Another year, another round of changes for Medicaid’s funding of mental health treatment.
Such has been the story for years now in Michigan. The reason goes back to a “rebasing” process enacted in 2010 as a way to balance the distribution of Medicaid for mental health services throughout the state. But critics, including patients themselves,1 say the budget changes have created uncertainty and in some cases left struggling individuals without critical care.2
Robert Sheehan is the CEO of the Michigan Association of Community Mental Health Boards, an advocacy group and trade association comprised of mental health organizations. He says he agrees with ensuring equitable funding throughout the state. It’s harder for him to support pulling funding from those in need.
“The approach is ‘cut the mountain to fill the valley,'” he told Skywood in this exclusive interview. “The problem with that is even the better funded communities don’t have enough money.” The result is the revocation of critical care for patients in regions that previously had higher-than-average funding.
Among those to feel the direct impact of this funding shift is Washtenaw County’s Liz Orvis. In 2015, the then 32-year-old was battling suicidal thoughts when she discovered she was one of 230 people across the county losing access to public mental health services that year.5
The result was debilitating.
“I was just about to start a new therapy group, and there were some great things happening. But more than anything, it’s taken away my independence. I am still able to function, but I now rely a lot on my mother. She pays for my doctor visits and helps me set up my medicine every week.”6
All the way across the state in Ottawa County, J.R. Robinson was dealing with similar setbacks.7 He is in his early 50s and struggles with bipolar disorder, a condition characterized by alternating states of depression and elation.8 Following a series of budget cuts in his county, he, too, was left without the care he’d come to rely on.
“It kept me from isolating; it kept me from drinking,” he said of classes he used to attend at the Community Mental Health of Ottowa County. Now, he said, “I’m struggling every day.”9
Of the state’s 10 regional entities responsible for managing mental health funding passed on by the state, none are feeling the fallout of this year’s shakeup more than Macomb County Community Health Authority. As of April 1, the agency will be working with a full $12.4 million less in its Medicaid budget.3
On the administration side, this has resulted in a “soft hiring practice” even in the face of more than 50 vacancies. Meanwhile, the cut has been absorbed by roughly 30 percent of Macomb’s services, including those for substance abuse disorders.4
What all of this points to is a need to “raise the valleys to the peaks,” rather than force the two to meet in the middle, said Robert Sheehan. All told, he and his colleagues estimate it would take a $25 million increase in Michigan’s Medicaid budget to make that happen. It’s a hefty chunk of money. But as Sheehan pointed out, Michigan would only be responsible for some $8 million, with the federal government covering the rest of the tab. Even still, Sheehan said “it’s a tough upward battle” in a state still struggling to ensure safe drinking water for all its citizens. The solution? “We have to change the revenue picture by changing the tax structure,” Sheehan told Skywood. In other words, the budget for mental health won’t increase until the tax revenue does.
If there’s one thing that hasn’t changed, it’s the relationship between public and private treatment centers in providing care for individuals throughout the state. “Michigan has a really good mix of private and public providers,” Sheehan said, adding it’s not that one is better than the other or that one treats something the other doesn’t. “Both do a good job.” Rather, he said it often comes down to a matter of location for clients, and what is most convenient for them.
That said, there is one possibility for privatization that worries Sheehan. And that is Governor Rick Snyder’s proposal to privatize the management of the budget allotted for treating mental health. Proposed in February of 2016, the idea appeared once again in the budget bill currently under debate. “Who holds the purse strings, who is seen–those are decisions we believe should come from the public sector.”
Written by Tamarra Kemsley