Pull Up Your Chair

This week, the Michigan Senate Subcommittee on Health and Human Services, chaired by Sen. Sylvia Santana (D-Detroit), passed its budget recommendation for the Department of Health and Human Services for Fiscal Year 2025. The budget legislation, Senate Bill 767, prioritizes $49.1 million in state funding for Medicaid access enhancements, including reimbursement rate increases for Federally Qualified Health Centers, autism services, anesthesia, office visits, speech-language services, and private duty nursing.

The Senate’s DHHS budget recommendation includes money for expanding certified community behavioral health clinic demonstration sites to bring the total number of statewide sites to 44. It also increases behavioral health support by providing funding for technical support in schools to obtain Medicaid reimbursement for mental health services.

Among other things, the proposed budget also includes funding for child welfare and foster care system improvements, the creation of the Office of Suicide Prevention, resources for seniors, including for home-delivered meals and the Michigan Elder Justice Initiative Long-Term Care Ombudsman Program, income assistance programs, and emergency and long-term housing support, and homeless and shelter grants. The recommended 2025 DHHS budget now heads to the full Senate Appropriations Committee for consideration.    

In testimony earlier this month, The Community Mental Health Association (CMHA) outlined several critical issues for the Fiscal Year 2025 (FY25) appropriations regarding Michigan's public mental health system, highlighting the necessity for adjusted Medicaid rates, continuous local match funding, and strategic enhancements to behavioral health services.

Medicaid Redetermination: CMHA urges the Michigan Department of Health and Human Services (MDHHS) to make real-time adjustments to Medicaid rates to prevent revenue losses following the redetermination process affecting over 3 million Michiganders. This adjustment is crucial as the number of Medicaid enrollees directly influences the revenue for the Prepaid Inpatient Health Plans (PIHP) and Community Mental Health Service Programs (CMHSP), which serve a consistently needy population.

Medicaid Rates: The CMHA recommends increasing FY25 Medicaid rates to address the need for higher wages and provider rates for recruiting and retaining clinicians across various clinical disciplines. According to the CMHA, the current rates are based on outdated cost data and utilization patterns that don’t reflect recent wage increases or current service demands post-pandemic.

Section 928 - Local Match Draw Down: CMHA is advocating for a $5 million allocation from the general fund to continue phasing out the use of local/county dollars for Medicaid match purposes. This process should have been in its fourth year in FY24.

Certified Community Behavioral Health Clinics (CCBHC): They support the FY25 Executive Budget, which includes $193.3 million to expand the CCBHC program, add new sites, and enhance oversight.

Medicaid Inmate Exclusion Policy: The recommendation includes $30.5 million to initiate pre-release Medicaid services for incarcerated individuals to ensure medical coverage upon reentry into communities.

Administrative Burdens: CMHA proposes language to reduce administrative burdens, including waiver reviews and audits for fully accredited CMHs and provider organizations, addressing the inefficiency and redundancy currently plaguing the system.

Behavioral Health Accelerated Degree Program: They suggest $10 million in grants for individuals entering an accelerated social work degree program, promoting workforce growth in public behavioral health.

School Mental Health Funding: CMHA suggests that the $300 million allocated for student mental health and school safety should be used to collaborate with public mental health systems to prevent the workforce from draining from community providers to school districts.

Direct Care Wage Increase: There’s a significant emphasis on increasing wages for the state’s 50,000 direct care workers (DCWs) in the behavioral health system to ensure competitive living wages. This includes a recommendation to revise the “pass-through” wage model to allow more sustainable and equitable reimbursement rates.

These initiatives highlight CMHA's comprehensive approach to addressing the systemic challenges within Michigan's public mental health infrastructure, aiming to improve service delivery, workforce stability, and patient care across the state.

The testimony from last week’s appropriations hearings was TLDR (too long; didn’t read), so here is a summary.

In recent testimony to the Michigan House Health and Human Services Subcommittee, Matt Maskart, CEO of Pathways Community Mental Health, highlighted the severe workforce shortages and administrative burdens affecting rural mental health services. Pathways serving regions in and around Luce County face significant challenges due to sparse populations and distance from urban centers. About 10% of Pathways' clinical positions remain vacant, with some unfilled for over two years. This shortage has increased caseloads and staff burnout, exacerbated by a state budget shift toward school-based mental health services, which offer more attractive employment conditions. Maskart urged comprehensive investment in mental health services, reduced administrative burdens, and better wages for direct care workers to improve staff retention and recruitment.

Bradley P. Casemore, CEO of Southwest Michigan Behavioral Health, testified before the Michigan House Subcommittee on MDHHS Appropriations, highlighting the critical financial situation facing Prepaid Inpatient Health Plans (PIHP), which serve Michigan’s most vulnerable populations. Despite administering $4.2 billion annually across various programs, PIHPs are grappling with Medicaid financial shortfalls exacerbated by inflation and workforce shortages. Casemore emphasized that the fiscal year 2025 projections look dire, with several PIHPs facing negative margins, and advocated for accurate Medicaid rate adjustments and adequate appropriations to reflect expanded service needs. He stressed the need for continued support to avoid financial jeopardy in the public behavioral health system and urged consideration of PIHPs for administering opioid settlement funds.

Common Ground's Virtual Behavioral Health Urgent Care (BHUC) program in Michigan has shown promising results since its inception. Thanks to initial private funding, the program developed a robust technological platform and recruited expert clinical staff. Initially piloted on limited days and hours, the organization’s COO shared in testimony that the program has successfully served thousands across the state, providing timely and accessible virtual mental health services. The need for such services was notably emphasized following mass violence events in Oxford and East Lansing, where local demands overwhelmed existing services. Common Ground seeks additional funding to expand BHUC's operations, enhance staff training, and increase public awareness. This investment aims to establish a sustainable model that integrates with State-Sanctioned Crisis Services and expands coverage beyond its current regions.

The Michigan Behavioral Health and Wellness Collaborative testified before the subcommittee, stressing the need to address Michigan's mental health crisis exacerbated by the pandemic by highlighting the significant workforce shortages and barriers to care that hinder service delivery. The Collaborative also advocated expanding Certified Community Behavioral Health Clinics, revising the Conflict-Free Access & Planning policy, increasing workforce funding, and improving coordination and care accessibility. Their testimony emphasized the urgency of systemic changes to ensure comprehensive and accessible mental health services for all Michiganders.

In testimony provided in Lansing earlier this month, The Michigan Association of Substance Addiction Providers (MIASAP) emphasized the urgent need for a unified response to the opioid crisis in Michigan. Representing the collective voice of SUD professionals, MIASAP highlighted the crisis as a pervasive threat affecting all Michiganders. With Wayne County at the center, Michigan has faced soaring overdose rates, reaching over 3,000 drug overdose deaths in 2021 alone. MIASAP’s "Recovery for All" initiative advocates for inclusive, comprehensive addiction services, from prevention to sustainable recovery. The testimony stressed the critical need for strategic allocation of opioid settlement funds to enhance the substance use disorder workforce, remove barriers to care, foster local government collaboration, and build sustainable recovery systems. Despite the availability of settlement funds, their current deployment is not always aligned with the settlement agreement, prompting MIASAP to call for funds to support systemic changes to combat the epidemic effectively.

The State of Michigan is being urged to maintain funding for the Foster Care Disability Navigation program, which has significantly aided students in foster care with disabilities. A proposal for a $1 million annual appropriation to The Arc Michigan for the next three years aims to sustain vital navigation services and educational case management. The request aligns with recommendations from various state workgroups and highlights the program's impact, including potential boosts in graduation rates and economic outcomes. With more than 7,000 foster care children in Michigan identified as having disabilities, continued funding is seen as crucial for addressing educational disparities and supporting this vulnerable population. Learn more from testimony given by The Arc.

A proposal for a Northern Michigan Mental Health Campus aims to alleviate the severe shortage of psychiatric services by providing youth and adult inpatient beds, IOP, and PHP in Northern MI and the UP. The campus will offer essential mental health care, reduce pressure on downstate facilities, and improve community well-being. Facilities include separate areas for justice-involved youth and potential accommodations for families.

The Heart of the City Development Center in Saginaw County proposed an Adult Day Support Center for individuals aged 26+ with Intellectual and Developmental Disabilities (IDD). The center aims to enhance well-being through vocational training, life skills, social engagement, and peer support. Serving a population where 20.4% are disabled, the center addresses a critical need for specialized services, promoting independence and community inclusion. Programs will also support caregivers, fostering a comprehensive community impact.

Senators Casey, Kaine, Baldwin, and Congresswoman Dingell introduced the Long-Term Care Workforce Support Act on April 15, 2024. This legislation aims to address the crisis in the direct care workforce, which is currently underpaid and understaffed, leading to high turnover rates. The Act proposes increasing wages, improving access to paid benefits, providing mental health support, and offering direct care workers educational and career advancement opportunities. This initiative seeks to stabilize and grow the workforce, ensuring safe working conditions and fair compensation for the 4.8 million workers assisting over 13 million people, including the disabled and elderly. Learn more about the Long Term Care Workforce Support Act here.  *Source DirectCareWage Coalition

Additional Resources: 

In recent special elections, Democrats in the House regained their full majority status, marking a significant political shift. Mai Xiong and Peter Herzberg secured their seats in Michigan's state legislature, ending a previous 54-54 split between parties. Xiong notably triumphed in the 13th District with an overwhelming 77.6% of the vote, and Herzberg clinched the 25th District with 59.5%.

Michigan's MDHHS and Community Mental Health Association, in partnership with CADCA, are accepting applications for the Opioid Coalition Academy (OCA). This three-week program trains community coalitions on implementing substance use disorder strategies, with a focus on prevention, harm reduction, treatment, and recovery. The first cohort starts July 29 in Mount Pleasant, with a $50 fee and major costs covered by funding. The training opportunity is being hosted by the Michigan Department of Health and Human Services Substance Use, Gambling and Epidemiology Section and Community Mental Health Association of Michigan, in partnership with the CADCA (a premier prevention association equipping coalitions with tools, knowledge, and support to create positive change in communities). The deadline to apply is May 6. For more details, contact Madison Watts at [email protected]. More information regarding the training opportunity is available in the application . See the Final_CADCA_Application.docx.

To bolster student well-being, the Michigan Senate has proposed an increased investment in mental health resources within the $20.3 billion PreK-12 education budget for Fiscal Year 2025, outlined in Senate Bill 751 (SB 751). This legislation, led by Sen. Darrin Camilleri, earmarks an additional $150 million specifically for mental health and school safety initiatives. Notably, $50 million of this allocation is an ongoing investment to sustain these critical school services.

SB 751's focus on mental health reflects a growing recognition of the importance of providing students with robust support systems. This initiative builds on previous efforts by continuing the one-time per-pupil mental health grants established in the prior fiscal year. The bill mandates that at least half of each district's grant must be dedicated to enhancing student mental health services. This ensures that funds are channeled explicitly to areas directly impacting students' emotional and psychological well-being.

This legislative commitment aims to create safer and more supportive educational environments across Michigan, allowing schools to meet their student populations' diverse needs better.

National Council for Mental Wellbeing Hill Day June 5-6

WEBINAR: MDHHS will explore the new policy providing reimbursements through Medicaid. Timothy McNeill from Freedmen's Health consulting firm will cover the recent policy changes to reimbursements through Medicare. Learn about the ins and outs of payment changes and how they work for social and healthcare providers and communities.

CHWs are valuable resources for health in communities across our state, linking residents with vital resources, information, and connections to care. These new policies provide an opportunity to expand services to improve health in various ways.  

In our second webinar later this fall, we'll hear directly from CHWs on how the policies work in different care settings and learn about their experience with implementation and reimbursements.

Register to join us on May 2 by clicking the link below. Questions? Contact Grace Brooks at [email protected].

What: CHW Payment Policy for Medicaid and Medicare 
When: Thursday, May 2, 2024, 10:00 - 11:30 a.m.
Where: Zoom 
Who: Health Fund grantees, care providers, and care communities
Register: Health Fund

Registration is now open for the Michigan League for Public Policy’s 2024 Public Policy Forum at the Lansing Center on April 15, 2024. This year's theme, "Economic Justice for All," promises insightful discussions on public health improvement and eradicating social and economic injustices, featuring keynote speakers Dr. Mona Hanna-Attisha and Dr. Luke Shaefer. A panel moderated by Zoe Clark, with experts including Linh Song, Kim Trent, and Aditi Shrivastava, will explore cash's role in alleviating poverty and enhancing children's outcomes. Open to a broad audience, from policymakers to community members, this free forum aims to forge a bold path for economic justice in Michigan. Register here.

The Michigan Health Policy Forum (Michigan State University) is set to present its Spring 2024 Forum titled "Breaking Barriers, Building Bridges: Unleashing Innovation in Behavioral Health Care" on Monday, May 20, 2024, from 1:00 to 4:30 PM. An optional networking luncheon will precede the event from 12:00 to 1:00 PM. This in-person event will take place at Lansing Community College West Campus, 5708 Cornerstone Drive, Lansing, MI, offering free parking and limiting in-person attendance to 125 people. Registration for the luncheon requires a fee of $15.00, and attendees must register individually with their name and email. For those unable to attend in person, a livestream option will be available without registration, with the link to be distributed later. Further details, including the agenda and speaker information, can be found on their website at michiganhpf.msu.edu. For inquiries, contact [email protected].

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If you have an event you want to share, please get in touch with Daniel Cherrin.