Census numbers tell of stagnancy and slow recovery

Today is the big day that comes each year: the release of American Community Survey figures on income and poverty.

Ready for some numbers?

Michigan’s household median income in 2013 ($48,273) was a bit higher than in 2012, but is nearly $1,000 lower than in 2009. The income bracket that grew the largest from 2009 to 2013 was the share of Michigan households who make under $10,000 a year. The only other income bracket with a significant share increase was households making more than $200,000 a year. These numbers taken together suggest that the slow economic recovery in Michigan is primarily benefiting those at higher incomes. (more…)

Back to school: Are children ready to learn?

For children to succeed in school, they must go to school “ready to learn” –  rested, fed and healthy. But how many children will start the school year with a toothache or other dental problem?

According to the Department of Community Health’s 2011 -2012 Count Your Smiles survey, the number is likely pretty high. (more…)

Healthy Michigan plan enrollment tops 275,000

Enrollment in the Healthy Michigan Plan as of June 2 totals 276,622. This is truly remarkable considering the program was implemented just over two months ago on April 1. Genesee County, at 98.5%, has enrolled the highest percentage of those potentially eligible. What a great achievement.

The Healthy Michigan Plan is Michigan’s unique Medicaid expansion plan. It provides comprehensive healthcare coverage to Michigan’s low-income uninsured residents. To be eligible for the program, an individual must be between the ages of 19 and 64, not currently eligible for Medicaid or Medicare, a citizen or lawfully admitted to the U.S., and have income less than 133% of the federal poverty level (up to $15,521 for an individual or $31,721 for a family of four).

Application for the program can be made by phone (1-855-789-5610), online at www.michigan.gov/mibridges, or in person at a local Department of Human Services office. Applications made through the on-line system can have eligibility determined in a matter of minutes and sometimes even seconds. (more…)

Healthy Michigan Plan gets healthy start!

The Healthy Michigan Plan, Michigan’s Medicaid expansion, opened for enrollment on April 1, and within the first 72 hours, 36,329 applications were submitted through the MIBridges website and 20,995 were approved for coverage. By Tuesday, the number of enrolled shot up to 59,280 — an amazing number for a two-week period.  That means that more than 109,000 people are now covered, including those who were transferred over to the plan from the Adult Benefits Waiver program.

The program is off to a great start — great news for Michigan’s low-income uninsured. The online enrollment system is working well with the majority of applications being processed in a matter of minutes or even seconds. (more…)

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.

Healthy Michigan Plan enrollment opens April 1

The Department of Community Health has announced open enrollment will begin for the Healthy Michigan Plan on April 1. This long-awaited announcement is great news for Michigan’s low-income uninsured residents.

Starting next week, adults (ages 19-64) in families with incomes below 133% of the federal poverty level (up to $15,521 for an individual or $31,721 for a family of four) who are not currently eligible for Medicaid or Medicare, and not pregnant, will be able to apply for the comprehensive coverage offered by the Healthy Michigan Plan. Citizenship, or lawful admittance to the U.S., is also required. (more…)

MI exceeds healthcare enrollment target

Enrollment in healthcare plans under the Affordable Care Act is picking up steam, particularly in Michigan.

Nationwide, more than 4 million people have enrolled in healthcare coverage through a state-operated exchange or the federal Marketplace through Feb. 26. And in Michigan, more than 112,000 individuals have enrolled in a plan through Feb. 1, placing Michigan 12% above its federally set target for the period and one of only a handful of states to exceed its enrollment target. (more…)

Exhausted but inspired

I recently returned from Health Action 2014, Families USA’s annual conference, in my usual condition – exhausted yet inspired! It was a good year for Michigan: Dizzy Warren, of Michigan Consumers for Healthcare, was awarded one of the three Advocate of the Year awards, and Michigan blogger Amy Lynn Smith won the painting created onsite by Regina Holliday!

The conference opened with a cancer survivor sharing her story of having her COBRA coverage end on Dec. 31, 2013 during her cancer treatment. Thanks to the Affordable Care Act, she was able to sign up for coverage starting Jan. 1 and continue her treatments uninterrupted. (more…)

Healthy Michigan Plan moves forward

Great news to start the year! The federal government Monday approved Michigan’s request to expand Medicaid eligibility through a new program, the Healthy Michigan Plan.

This action brings Michigan one step closer to providing comprehensive coverage to Michigan’s low-income, uninsured residents.

It has been a long, tough road to get to this point. (more…)

A gift for the future

From the First Tuesday newsletter
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 The holidays are upon us, and I’d like to offer Michigan the gift that keeps on giving – 10 ways to invest in our future.

The generations that came before us knew what it took to build a Mighty Mac, freeways and strong universities. Yet today, when you hear about economic development, you often hear about tax cuts, not investments. We can’t cut our way to prosperity. We simply must pay it forward for future generations and give them the investments they need for a strong economy.

A recent report by Senior Policy Analyst Pat Sorenson offers 10 ways to invest in our economy. It’s the League’s gift for the future:

1.
Invest
In early childhood.
2. Make sure all kids get
a great education – and a diploma!
3. Make college affordable 4. Encourage good health
with access to physical and mental health treatment 5. Offer help
with basic needs to those who cannot work or who cannot find
a job. 6. Invest in community services to attract businesses and young
professionals. 7. Generate revenue by strengthening the personal income tax,
based on the ability to pay. 8. Make sure businesses pay their fair share 9. Bring sales tax
into the modern age by taxing services and Internet sales. 10. End ineffective tax breaks
and put funds
into what works.

Happy holidays, and make sure to sign up for our Dec. 9 policy forum!

– Gilda Z. Jacobs

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