Michigan begins to design 4 pilot projects to test mental health integration

Source: Jay Greene, Crain’s Detroit Business, August 4, 2017

What is going on at the Michigan health department about designing four pilot programs to test a controversial plan to combine physical and behavioral Medicaid services among mental health agencies, providers and HMOs? So far, nothing, at least on the selection and design of the pilots. … Section 298 is a controversial budget section that, under Snyder’s original plan put forth in early 2016, would have allowed some of the state’s health plans to manage the $2.6 billion Medicaid behavioral health system. The Medicaid HMOs already manage a nearly $9 billion physical health system. Over the past two years, Michigan’s 11 Medicaid health plans have lobbied legislators and the public to try a semi-privatized approach under Snyder’s plan, which was finally approved in June. … Republicans in Michigan want to test the concept in four pilot projects that everyone believes will be Kent County, an urban area like metro Detroit, a northern Michigan rural area and in western Michigan, which could include Kalamazoo County, sources tell me. Lori said the state has not received any formal suggestions for where the four pilots would be located. …


Plan to privatize Mich. mental health aid advances
Source: Karen Bouffard, Detroit News, June 20, 2017
The first step in a plan to turn control of Michigan’s $2.6 billion mental health budget over to privately owned insurance companies is poised for inclusion in next year’s state budget, despite a wall of opposition from mental health providers, patients and families across Michigan.  The contentious plan is embedded in two provisions of the state budget for the Department of Health and Human Services, part of the Omnibus Budget bill approved by the state House on Tuesday expected to be approved by the state Senate on Thursday. …

Lobbying ramp-up precedes mental health funding proposal
Source: Justin A. Hinkley, Lansing State Journal, April 27, 2017

Physical health insurers ramped up lobbying operations and far out-spent their behavioral health counterparts in the months before lawmakers pulled an about-face on who should manage billions of Medicaid dollars for mental health services. Community mental health groups and allied advocacy groups spent about $52,400 on lobbying in 2016, nearly $8,700 more than their average from the previous three years, state records show. That happened as they fought to maintain management of Medicaid money for behavioral health. However, lobbyists for the private insurers who currently manage Medicaid dollars for physical health spent a combined nearly $838,000 last year, about $21,000 more than their previous three years’ average as they seek to take over the mental health dollars. … That ramp-up happened as lawmakers and Gov. Rick Snyder’s administration changed positions on the Medicaid issue — to the benefit of the physical health insurers. In February 2016, Snyder called for the private health management organizations who oversee physical health spending to also take over mental health money by Oct. 1, 2016. Lawmakers denied that proposal and instead asked the administration to study the issue and make recommendations by spring 2017. The administration did that last month, changing its position from 2016 and calling for the two funds to remain under separate management. Last week, however, lawmakers in the Senate advanced a budget proposal that would give the mental health money to HMOs by 2020. …

Health chief Nick Lyon: I was responsible for budget language to shift mental health funding
Source: Jay Greene, Crain’s Detroit Business, October 27, 2016

Embattled Director Nick Lyon of the Michigan Department of Health and Human Services faced behavioral health leaders Tuesday and acknowledged he was the one who made the decision to insert controversial language that would have privatized mental health funding into Gov. Rick Snyder’s 2017 proposed budget earlier this year. The budget language, known as Section 298, called for the privatization of the $2.4 billion public mental health system under the management of managed care organizations that would contract with the state, ignited a firestorm of opposition among mental health officials, advocates, providers and families of the affected 300,000 patients and clients. While replaced this summer with more inclusive wording that requires the Department of Health and Human Services to issue a report with recommendations to the state Legislature in January on how to improve integration between the parallel physical and behavioral health systems, the Section 298 process created a rift and air of distrust and uncertainty between mental health officials and state government. …

Lessenberry: Privatizing Michigan health care
Source: Jack Lessenberry, Windsor Star, September 27, 2016

This is a story that hasn’t gotten major attention, but which is deeply worrying those who work with the mentally and developmentally disabled in Michigan: They fear the Snyder Administration wants to partly or totally privatize mental health services in the state. … The governor has long been a fan of privatizing services, and their fears mushroomed after an early draft of the governor’s fiscal 2017 budget called for privatizing the $2.4 billion public mental health system. That hasn’t happened yet. But the state does seem to be moving in that direction. Last month, a number of mental health advocates walked out of a meeting with state officials on how to coordinate mental health service services and payments. They had worked hard this spring to come up with a set of core values they believe need to be part of any new state proposal. … Hoyle said he wanted the state Department of Health and Human Services to commit in writing to support the core values they had agreed on in April, after a series of meetings between the advocates with Lt. Gov. Brian Calley. Though Calley is commonly regarded as being more conservative than Gov. Rick Snyder, he has an autistic daughter, and his participation was generally praised. However, Calley doesn’t control the legislature. The prison food scandal was bad enough. But far worse are the scandals at the now-privatized Detroit Medical Center, where the Detroit News reported last month that medical instruments are frequently filthy, and that doctors have attempted to operate with tubes clogged with old blood and bone fragments. … Additionally, he said, costs and recovery periods are much harder to quantify than, say, the average recovery time for a broken arm. “The conflict over whether to spend more dollars for a higher quality of life for the individual or provide less care for higher profits will always be present,” he said. Wayne County’s Watkins, who has a long background in government and politics as well as health care, doesn’t see privatization as necessarily an evil. “Much of the current community health system is private non-profit.” The danger, he said, lies in the threat “of a wholesale transfer of taxpayer dollars for mental health services to the private, profit making insurance companies.” …

Town hall meetings set on mental health funding, bid to privatize
Source: Christina Hall and John Wisely, Detroit Free Press, September 21, 2016

A series of town hall meetings about mental health funding and services in Michigan is kicking off Thursday, with the first of three meetings in metro Detroit to be held in Oakland County. Each event is to have a panel of state legislators from their respective counties to hear from advocates, community mental health leaders and citizens concerned about mental health reform. Other town halls are scheduled for venues in Macomb and Wayne counties. … Gov. Rick Snyder’s budget proposal earlier this year included language that was interpreted to allow for privatizing the administration of Medicaid spending on mental health. It later was withdrawn, but some patient advocates fear it will return in January when the Michigan Department of Health and Human Services is expected to report to the Legislature on proposals to reform the state’s mental health system. …

The price to privatize mental health care
Source: Jack Lessenberry, Michigan Public Radio, September 1, 2016

Six months ago, an early version of the governor’s next budget had so-called “boilerplate” language that appeared to do just that. According to an analysis by Crain’s Detroit Business, the budget “calls for privatizing the $2.4 billion public mental health system by turning over state funding to Medicaid HMOs.” This hasn’t happened yet. But a new policy is expected to be finalized this fall and presented to the legislature in January, and mental advocates are worried. …

Are Snyder’s proposed changes to the mental health care system good for Michigan?
Source: Ryan Grimes, Michigan Radio, March 29, 2016

So it’s understandable that the governor’s proposed budget for the new fiscal year has caught the collective attention of Michigan’s mental health community. Snyder is eyeing the state’s $2.4 billion mental health care system. He proposes turning a large part of the funding to Medicaid HMOs, the largest of which are for-profit. … Under the governor’s plan, Medicaid would go through HMOs rather than straight to community mental health departments. Fischer tells us it was suggested that the governor’s proposed plans would save over $200 million, but there’s some uncertainty as to how the Snyder administration arrived at that number. He says organizations like the Michigan Association of Community Mental Health Boards “have started to delve into that and say, we don’t see those savings.”

Snyder backs off mental health privatization
Source: Justin A Hinkley, Lansing State Journal, March 11, 2016

Eighteen days after one lawmaker called it “a nonstarter,” Gov. Rick Snyder’s administration has officially backed off a request to allow private health maintenance organizations to manage public mental health dollars. Lt. Gov. Brian Calley said in a statement Friday that language in Snyder’s fiscal 2017 budget request calling for the shift “needs to be replaced.” As reported by the State Journal on Feb. 23, Calley said Friday he’d convened a work group of representatives from both sides of the issue to develop new budget language over the next two months. … In his statement, Calley said he’d asked the Community Mental Health Association, the HMOs and others to come up with language that would send more money to direct services and better integrate the two types of care.

Proposed state budget would result in mental health care privatization
Source: Paul Kampe, The Daily Tribune, February 24, 2016

A proposed 2017 budget recently delivered by Gov. Rick Snyder could result in the privatization of the state’s community mental health system and the largest cut to the system in the state’s history, according to local mental health officials. “Boilerplate” 298 would create a so-called “carve-in” system with for-profit Medicaid health plans. The transfer of responsibilities currently held by the public health system to for-profit Medicaid health plans could result in a $300 million reduction in behavioral health services, according to Oakland County mental health care officials. The change, which would affect approximately 300,000 Michigan residents, would take effect in late-2017.

Official: Snyder not privatizing mental health

Source: Justin A Hinkley, Lansing State Journal, February 18, 2016
An administration official sought to assure lawmakers on Thursday that Gov. Rick Snyder is not pushing to privatize state mental health services. In what state Rep. Rob VerHeulen, R-Walker, said “contemplates a major shift,” the governor in his 2017 budget proposal called for shifting management of Medicaid dollars for mental health, substance abuse and developmental disabilities from groups of public community mental health organizations called Prepaid Inpatient Health Plans, or PIHPs, to private health management organizations, or HMOs. The move was quickly criticized by community mental health groups as a bid to send public health care dollars to profit-driven companies.