Michigan’s behavioral health redesign should be reframed away from debates over governance and control and toward the core question of access to care. The real issue is whether the system can expand treatment capacity quickly enough to prevent crises from spilling into courts, hospitals, jails, and housing systems. There is a lot to talk about, so “Pull Up Your Chair & Let’s Start the Conversation”.

Reframing Michigan’s Behavioral Health Redesign

Last week I spoke with a district court judge who shared their frustration in how many cases before his court involve people with behavioral health conditions or substance use disorders. In many instances, the justice system is managing problems that are fundamentally about access to treatment and stabilization.

During a recent walk, I listened to the Get Connected podcast featuring Dr. Kenneth Rosenberg, author of Bedlam. Although recorded several years ago, the central point still holds when treatment systems fail, the consequences appear somewhere else.

That observation applies directly to Michigan’s current behavioral health redesign debate.

Over the past year, much of the discussion has focused on governance. Who holds the contract. Who manages Medicaid dollars. Who certifies providers. Who controls the system. These are legitimate policy questions with real implications. But they are not the most important ones.

The real issue should be about access to care and whether the system has the capacity to provide it.

When people cannot access treatment quickly enough, the consequences move across the public system. Courts see repeat cases driven by untreated illness and addiction. Emergency departments hold patients waiting for behavioral health placement. Police respond repeatedly to mental health crises. Jails house individuals who need treatment. Housing providers struggle to stabilize residents whose underlying conditions remain untreated.

Michigan’s behavioral health system operates through several layers. The Michigan Department of Health and Human Services (MDHHS) contracts with ten Prepaid Inpatient Health Plans (PIHP). Those PIHPs contract with Community Mental Health Service Programs (CMHSP), which then contract with the providers who deliver services. This structure creates a multi-layered gatekeeping system in which regional intermediaries control access to treatment, payment for services, provider network participation, and crisis response capacity.

Providers have raised concerns about how this system functions for years. They point to inconsistent access to care, administrative barriers, payment delays, and conflicts that arise when public entities compete with the very providers they regulate.

When access slows or provider capacity is constrained, the pressure does not remain inside the behavioral health system. It shifts to our courts, hospitals, first responders, jails, and streets. Judges see the same individuals cycling through their dockets. Emergency departments experience behavioral health boarding. Law enforcement responds repeatedly to crisis calls. Jails become de facto psychiatric facilities. Housing systems struggle to stabilize tenants without adequate treatment support.

These institutions did not create the problem. They are absorbing the consequences of it. For that reason, Michigan’s redesign debate should not simply be about governance. It should focus on whether the system can expand treatment capacity quickly enough to meet demand. If the system cannot scale, the consequences will continue to spill into courts, hospitals, jails, and housing systems across the state.

The better question is how Michigan builds the stabilization infrastructure it currently lacks.

That infrastructure includes crisis response systems such as mobile crisis teams, crisis stabilization centers, and coordinated use of the 988-crisis line. It includes justice diversion tools such as mental health courts, assisted outpatient treatment (listen to The Dr. Drew Podcast and his interview with Eric Smith on the value of AOT), and treatment alternatives to incarceration. It includes treatment capacity through Certified Community Behavioral Health Clinics (CCBHC) (see CCBHC stories below), outpatient and residential addiction treatment programs, and integrated behavioral health services. It also includes supportive and recovery housing that connects residents with treatment and recovery support.

None of these solutions work if the financing structure discourages provider participation or limits network growth. Providers are often described as vendors in the system. In reality, they represent the system’s treatment capacity. Community-based providers are the front line of care for people experiencing behavioral health crises, addiction, and recovery. When they cannot participate easily or sustainably, the system loses capacity.

The result is fewer treatment slots, longer wait times, and more crises spilling into courts, hospitals, jails, and housing systems. For policymakers, the practical question is, what changes would reduce the number of people cycling between courts, emergency departments, jails, and homelessness?

Working backward from these outcomes connects the redesign debate to real-world results.

When people cannot access treatment quickly enough, the consequences appear across the entire public system. Courts manage repeat cases driven by untreated illness and addiction. Emergency departments become holding areas for behavioral health crises. Police respond to mental health emergencies they were never trained to manage. County jails function as the state’s largest psychiatric facilities. Housing providers struggle to stabilize residents whose underlying conditions remain untreated.

Any discussion of reform should start with a clear objective: removing the barriers that prevent providers, courts, hospitals, and communities from working together to stabilize people before crisis becomes chronic.

Jason Jennings is an author of business books such as The Reinventors, Hit the Ground Running and Think Big, Act Small. He said,

It’s time to fix what broken, and if it’s not working, then let’s replace it.

House Panel Reviews CCBHC Demonstration During Medicaid and Behavioral Health Hearing

The House Appropriations Subcommittee on Medicaid and Behavioral Health last week heard testimony from state officials and behavioral health providers regarding Michigan’s Certified Community Behavioral Health Clinic (CCBHC) demonstration program.

Meghan Groen, chief deputy director of health services for the Michigan Department of Health and Human Services, provided an overview of the CCBHC demonstration program and responded to questions from committee members. According to the committee minutes, Groen agreed to provide additional information requested by lawmakers, including the process used to account for mild-to-moderate behavioral health services when determining capitated rates for managed care organizations, the proportion of CCBHC costs associated with crisis stabilization services and patient service metrics.

Provider representatives also testified regarding implementation of the model and its impact on behavioral health services. Julia Rupp, chief executive officer of West Michigan Community Mental Health, and Beth Ann Meints, administrator of clinical services at Kalamazoo Community Mental Health, presented testimony describing the role of community mental health agencies in the demonstration. Their presentation outlined how CCBHCs build on the existing public behavioral health system and expand access to services through partnerships with local providers. Presentation by Beth Ann Meints, Integrated Services of Kalamazoo and Julie Rupp, CEO West Michigan CMH.

Brent Wirth, president and chief executive officer of Easterseals MORC, testified that the CCBHC model has changed how behavioral health services are delivered and funded by allowing providers to deliver a broader set of integrated services under a prospective payment model. He told lawmakers that Easterseals MORC operates CCBHCs in Oakland and Macomb counties and serves more than 26,000 individuals annually. Easter Seals/MORC Presentation. Wirth said the CCBHC model has enabled the organization to expand access to care and increase the number of individuals served. According to testimony submitted to the committee, the number of individuals served through Easterseals MORC’s CCBHCs has increased by 97 percent since 2018. He also said the organization is currently conducting between 400 and 500 new intakes each month.

Wirth said the prospective payment system associated with the CCBHC model allows providers to invest in staffing, technology and service delivery infrastructure. He cited the organization’s use of a digital patient engagement platform designed to reduce missed appointments, which he said lowered no-show rates from 16 percent to 9 percent.

Juliana Harper, vice president of behavioral health programs at Easterseals MORC, and Jimmie Johnson also participated in the presentation and answered questions from the subcommittee regarding services delivered through the program.

Daniel Cherrin, representing the MI Care Council and the MI Behavioral Health & Wellness Collaborative, submitted written testimony to the subcommittee.

In his written statement, Cherrin said the CCBHC model expands access to integrated mental health and substance use disorder treatment, crisis services and coordinated care. His testimony noted that the model requires clinics to provide a comprehensive set of services and report standardized data on quality outcomes. MI Care Council and MI Behavioral Health & Wellness Collaborative

The subcommittee did not take action following the testimony. Chair VanWoerkom adjourned the meeting shortly before noon.

Medicaid and Behavioral Health Appropriations Subcommittee url, and meeting minutes

CCBHC Expansion and Certification Issues Surface in MDHHS Discussion

During a recent conversation with Michigan Department of Health and Human Services officials, behavioral health providers discussed several emerging issues related to Certified Community Behavioral Health Clinics (CCBHCs), including legislative expansion, sustainability of grant funding, rural access, and operational challenges within the model. MDHHS indicated that sustaining current CCBHC expansion grants will likely require legislative support and additional funding, and encouraged providers to help educate lawmakers about the value of the model as the Legislature considers future funding. The department also confirmed it is exploring ways to expand CCBHCs into rural communities and provide readiness support for organizations seeking certification. Providers raised concerns about protecting small and specialty providers that may not become CCBHCs, ongoing claim denials and billing issues in some regions, and certification barriers affecting crisis services delivered through Designated Collaborating Organizations. MDHHS said it is reviewing these issues and asked providers to continue sharing examples of operational challenges as the state evaluates potential policy and administrative responses.

There seems to be support for the CCBHC demonstration project to continue from providers, the Department, and PIHPs and CMHSPS. However, we previously wrote about OCHNs public opposition to CCBHCs when they announced their strategic plan. In their plan they saw CCBHCs as a threat. PUC, 9/1/2025.

Behavioral health is a major focus of many Rural Health Transformation Program (RHTP) proposals. This blog post highlights emerging trends in how states propose to use RHTP funds, including integrated care, crisis services, workforce investments, and technology solutions. It also offers considerations for how states can align these efforts with broader state policy strategies likely to shape rural mental health and substance use systems over the coming years. Source: NASHP.

Dive Deeper in this link to a March 3, 2026 MDHHS presentation to a House Committee on the Rural Health Transformation Program. Join the National Council for Mental Well Being on Tuesday, April 28, for Risks of Being Rural: Tailored Mental Health Resources for Rural Communities, a Breakout Session featuring leaders from The Cook Center for Human Connection.

For millions of Americans, the biggest barrier to mental health care isn’t stigma or cost. It’s that there simply aren’t enough providers. Last week, Inseparable released a new report showing just how severe the workforce shortage has become,  and what states can do to fix it.

Read here: The Workforce Report: Bridging the Mental Health Care Gap.

Here is a link to a snapshot of Michigan. According to the report,

 When people finally decide to seek help, they often face months-long waitlists, or discover there are no providers available at all. Their report outlines the steps states can take right now to strengthen the mental health workforce and expand access to care, including:

Partnering with Community-Based Organizations to Support Medicaid Beneficiary Advisory Councils

 Community-based organizations (CBOs) can play an important role in helping Medicaid agencies strengthen member input through the recently established Beneficiary Advisory Councils (BACs), which are required by the Centers for Medicare & Medicaid Services. Because CBOs have deep community ties, they can help engage Medicaid members in ways that agencies are often not equipped to do. Their expertise includes developing targeted outreach strategies, building BAC member capacity, facilitating effective meetings, and promoting long-term BAC sustainability. Learn more about CBOs from the Center for Health Care Strategies.

Campaign for Governor

Peer Legislation Moves in Congress

If passed by Congress, the Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act (H.R. 6841 / S. 3521) will work to help to grow the behavioral health workforce amid a massive shortage.  It would expand Medicare coverage of peer support services at community mental health centers, CCBHCs, FQHCs, and rural health clinics; Ensure that the nearly 8 million Medicare beneficiaries under age 65 living with disabilities can access peer support closer to home; and fill gaps in rural and underserved communities where professional mental health providers are scarce. This bipartisan legislation was introduced in the House by Reps. Judy Chu and Adrian Smith, with a companion bill in the Senate introduced by Sens. Catherine Cortez Masto and Bill Cassidy. Learn more from the National Council on Mental Wellbeing.

Openings

MDHHS director visits Hegira Health’s newly opened psychiatric
residential treatment facility and DWIHN’s Integrated Crisis Care
Campus slated to open this fall in southeast Michigan 

Michigan Department of Health and Human Services Director Elizabeth Hertel visited with officials at Hegira Health, Inc., and Detroit Wayne Integrated Health Network (DWIHN) today to discuss the state’s continuing commitment to expand access to behavioral health care. 

“Everyone deserves access to health care when and where they need it and at the level of care they need,” said Hertel. “The department has been working with community partners to ensure Michigan families have access to a variety of types and levels of behavioral health care, from community clinics to crisis stabilization units to residential treatment. By expanding care in communities, residents can get help sooner, allowing them to live safe and healthy lives.”  

Psychiatric residential treatment facilities 

Hegira offers a variety of services including The Treehouse, the state’s newest psychiatric residential treatment facility (PRTF) opened earlier this year; residential substance use disorder treatment; and a Certified Community Behavioral Health Clinic (CCBHC). CCBHCs are federally required to provide nine comprehensive behavioral health services, including 24/7 mobile crisis response and medication-assisted treatment for substance use disorders.  

Michigan has 35 CCBHCS in its Medicaid demonstration project, as well as several additional provider organizations currently receiving federal grant funding to establish clinics and provide CCBHC services. In FY 2024, 30 Medicaid-funded CCBHCs provided services to approximately 133,300 unique individuals across Michigan. Approximately 30% of individuals served were children and young adults ages 0 to 21, and 70% were adults.  

“We believe that prioritizing wellness is essential for individuals to reach their full potential. It is a source of pride and a significant responsibility for us to play an essential role in our community's health care landscape," said Carol Zuniga, president and CEO, Hegira Health Inc.  

Recent investments to create step-up and step-down facilities like CCBHCs, Crisis Stabilization Units (CSUs) and PRTFs relieve pressure on hospital emergency departments by expanding the number of beds for youth who need short-term crisis stabilization or residential treatment.   

Hegira’s PRTF is the fourth to open in the state and offers four beds for youth ages 9 to 17. PRTFs provide an environment that allows Medicaid-eligible youth to transition or step down from inpatient care services to community placement.  

Gov. Gretchen Whitmer’s FY 27 budget includes an $8.3 million investment for additional PRTFs in Grand Rapids, Lansing and Livonia that are expected to bring 50 new transitional beds online. 

Pine Rest and Hope Network DART offer two additional PRTFs in Grand Rapids. Catholic Charities of Ingham, Eaton and Clinton Counties recently opened a PRTF in Lansing that offers 36 beds serving youth ages 9 to17.  

For more information about PRTFs, visit Psychiatric Residential Treatment Facilities.  

DWIHN Integrated Crisis Care Campus 

As part of an effort to expand crisis care capacity and modernize behavioral health care in Wayne County, a $60 million budget appropriation was included in the FY 2023 budget for DWIHN to build a new Integrated Crisis Care Campus in Detroit.  

The facility is designed to meet a broad range of community behavioral health needs, including a trauma-informed, home-like environment for individuals in crisis. The campus will also bring physical health, dental and vision services together under one roof to better serve the community’s full range of health care needs. 

“The progress we’re seeing on this long-awaited, state-of-the-art health care facility reflects our commitment to expanding access to care,” said James E. White, DWIHN president and CEO. “Once completed, it will bring critical, integrated health services directly into the neighborhood. I couldn’t be more proud or excited to provide these much-needed resources.” 

The facility will offer walk-in crisis services designed to reduce reliance on emergency departments and a dedicated youth CSU to support children and adolescents in crisis.  

Michigan Public Act 402 of 2020 created CSUs to provide immediate support to anyone in a behavioral health crisis and are an alternative to emergency department and psychiatric inpatient admission for people who can be stabilized through treatment and recovery coaching within 72 hours.  For more information about behavioral health services in Michigan, visit the MDHHS website.   Source: Hegira and DWIHN NR.pdf

See also, Healthcare returning to Algonac schools with new clinic opening - Times Herald

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