House and Senate healthcare budgets: A mixed bag for families and children

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May 2017
Emily Schwarzkopf, Policy Analyst

Budget Brief JPG USE THIS ONEWith much attention being paid to healthcare at the national level as Congress and President Donald Trump continue to debate the fate of the Affordable Care Act, it is important to continue to focus on investments in healthcare right here in Michigan as final decisions are being made on the 2018 state budget.

HEALTHCARE FOR 650,000 MICHIGANIANS

Healthy Michigan Plan: The Legislature has continued to fund the highly successful Healthy Michigan Plan which went into effect in 2014. Currently, over 650,000 Michiganians receive robust coverage and services through this program. The continuation of the Healthy Michigan Plan is critical for residents and the state’s economy. Sixty percent of Healthy Michigan enrollees report that their ability to access primary care was better than prior to being enrolled, and 70% stated that they were more likely to contact a primary care provider before going to the emergency room. Eighty-six percent of enrollees have reported that their ability to pay their medical bills has improved since being enrolled in the program.

BB 2018 healthcare budget graphic 1For 2018, the governor has recommended continued funding through federal funds and required state matching funds to support the program.

  • The Senate and House agree to continue funding the program with federal and state funds.

The League supports adequate funding to support the Healthy Michigan Plan in the 2017-2018 budget year and beyond.

BEHAVIORAL HEALTH

Direct Care Worker Wages: The governor recommended funding that would result in wage increases for direct care workers who provide services through the state’s community mental health services. For 2018, the governor requested a total of $45 million to provide a 50-cent per-hour increase. The request for this increase follows a report that highlighted the challenges of recruiting and retaining direct care staff. The report found that wages for direct care staff were uncompetitive compared to entry-level wages in other similar occupations.

  • The Senate recommends the 50-cent increase, but delays its implementation by six months.
  • The House recommends a per-hour increase of 25 cents.

Behavioral Health Integration: One of the hotly contested issues in the Department of Health and Human Services budget continues to revolve around budget language (Section 298) that was placed in the current-year budget calling for the integration of behavioral and physical health. Last year, a workgroup was created to discuss and look for ways to improve the coordination of physical and behavioral health. The workgroup was tasked with submitting two reports to the Legislature that outlined policy recommendations, recommendations for financing models and benchmarks for implementation. The final report was not due until after the governor’s 2018 budget proposal was released, so the governor recommended continued conversations on how to coordinate services while maintaining the core values adopted by the workgroup.

  • The Senate includes additional boilerplate (Section 234) along with making changes to boilerplate Section 298. The Senate recommendation calls for continued improvement in the system but also an unspecified number of pilot projects. There is legislative intent that calls for a move toward a single contracting model by September 30, 2020.
  • The House includes authorization for three pilot studies to test financial integration between Medicaid health maintenance organizations and behavioral health providers. The language requires the department to provide a report on the timetable and plan for full integration.

The League continues to monitor the progress and conversations regarding integration of physical and behavioral health services. As participants in the 298 workgroup, it is our belief that any action should continue to follow the core values and benchmarks as established. It is also the League’s position that we continue to work to provide competitive wages for all individuals, especially those providing critical services to our state’s most vulnerable residents.

PUBLIC HEALTH

Flint Water Crisis: The Legislature has been providing funding to address the health and safety concerns as a result of the Flint water crisis. For budget year 2018, the governor recommended $13.4 million total for food and nutrition services, health services at child and adolescent health centers, water filter cartridges and replacements, and other services.

  • The Senate supports the governor’s recommendation and additionally includes funding for the double-up food bucks program and additional water testing by the Genesee County Health Department.
  • The House agrees with the governor to continue to support the ongoing crisis response and recovery in Flint.

Lead Poisoning Elimination Recommendations: The Childhood Lead Poisoning Elimination Board, created in 2016, reported 80 recommendations. The governor included $2 million to begin implementation of these recommendations.

  • The Senate reduces the funding for implementation of these recommendations to $100—a placeholder to ensure continued discussions in the joint House/Senate conference committee.
  • The House allocates $500,000 in funding to begin implementation of the board’s recommendations.

The League is supportive of additional funding to address the concerns surrounding the Flint water crisis and continues to advocate for increased investments in our cities and policy changes that will ensure this does not happen in any other Michigan city.

SERVICES FOR SENIORS

In-Home Services: With our aging population, proper investments are needed to ensure that we continue to care for them. In order to address waiting lists, the governor proposed an increase of $2.1 million for in-home services.

  • The Senate agrees with the governor and increases the funding for in-home services to eliminate waiting lists.
  • The House recommendation does include an increase, but totaling only $1 million.

Meals on Wheels: With potential threats to grants that fund Meals on Wheels programs coming from the recent release of the federal administration’s “skinny” budget, it is important that as a state, we support efforts to provide meals to seniors. In order to address the growing waiting list, the governor asked for $1.5 million.

  • The Senate supports the governor’s inclusion of $1.5 million for senior nutrition services.
  • The House reduces the amount of funding for this program, only providing $750,000 to support Meals on Wheels.

The League is supportive of additional funding for senior services to ensure that our aging population is able to live out their lives in the comfort of their own homes.