As a result of a practice called “Medicaid Rebase” or “Medicaid Redistribution,” Macomb County Community Mental Health (MCCMH) has lost more than $37 million in Medicaid funding since fiscal year 2016.
The reduction is the result of a policy by the Michigan Department of Health and Human Services to redistribute Medicaid funds away from densely populated area like Macomb County and bring more funding to the west side of the state and rural areas in the northern part of the state.
Bruce Dutton is the manager of a Warren facility called Clubhouse Michigan, one of 47 such facilities in the state that provides training, acceptance and other services for adults with mental health issues. He sees the affects of the reduced funding through his work with individuals who are mentally ill. Clubhouse members are asked to assist with chores around the facility.
One day, while Dutton was helping clean the bathrooms with a clubhouse member, the subject turned to politics. The member confessed to Dutton that she had not voted in the last two state election cycles.
When Dutton asked the member why she had not voted, her reply was “because we don’t matter.”
In a society that quite often pushes the plight of the mentally ill aside, Macomb County has been pushed to a corner on the far side of the room. A cornered animal has but two choices: to give up or to fight back. MCCMH has chosen to fight back.
MCCMH Executive Director John Kinch played host to a Legislator’s Breakfast Educational Forum and Discussion Friday morning at the Community Care Center in Sterling Heights and outlined some of the battles the organization is and will be facing.
He praised the Macomb County delegation of state senators and representatives for helping restore $5 million of lost Medicaid in 2017.
He is asking for the state to return an additional $7.5 million in the 2019 state budget. That would be just enough to maintain a fund equity that would allow the MCCMH to maintain its contract with the state and be able to continue administering mental health services to the community.
“We have been reduced in the number of dollars, not because of the delivery of services but because of Medicaid redistribution,” he said. “A number of our dollars in Macomb County have been redistributed to the west side of the state and northern Michigan. In the process, we have lost around $37 million. Seventeen percent of our Medicaid dollars have been removed from our budget from 2016-17. That’s why were asking for the $7.5 million, to help restore those dollars.”
The total budget for MCCMH has dropped from more than $208 million in 2015 to a projected budget of just under $169 million in 2018.
The result was the need to reduce or eliminate millions of units of community based services, particularly those most vulnerable people in intellectual and developmental disabilities.
Yet in Macomb County, for the past 15 years there has been a steady increase in the number of children, adolescents and adults who have enrolled in Medicaid. Add to that the increased number of people with both mental illness and substance abuse disorders and those who die of drug overdoses who leave behind the collateral damage of orphaned children.
In an attempt to find and divide federal mental health money at the state level, Kinch revealed what he called a migration of reimbursement away from the more expensive programs. It is another reason why the county is losing money. Medicaid programs are broken down into three categories:
DAB: Disabled, aged and blind
HMP: Health Michigan Plan
TANF: Temporary assistance for Needy Families
MCCMH receives a monthly Medicaid capitation payment from the state Department of Health and Human Services. The amount of the capitation payment is based upon the number of Medicaid-eligible consumers in those three programs. The state has an actuary that calculates the rates for each based upon age, gender, geography and other factors.
In 2017, the state reimbursed for DAB clients an average of $253.97 per month per fiscal year, $15.54 for HMP clients and $8.05 for TANF clients. Since 2015, analysis has shown a decreasing number of DAB eligibles while showing an increase in HMP and TANF eligibles.
The changes are made when mental health clients in Macomb County reapply for services each year. Depending upon how they fill out the form, their status may change. The client isn’t aware of the changes because their services don’t change, only the formula to reimburse the county changes. Due to the eligibility movement out of DAB, it is calculated that MCCMH lost $5.1 million in revenue over a three-year period from 2015 through 2017. For fiscal year 2018, MCCMH is projecting a loss of $3.3 million in revenue due to the eligibility movement out of DAB.
“What the state is doing is trying to find money, so they’re doing the reclassification. It’s a shell game,” Congressman Sander Levin, who attended the breakfast, said. “The state isn’t stepping up to its responsibilities.”
Marilyn Lane of the Macomb County Executive’s Office said it is the county’s responsibility to work with local state representatives and senators and to vote no on the upcoming budget if it doesn’t include increased funding for the MCCMH.
State Rep. Jeff Yaroch, who represents the 33rd District, said the message was heard loud and clear.
“We understand, we get it. But we are 10 against 110 (Macomb County state representatives versus the rest of the state),” he said. “We need to fight to get our money back. In Macomb, we’re fighting to get our money back.”