of Flint, Michigan.

From 1926 through 2025, the Mott Foundation granted more than $4.4 billion in support of charitable efforts—more than $9 billion adjusted for inflation. In the coming decade, the foundation plans to award up to $370 million to boost education in Flint—including as much as $100 million for school facilities—$100 million to reduce childhood poverty in Flint, $200 million in support of national youth engagement, $100 million to advance one-water solutions, and $40 million in support of access to justice globally. “Through times of peace and prosperity—as well as world wars, natural disasters, and manmade crises—the Mott Foundation has been able provide support to help communities chart their paths forward,” said Mott Foundation president and CEO Ridgway White. Source Candid.

MacKenzie Scott awards $45 million to Trevor Project for LGBTQ+ youth, Candid

Health Endowment Fund Releases New Report on Behavioral Health Access in MIchigan

Michigan saw an increase in need for behavioral health care from 2019 to 2022, along with modest gains in the percentage of residents who were able to access that care. Meanwhile, large numbers of people with substance use disorders and members of specific groups continued to go untreated for their behavioral health needs, according to the latest edition of Behavioral Health Access in Michigan — produced by Altarum and commissioned by the Health Fund.

This latest edition offers a broad analysis of the availability of behavioral health care in Michigan using surveys and claims data collected in 2022. Previous versions examined data from 2016 and 2019, helping to create a longitudinal portrait of the state of behavioral health access in Michigan.

On February 24 the Fund is hosting a virtual discussion with the study's authors and a panel of behavioral health leaders from across the state who will reflect on what the data means for providers, policymakers, and the health of Michiganders. Register for the webinar here. Source Michigan Health Endowment Fund.

Expansions

Crisis

Risk Management

Telehealth

Eleos released its’ AI Buyer’s Guide for Behavioral Health last week. Here is the link to Download your buyer's guide from Eleos.