A Closer Look at the Governor’s FY 2015 Budget for the Department of Community Health

Full report in PDF

The governor’s budget recommends total funding for DCH of $17.4 billion, including $2.9 billion in state General Fund dollars, an increase of approximately 3% over the current year adjusted appropriation of $16.9 billion. The bulk of the funding is for the state’s Medicaid and Healthy Michigan Plan programs (74%), followed by mental health and substance use disorder services (18%).

The budget for the Department of Community Health is the state’s largest, growing by over 60% between Fiscal Years 2005 and 2014. Of note, is that the state General Fund investment has only increased 13% over the FY 2005 appropriation. This year, federal funds make up nearly 69% of the DCH budget.

The FY 15 budget includes many positive recommendations including full-year funding for the Healthy Michigan Plan, continued expansion of Healthy Kids Dental, continuation of half of the primary care rate increase, funding to begin implementation of the Mental Health and Wellness Commission recommendations, restoration of funding for senior meals and services, to name a few.

However, there have been troubling shortfalls identified in the Medicaid health plan services as well as in the public mental health system. Also troubling is the acknowledgement in the budget of the shortfall in the Health Insurance Claims Tax with no recommendation to resolve it. These funds are used to match federal funds to provide Medicaid services.

In addition, we continue to be concerned about the practice of taking ongoing program funding and arbitrarily reclassifying all or part of it as “one-time” funding as has been done with graduate medical education and several other programs over the last several years.

Details on specific Executive Budget recommendations follow:

Medicaid: Approximately one in every five Michigan residents is enrolled in Medicaid for their healthcare coverage, and more than half of all births in the state are paid for by the program. In each of the last three years, half of the children in the state have been covered by Medicaid as child poverty in Michigan continues to increase. In the current fiscal year, the governor projects that 1.82 million Michigan residents will be covered by Medicaid, with an additional 214,000 benefiting from the implementation of the Healthy Michigan Plan that will take effect on April 1.

  • The governor’s budget for 2015 recognizes state General Fund savings of over $243 million as a result of federal approval of Michigan’s waiver to expand Medicaid through the Healthy Michigan Plan effective April 1, 2014. The savings are realized because the state currently spends 100% state General Funds for limited services to very low-income uninsured individuals, and with the expansion, federal funds would be available to pay for services for this population. The governor recommends that half of the savings, or $122 million, be placed in a newly created Health Savings Fund that would ensure that the state has sufficient funds to cover the future reductions in federal matching funds. Healthy Michigan Plan funding is 100% federal funding for calendar years 2014, 2015, and 2016. The federal funding declines during calendar years 2017- 2019, reaching 90% in 2020 where it remains.
  • The Healthy Michigan Plan, championed by Gov. Snyder, will provide comprehensive health coverage to about 400,000 currently uninsured people in the state through 2015, nearly doubling the projected enrollment for FY 14. This comprehensive program covers individuals with incomes up to 133% of the federal poverty level. Full-year funding of $2.2 billion, all federal funds, is recommended. A staffing increase of 36 positions is included to administer the program.
  • The governor recommends $25.2 million for autism services, down from $35.2 million this year. The funding reduction does not represent a program reduction rather it represents a slow start due to the need to develop provider capacity. To increase needed capacity, $3 million in continuing “one-time” funding, increased from $2 million in the current fiscal year, is recommended to train autism services providers through the creation of university autism centers. One million dollars each is allocated to Eastern Michigan University, Western Michigan University and Michigan State University.
  • Funding of $26 million in state funds, bringing in $49.4 million in federal funds, is recommended to continue approximately half of the rate increase for primary care providers. This rate increase, required in FY 13 and FY 14, was 100% federally funded for the first two calendar years. In calendar year 2015, the rate increase is no longer required or 100% federally funded, so a state investment is required to continue.
  • The special payment for rural and sole community hospitals is recommended for elimination. It was classified as “one-time” funding in FY 12, but converted to ongoing funding for FY 13 and FY 14.

Healthy Kids Dental: Michigan currently provides enhanced dental services to more than 500,000 children in 78 counties. Access to dental services is essential to prevent tooth decay, the number one chronic disease in children.

  • The governor recommends $5.4 million in state General Fund and $10.3 million in federal funds to expand the Healthy Kids Dental program to an additional 100,000 children in Kalamazoo and Macomb counties. With that expansion, the program would cover over 611,000 children in 80 of 83 Michigan counties.
  • Not yet covered are more than 400,000 children in three of the most populated Michigan counties that are the home to many low-income children and children of color, including Wayne, Oakland and Kent counties. Healthy Kids Dental improves access to care by partnering with Delta Dental of Michigan to increase provider reimbursement rates and simplify administration.

Mental Health and Substance Abuse Services: Since Fiscal Year 2005, Medicaid-related mental health spending has increased by over 50%, while non-Medicaid spending has decreased, leaving thousands of residents without needed services. Funding for substance use disorder services increased by 12%, largely because of increases in federal funding, but fewer individuals were served in FY 13 than in the previous nine years, despite the growing problem with heroin/other opiates addiction.

  • With the expansion of Medicaid eligibility, individuals enrolled in the Healthy Michigan Plan will also have access to comprehensive mental health and substance use disorder services. As mentioned above, great concern has been raised about the adequacy of the funding to provide the promised services.
  • The governor also recommends $15.6 million in state General Fund, $5 million of which is “one-time” funding, to begin implementation of the recommendations of the Mental Health and Wellness Commission, which released its recommendations for improvements in mental health services in January 2014.
  • The governor recommended $3.4 million in state General Fund for the Mental Health Diversion Council to treat those with mental illness or developmental disabilities in settings other than the criminal justice system. Additional funding of $2.7 million is included in the Judiciary and Corrections budgets.

Public Health and Children’s Services: Nearly two of every three dollars spent on public health services is federal. Over the last decade, nearly all increases in total public health funding have been from federal grants or other sources, while state funding has remained essentially flat.

  • The governor recommends continuation funding of $39.4 million for local public health services. Appropriations for local public health essential services, while increased by $2 million in FY 2014, remain below the Fiscal Year 2005 appropriation.
  •  The governor includes $2.5 million in state funds to conduct a regional needs assessment and expand home visiting services to at-risk families with young children in rural areas in the Upper Peninsula and Northern Lower Peninsula.
  • The proposed budget includes $2 million in “one-time” funding for a pilot program to improve child and adolescent health services by working with two existing school-based clinics to identify satellite locations that will be serviced by mobile teams, increasing access to nursing and behavioral health services in schools.
  • The essential health provider program was increased by $600,000 to reflect the projected additional private revenue. This program assists primary care providers who practice in medically underserved areas with the repayment of their educational loans.
  • After three years of “one-time” funding, island (Bois Blanc, Mackinac, Beaver, and Drummond) health clinic funding was converted to ongoing.

Services for the Aging:

  • The governor’s budget includes $5 million in state funds to help eliminate a waiting list of an estimated 4,500 seniors eligible for home-delivered meals ($1.8 million) and in-home services ($3.2 million) provided through Area Agencies on Aging around the state. With this increase in home-delivered meals, the reductions in funding over the last decade have been completely restored.
  • The governor also expands funding by $9 million in state funds, $17.2 million in federal funds to eliminate the waiting list for the MIChoice program that provides in-home and community services to help seniors or those with disabilities remain in their homes rather than moving to nursing homes, serving an additional 1,250 individuals.
  • The governor recommends the expansion of PACE (Programs for All-Inclusive Care for the Elderly) to more counties, funded through corresponding savings in nursing home costs.