Written by × November 17, 2019
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 imbedded 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 Wednesday expected to be approved by the state Senate on Thursday.
The provisions include the long-term goal of privatizing behavioral health services for 350,000 Michigan residents with mental illness, substance use disorders, or intellectual or developmental disabilities. The plan would begin with four pilot projects as early as Oct. 1.
The pilots would allow health plans that have contracts with Michigan’s Medicaid program to provide behavioral health services, integrated with the physical health services they already provide. The 10 regional public bodies that currently control state behavioral health funds — distributing the money to local agencies and Community Mental Health organizations as they think best — would be reduced to four, and eventually eliminated if the system is privatized statewide.
Legislative supporters say the plan will save money by keeping patients healthier and out of emergency rooms, and by reducing administrative costs. Opponents argue that insurance companies have little experience with behavioral issues, and could try to cut corners to the detriment of patients.
State Sen. Mike Shirkey, R-Clarklake, chairman of the Senate Health Policy Committee and one of the plan’s top proponents, said Michigan needs to spend more on behavioral health services, but without increasing the strain on the state budget. This plan will save money on administration and physical health that can be used to beef up behavioral health services, he explained.
“We’re having to spend more money globally (on behavioral health), so we have to spend the money we’re currently spending better,” Shirkey said, adding the opioid epidemic has increased the demand for mental health and substance use treatment across the state.
“The goal isn’t to save money, period. The goal is to redirect money to more the behavioral/mental health side, and the only way to do that is to find those kind of savings on the physical health side, not bring in more money globally.”
Shirkey said integrating physical and behavioral health services will keep patients healthier and cut down on emergency room visits for avoidable problems, such as when patients stop taking their medication. The potential savings have not been estimated, he added.
“The health plans have highly refined systems, at least the good ones do, where they’re in direct and constant communication with their enrollees and have a very good chance of predicting when these things may be going south before they actually happen, thereby avoiding those (incidents) where things do get out of balance,” Shirkey noted.
How it works in Mich.
In a June 12 letter, 11 statewide mental health organizations asked Gov. Rick Snyder to veto the privatization language, in part because the proposal directly contradicts recommendations from three state-initiated reviews of the mental health system conducted since February 2016.
The first review was lead by Lt. Gov. Brian Calley, and involved more than 100 stakeholders including mental health providers, insurers and consumers. Town halls, called “affinity groups,” were then held across the state, attended by roughly 1,100 people including therapists, advocates, insurers and consumers. Nearly 70 percent were patients or their family members. A third review was conducted by a work group of insurers, providers and mental health advocates focused exclusively on the privatization issue.
All three groups recommended against privatization, in large part to preserve the local nature of behavioral health services.
“We know that recovery occurs in the communities and it’s important to keep access to and decisions regarding that care in the community,” said Deborah Garrett, who served on Calley’s committee. She’s the recovery communications director with REAL Michigan, a statewide, grassroots nonprofit for people recovering from substance use disorders.
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