Red alert: Delay on healthcare is time to redouble efforts

Monday, the Congressional Budget Office (CBO) released its score on the U.S. Senate healthcare bill, the Better Care Reconciliation Act or BCRA. According to the report from the nonpartisan CBO, nothing in the bill makes care better and it is largely a continuation of the flaws in the House-passed healthcare bill.

Over the last two days, a vote by the Senate on their healthcare bill went from imminent to delayed at least a week. But we still need to keep fighting and make sure everyone knows how bad the BCRA is.

The CBO report shows that under the Senate healthcare plan:

  • 15 million people would become uninsured in 2018, with a total of 22 million people by 2026.
  • Federal funding to states for Medicaid would decline by $772 billion, forcing states to increase provider rates or reduce care. These cuts would also force states to look at funding priorities whether it be infrastructure, education or healthcare.
  • States’ Medicaid expansion programs would be phased out. In Michigan, that would mean the over 670,000 Michiganians who receive care through the Healthy Michigan Plan would lose health coverage.
  • Individuals may lose coverage to critical health services including treatment for substance use disorders and maternity care.
  • Average healthcare premiums would go up 20% in 2018.
  • Individuals who are low income will pay more for less comprehensive coverage.
  • Four million people with employer-sponsored coverage would lose insurance.
  • Nearly all of the coverage gains experienced under the ACA would be eliminated by 2026 and the uninsured rate among the non-elderly would rise almost to its 2010 level, before the ACA took effect. (Under the ACA, the uninsured fell to a historic low of nine percent.)

I’ll admit, I have been having a hard time over the past couple of months thinking that legislation that hurts this many people would and could actually pass. I understand that there is a legislative process and following the announcement that the vote will be delayed, I’m sure that over the coming days and weeks we will see changes made to this bill, but changes may still result in large sums of people losing life-saving care.

CBPP BCRA-AHCA Comparsion 575x525

I want to enjoy my Fourth of July and I want you to do the same, but maybe you can also take a few minutes over the next couple of weeks to call Congress at (202) 224-3121 or attend an event or town hall and tell your Representative that you will not accept any healthcare bill that:

  • Reduces healthcare coverage;
  • Ends Medicaid expansion and the Healthy Michigan Plan;
  • Ends the traditional Medicaid program as we know it through per capita caps or block grants; and
  • Makes individual market coverage less affordable.

This delay on a vote is a great sign, but the fight is not over. We must keep up our pressure on our members of Congress. Thankfully, Michigan’s two U.S. Senators Debbie Stabenow and Gary Peters have already come out in strong opposition to the BCRA (but it doesn’t hurt to thank them for their support). The lives, safety net and economic peace of mind of our fellow Michiganians and Americans are at stake.

— Emily Schwarzkopf

Trump budget is anti-poor people, not anti-poverty

From the First Tuesday newsletter
Sign up for the newsletter and e-news

This past month saw two disastrous pieces of public policy come out of Washington: the American Health Care Act (AHCA) passed by Republicans in the U.S. House of Representatives and President Donald Trump’s federal budget proposal.

three fifths cuts in trumps budgetWe provide a more substantive update on the AHCA below, but here’s what you really need to know: It raises costs, reduces coverage and slashes funding for states. In short, it’s bad, and we’re hopeful that leveler heads in the U.S. Senate will agree.

But that was just the appetizer. On May 23rd, President Trump released his budget proposal, and it is an all-out assault on people who are struggling in our state and our nation. We were expecting significant cuts to vital programs based on the president’s “skinny budget,” but it is far worse than anyone could imagine.

If the president is looking to make history and leave his mark, this awful budget will certainly do that. Our colleagues at the Center on Budget and Policy Priorities say that his budget “contains the largest dollar cuts to programs for low- and moderate-income people proposed by any president’s budget in the modern era,” cutting these programs by an estimated $2.5 trillion over the next decade. About 59% of the president’s budget cuts would come from programs and services that help struggling families build a better life and keep food on their tables, clothes on their backs and a roof over their heads.

SNAP cutsFood assistance through the federal Supplemental Nutrition Assistance Program (SNAP) would be slashed by $193 billion over 10 years, targeting the elderly, working families and workers struggling to find a job. On top of the massive cuts to Medicaid in the House-passed AHCA, Medicaid would be cut by an additional $600 billion over 10 years. Possible per capita caps on Medicaid would make it even worse.

People who are struggling economically are not the only vulnerable residents who are being exploited by this budget. Disability programs would be cut by $72 billion, including Social Security Disability Insurance for workers with disabilities and their families and Supplemental Security Income, which provides income assistance to individuals with low incomes, including children, with disabilities.

There are also significant cuts to Great Lakes funding, other protections for our air, land and water, and other programs that are essential to our quality of life and our way of life in Michigan.

As our recent 2017 Kids Count in Michigan Data Book and Making Ends Meet report show, millions of people and kids in Michigan are either living in poverty or barely getting by. Many families have yet to feel any economic recovery and are one emergency or unexpected expense away from financial disaster. More people are working, but in lower-paying jobs, and they depend on food assistance, Medicaid and other programs to survive—programs that would be decimated under President Trump’s budget. Michigan is particularly vulnerable to President Trump’s budget cuts, as we’re the second most reliant on federal funds of any state in the nation.

Our congressional delegation must oppose this budget and any others that follow in this same direction of harming our state’s most vulnerable residents, especially our children. They need to hear from the people that these appalling cuts will hurt and put names and faces to the lives that hang in the balance. If you or someone you know depends on food assistance, Medicaid, disability services or other federal programs, I urge everyone to share their story at Handsoff.org. And whether you use these programs yourself or just know that they are vital to a better Michigan for all, I encourage you to contact your congressperson directly and tell them to oppose the Trump budget or any other proposal that includes massive cuts to these programs.

— Gilda Z. Jacobs

CB…oh no?!

Earlier this month, the House Republicans in Congress passed the American Health Care Act (AHCA) without an updated Congressional Budget Office (CBO) score. The CBO is an independent, nonpartisan office that analyzes the cost and impact of proposed federal legislation. Wednesday, in full nerd behavior I anxiously awaited the release of the new report.

While earlier versions of the AHCA revealed that over 24 million people would lose their health coverage, the effect of amendments that allowed for waivers for essential health benefits and pre-existing conditions was not yet known … until now. (Yes, 20 days after the bill was voted on by the House). What we know from the newest CBO score is that not much has changed. According to the report released yesterday:

CBO Uninsured Rate F 448 x 457

  • 23 million more people would be uninsured by 2026;
  • $8 billion dollars allocated for high-risk pools would not be sufficient to cover the large increases in premiums for high-cost enrollees;
  • Medicaid enrollment (including children, people with disabilities and the elderly) would decrease by 14 million people;
  • People needing maternity, substance abuse & mental health care would incur thousands of dollars in extra out-of-pocket costs in states who apply for a waiver.
  • Premiums would go up 20 percent more than current law in 2018.
  • In states that pursue waivers, the report says that average premiums would fall but “less healthy people would face extremely high premiums.”

Last week, our national partners at the Center on Budget and Policy Priorities released two reports on the effects the AHCA has on rural America and home- and community-based services. Both of these reports once again put on display the great harm this legislation would bring.

One of the things that really stood out to me was the huge effect the AHCA would have on our rural Michiganians. In Michigan, 113,800 people in rural communities gained coverage through Michigan’s Healthy Michigan Plan. That’s nearly 20 percent of the total enrollment of the program. Those suffering from opioid addiction (of which rural Michigan has been greatly affected) have been particularly helped by the expansion of Medicaid. The coverage gained allowed these people to access the necessary treatment and education they need to fight this growing epidemic.

Home- and community-based services are optional services that states are not required to provide but many individuals rely on as a way to receive care at home rather than in a nursing home. In 2013, 102,810 Michigan residents relied on these services. Restructuring Medicaid through per capita caps and the ultimate end of Medicaid expansion would result in a significant cost shift to states, so much that states could choose to no longer provide these important services to seniors and people and kids with disabilities.

There is no doubt that the Affordable Care Act needs to be improved and as the U.S. Senate moves forward in its process, we can hope that they look at this data to develop legislation that rejects caps on the Medicaid program, continues successful Medicaid expansion programs—including Michigan’s Healthy Michigan program, and increases the number of insured individuals.

We know you are being pulled in a lot of directions right now, but we still have a lot of work to do on the healthcare front and we need you to keep fighting. We have a helpful website set up with our coalition partners so you can contact your member of Congress, and all these reports to help keep you informed on the devastating impact of the AHCA. And they come in handy when you battle your friends on the intricacies of Medicaid financing … oh wait, I’m the only one that does that?

— Emily Schwarzkopf

Protect healthcare for 650,000 Michiganians

pdficonApril 2017
Emily Schwarzkopf, Policy Analyst

Continuation of the Affordable Care Act (ACA) and the Healthy Michigan Plan are critical for Michigan residents and the state’s economy. In recognition of the program’s success, the governor recommended, and the League supports, sufficient funding for the Healthy Michigan Plan in the 2018 budget year.

Budget Brief JPG USE THIS ONE

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.

The program has also made a significant impact on Michigan’s economy. The Healthy Michigan Plan has resulted in 30,000 jobs annually, $2.3 billion in additional personal spending power, and $150 million in state tax revenue as a result of added economic activity. Further, 90% of hospitals report reductions in uncompensated care, with overall uncompensated care dropping by nearly 50% across the state.

BACKGROUND ON MEDICAID EXPANSION

When it was first passed, the ACA included a requirement that states expand Medicaid to those with family incomes at or below 133% of the federal poverty level. The existing Medicaid program generally had only covered the aged, blind and disabled up to 100% of poverty, with higher income levels for certain populations (children and pregnant women) and lower for others (childless adults).

However, the June 2012 United States Supreme Court decision questioning the constitutionality of the ACA (National Federation of Independent Business v. Sebelius) found the provision to require states to expand Medicaid unconstitutional. As a result, states were given the option to expand their Medicaid programs without penalty. State programs would be covered 100% by federal funding through calendar year 2016. The federal match rate will phase down to 90% over the next five calendar years: to 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020 and all subsequent years.

BB Protect healtcare for 650,000 Michiganians chart 1The Healthy Michigan program has been shown to be incredibly successful for those receiving coverage through the plan. The benefits for Healthy Michigan enrollees must be based on federal benchmark coverage and include the 10 essential healthcare services. The plan also covers dental and vision services, hearing aids and nonemergency medical transportation.

MICHIGAN’S FEDERAL WAIVERS

The legislation that created the Healthy Michigan program required Michigan to get two waivers from the federal government. The first waiver allowed the state to include cost-sharing requirements (including copays) and the use of health savings accounts into which newly-eligible enrollees would contribute. The contributions of enrollees could be reduced if certain healthy behaviors are addressed.

The second waiver limited the amount of time an enrollee could be enrolled in the Healthy Michigan Plan to 48 months. Once the 48-month cap is reached, an individual would have the opportunity to remain on Medicaid with higher cost-sharing requirements or purchase private insurance through the healthcare exchange and be considered eligible for premium tax credits. Both of these waivers were approved by the federal government.

Another important component of Michigan’s legislation is that should annual state savings and other nonfederal savings associated with the implementation of the program not be sufficient to cover the reduced federal match, the Healthy Michigan program would end. The state realizes savings from programs that were previously funded either partially or entirely by the state General Fund that are now covered in Healthy Michigan, including non-Medicaid mental health funding, Adult Benefits Waiver program, prisoner healthcare costs and Plan First! Waiver program costs. Savings can also be seen as a result of revenue from the Health Insurance Claims Assessment, the use tax on Medicaid managed care organizations, provider assessments and an established hospital quality assurance assessment program retainer on special hospital payments.

CONTINUED THREATS

Despite the recent defeat of the federal American Health Care Act, there is still the possibility that Congress will fundamentally change the way Medicaid funding is allocated and limit how long Medicaid expansion will continue. As Congress moves forward on other priorities, including tax reform, there is the possibility that Congress, in order pay for tax breaks, could shift the costs of the Medicaid program to the states through block grants or per capita caps. There also is a chance that Congress could make changes in Medicaid financing in the forthcoming federal budget or when the Children’s Health Insurance Plan (CHIP) funding is reauthorized in late summer or early fall. While the League encourages the Michigan Legislature to continue funding for the Healthy Michigan Plan in 2018 and beyond, it is also important to stay vigilant in protecting Medicaid funding and the Affordable Care Act.

THE GOVERNOR’S 2018 BUDGET RECOMMENDATION

The governor’s executive budget proposal includes continued funding for this critical program. Since the state is required to pay a share of the costs, the governor has recommended total funding of $4.1 billion, including a $200.4 million investment of state General Funds to cover the costs of the state’s match contribution. This amount does not take into account additional savings from revenue impacts or other budgetary savings created as result of the implementation of the Healthy Michigan Plan.

With federal budget cuts, the sky may really be falling

My son loves books, and one of our favorite things to do every night is read before bed. Many of the stories we choose also provide a learning experience. One of our recent favorites has been Chicken Little, which I think my son chooses to laugh at me stumbling over tongue-twisting character names. It also gives us a chance to talk about thinking rationally.

This lesson is applicable from our kids to my policy work to the highest levels of government. But when President Donald Trump released his “skinny budget” in March—despite being light on detail—the potential impact it could have on our state budget and Michigan residents was stifling. And at times, I really do feel like the sky is falling.

My fear is not unfounded. Michigan has grown increasingly reliant on federal funds. Over the past decade, while our total state budget has grown by about 29%, federal funds in our budget have grown by nearly 69%. In our current budget, federal funds provide $22.7 billion of our $54.2 billion state budget. This means that more than $4 out of every $10 provided for important programs like public education, healthcare for children and families with low wages, food assistance and road maintenance are paid for by federal dollars.

Think-the-federal-budget-does-not-matter_CROP

These federal grants do matter to our state budget. According to a recent report from the Center on Budget and Policy Priorities, federal grants to states and local governments make up nearly one-third of non-defense discretionary spending. Michigan receives 3% of total federal grants to states, and only California, New York, Texas, Florida, Georgia, Illinois, Pennsylvania and Ohio get a bigger share than Michigan. Cuts to these discretionary programs, which are already at historically low levels, would harm workers, college students, local communities and families with low- and moderate-incomes.

What’s more is that this “skinny budget” proposes to completely eliminate funding for the Low Income Home Energy Assistance Program (LIHEAP), which helps families and many seniors pay heating bills; a block grant that supports housing, community facilities and economic development; the HOME program which helps develop and repair affordable rental housing and repair homes for homeowners with low incomes; and the Community Services Block Grant, which provides anti-poverty services.

While President Trump’s budget only outlines changes in discretionary spending, changes to mandatory grants may still be forthcoming, for example block granting or putting a per capita cap on Medicaid. (While the first round of the American Health Care Act was withdrawn, you can bet that Congress will try, and try again, to repeal the Affordable Care Act and alter Medicaid funding.) Changes in these programs, including Medicaid, the Children’s Health Insurance Program (CHIP), free and reduced-priced school meals, child care assistance and other assistance for families with low incomes, would mean deep cuts to these programs as states would be unable to absorb the costs themselves. This would reduce services to those Michigan residents who really need it.

Cuts to federal grants to state and local governments, and changes in federal programs, will only mean cuts to the very Michigan residents that rely on these services. Changes will result in more potholes and unsafe bridges, fewer Michigan residents with healthcare coverage, more children going hungry, less affordable housing, more poverty and more problems, all having a long-term negative impact on our economy.

So pardon my doomsday sentiment, but states really rely on federal funds to run. And these changes would affect our state for years to come. But we can change the future. It is important for all of us to get in touch with our members of Congress and tell them the things that really matter to us as they make decisions on the federal budget that will have a direct impact on our great state.

— Rachel Richards

Kresge grant helps League redefine health policy work in Michigan and Detroit

For Immediate Release
March 31, 2017

Contact:
Alex Rossman
arossman@mlpp.org
517-487-5436

$600,000 grant funded two new health policy analyst positions, helps League improve integration of state health and human services

LANSING—A $600,000 grant from The Kresge Foundation awarded to the Michigan League for Public Policy will help transform the League’s health policy work in Detroit and around the state. The funding enabled the League to hire two new health policy analysts, one focusing on Medicaid and the other specializing in the social determinants of health.

“These policy analysts provide valuable expertise regarding additional opportunities to integrate health and human services policies that will lead to great health and well-being for Michiganders,” said David Fukuzawa, managing director for The Kresge Foundation’s health and human services programs. “The League will serve as a valuable resource for Michigan’s Department of Health and Human Services as the department continues to develop integrated services for the state.”

The funding from The Kresge Foundation will support the League’s research and analysis examining the current health and well-being of Detroiters and Michigan residents. The League will identify gaps in state services and support systems and create specific policy recommendations to address those gaps. This work by the League’s two new health policy analysts will advance public policy change by supporting the integration of health and human services and helping lawmakers, state department officials and service providers better understand the connection between health and other factors.

“The Kresge Foundation has been a longstanding supporter of our work at the League, but this significant grant will help take our health policy efforts to the next level,” said Gilda Z. Jacobs, president and CEO of the Michigan League for Public Policy. “We work on a variety of issues to improve the physical and economic well-being of kids and families in Detroit and around the state, and we are seeing more and more how all of these issues connect. A child’s health is directly impacted by their environment, nutrition and family’s income, and their health affects their education and future occupations and earnings. We need comprehensive strategies to tackle all of these issues, and this grant will enable us to do that.”

The League’s health policy analysts will research and write reports, analyze current and proposed policy, and work with partners, department staff and policymakers on social determinants of health and Medicaid-related issues. Emily Schwarzkopf, the League’s health policy analyst working on Medicaid, has hit the ground running as the League and our partners work to protect the Affordable Care Act and the state’s Medicaid expansion program, the Healthy Michigan Plan. Health Policy Analyst Julie Cassidy will be working on the social determinants of health, a relatively new focus of health policy work that takes a holistic approach and incorporates other needs and services.

The Kresge Foundation is a $3.6 billion private, national foundation that works to expand opportunities in America’s cities through grantmaking and social investing in arts and culture, education, environment, health, human services and community development in Detroit.

###

The Michigan League for Public Policy, www.mlpp.org, is a nonprofit policy institute focused on economic opportunity for all. It is the only state-level organization that addresses poverty in a comprehensive way.

2016 Community Health Budget Continues Key Investments

 

The 2016 budget for the health programs within the Department of Health and Human Services continues key investments, and includes few of the program reductions and funding shifts recommended by the governor.

The vast majority of health funding, nearly 90%, is for the state’s Medicaid-funded programs, including the Healthy Michigan Plan and Medicaid-funded mental health and substance abuse services. In 2016, federal funds will make up over 70% of the health component of the budget.

Medicaid and Healthy Michigan Plan

Nearly one in every four Michigan residents is enrolled in Medicaid or the Healthy Michigan Plan for healthcare coverage. Implementation of the Healthy Michigan Plan together with enrollments through the Marketplace have dramatically reduced, from 14% to 7%, the number of uninsured adults in Michigan according to a survey by the Center for Healthcare Research and Transformation.

In the current budget year, the governor projects that 1.7 million Michigan residents will be covered by Medicaid, with an additional 540,000 recipients enrolled in the Healthy Michigan Plan. The governor’s proposed budget for 2016 projected a very small increase in Medicaid enrollees (about 13,000) and continued growth in Healthy Michigan Plan enrollees (40,000), bringing total average enrollment for the Healthy Michigan Plan to 580,000.

Medicaid Caseloads

The governor recommended the continuation of $100 million savings in state funds for Medicaid based on lower projections of the number of persons who will be enrolled in the current year.

  • The House and Senate concurred with the governor’s recommendation.
  • Final Budget: Based on the May Revenue Estimating Conference, the projected Medicaid caseload was increased for both the 2015 and 2016 budget years, and additional funding of $46.6 million in state funds, $190.2 million in total funds, was recommended for 2016. The Legislature adopted the consensus recommendations.

Healthy Michigan Plan Funding

The governor recommended $3.5 billion for the Healthy Michigan Plan (including behavioral health services), which is financed with all federal funds for the final year. For the program to continue after April 30, 2016, Michigan must submit a second waiver to the federal government by September 1, 2015, and it must be approved by the end of 2015. The second waiver requires increased cost-sharing for those with incomes between 100% and 133% of the federal poverty level who have been enrolled in the program for 48 months.

  • The House and Senate concurred with the governor’s recommendation.
  • Final Budget: Based on the May Revenue Estimating Conference, the Legislature increased Healthy Michigan Plan funding to $4.1 billion, all federal funds, as the caseload continues to increase.

Prescription Drugs

The governor recommended the removal of prescription drugs from Medicaid managed care contracts and the development of a separate pharmacy benefit contract. This proposal was expected to generate higher drug rebates based on higher purchasing volume, as well as administrative savings, for a total of $16.8 million in state funds.

  • House: The House rejected this proposal and retained the pharmacy benefit in the managed care contracts with changes, including the adoption of a single formulary (list of covered drugs) and shared pharmacy rebates with the state. The House assumed greater state savings of $2.0 million than did the Senate.
  • Senate: The Senate agreed with the House, but retained the Executive recommended savings.
  • Final Budget: The Legislature adopted the House recommendation.

Autism Services

The governor recommended $36.8 million for autism services, restoring the reduction made in 2015 due to the slow start of the program. The Executive Budget also recommended increasing coverage through age 21 from the current age 6. One-time funding is continued to train autism services providers through Michigan State University, Western Michigan University, Central Michigan University, Oakland University and Eastern Michigan University. Total funding for training is reduced from $7 million to $2.5 million, with $500,000 allocated to each university.

  • House: The House concurred with expansion of services to Medicaid beneficiaries through age 21, but eliminated all but $100 of the university funding.
  • Senate: The Senate concurred with the governor.
  • Final Budget: The Legislature concurred with the Senate, but moved the university funding from one-time funding to ongoing funding to eliminate the uncertainty that one-time funding creates.

Increased Payments to Primary Care Providers

The governor recommended $8.3 million in state funds ($24.2 million in total) to provide full-year funding to continue approximately half of the rate increase for primary care providers implemented in 2013 to increase access. Full federal funding for this initiative ended in December 2014, so an additional state investment is required to continue this rate increase in 2016. This critical state investment is intended to encourage primary care doctors to serve the Medicaid population, particularly with the coverage expansion under the Healthy Michigan Plan.

  • The House and Senate concurred with the governor.
  • Final Budget: The Legislature adopted the governor’s recommendation.

Adult Dental Services

The governor recommended funding, effective July 1, 2015, to develop a statewide managed care contract for dental services for adult Medicaid enrollees to increase dental access for adults. Currently adult Medicaid beneficiaries experience great difficulty finding a dental provider who will accept Medicaid. An investment of $23 million, of which $7.9 million would have been state funds, was recommended and was financed from savings in other program areas. The total annual cost of the program would have been $92 million, of which $31.7 million would be state funds.

  • House: The House included only a $100 placeholder for this initiative to ensure discussions in the joint House/Senate conference committee.
  • Senate: The Senate supported the policy but delayed implementation to September 1, 2016, to reduce the cost in budget year 2016.
  • Final Budget: The Legislature did not include funding for this initiative, instead using the funding to increase the number of children covered by Healthy Kids Dental (see below).

Healthy Kids Dental Expansion

For 2016, the governor recommended expansion of the Healthy Kids Dental program to an additional 210,000 children—ages 0 through 8—in Kent, Oakland and Wayne counties, with an investment of $21.8 million ($7.5 million in state funds). With this expansion, the program would cover over 800,000 children, but not all eligible children in the state. Yet to be covered would be more than 170,000 older children in Kent, Oakland and Wayne counties.

Michigan currently provides enhanced dental services to more than 600,000 children in 80 counties. Access to dental services is essential to prevent tooth decay, the No. 1 chronic disease in children. Healthy Kids Dental improves access to care by partnering with Delta Dental of Michigan to increase provider reimbursement rates and simplify administration. With the expansion in 2015, all counties are now covered except Kent, Oakland and Wayne.

  • House: The House concurred with the governor.
  • Senate: The Senate delayed coverage until July 1, 2016, but covered all children in Kent, Oakland and Wayne counties.
  • Final Budget: The Legislature expanded coverage to more than 290,000 children ages 0 through 12 in Kent, Oakland and Wayne counties, adding $37 million in total funds, of which $12.7 million are state funds. With the higher caseload projections, this still leaves about 130,000 children behind.

Hospital Obstetrical Services Payments

The governor recommended the elimination of $11 million in total payments, $3.8 million from state funds, to rural hospitals for the special payment implemented in the 2015 budget year for obstetrical services. To stop the erosion of obstetrical services in Michigan hospitals, the Legislature created a special payment for qualifying rural hospitals in the current budget year. Over the last few years, a number of hospitals have closed their OB units and there are now 17 contiguous counties in northern and mid-Michigan with no hospital OB units. The special payment is to stop more closures, not reopen any units that have closed.

  • The House and Senate both rejected this recommendation and retained the funding.
  • Final Budget: The Legislature retained funding for this special payment to encourage rural hospitals to maintain their obstetrical units.

Hospice Room and Board Payments

The governor recommended no change in funding for hospice room and board payments, which were discontinued in budget year 2014 when federal funds were no longer available to cover a portion of the cost.

  • House: The House included a $100 placeholder to continue consideration.
  • Senate: The Senate restored funding of $3.4 million, all state funds.
  • Final Budget: The Legislature included $2.5 million, all state funds, but specified the funding is “one-time.”

Mental Health and Substance Abuse Services

The governor recommended continued restoration of $20 million, all state funds, as included in the current budget year supplemental to cover community mental health and substance abuse services for persons not eligible for Medicaid or the Healthy Michigan Plan.

Implementation of the Healthy Michigan Plan resulted in dramatic reductions in the state funds needed to serve those not eligible for Medicaid, as the vast majority of individuals were expected to transition from state-funded services to Healthy Michigan Plan services, which are 100% federally funded. The transition has not been smooth, and concerns continue that state funding reductions were too large and too fast. An increase of $20 million was included in the current year supplemental appropriation in recognition of the significant funding shortfalls to provide needed services to those not eligible for Medicaid or the Healthy Michigan Plan.

  • The House and Senate concurred with the governor.
  • Final Budget: The Legislature adopted the governor’s recommendation.

Mental Health and Wellness Commission

The governor included funding to continue implementation of the recommendations of the Mental Health and Wellness Commission ($12.7 million in state funds, of which $1.5 million continues to be one-time funding). The governor’s budget for 2016 eliminated all but $1.5 million of the one-time funding included in the 2015 budget. This one-time funding would be used to fund programs in the current year that were delayed by a budget-cutting Executive Order, and to establish a transition program for children who have had multiple hospitalizations at Hawthorn Center, the state’s mental health facility for children.

  • House: The House concurred with the reduction in one-time funding and also delayed the children’s transition program by six months and reduced funding correspondingly.
  • Senate: The Senate included a placeholder of $100 for one-time funding, proposed a further delay of nine months for the children’s transition program, and recommended about half of the ongoing funding for Commission recommendations be replaced by Michigan Health Endowment funding, which is controlled by the Board of the Michigan Health Endowment Fund.
  • Final Budget: The Legislature concurred with the Executive recommendation, but delayed the children’s transition program until the last quarter of budget year 2016.

Public Health and Child and Adolescent Health Services

For 2016, the governor’s proposed budget restored a $1.5 million increase that was originally provided in the 2015 budget to local public health departments for essential services, but was subsequently eliminated in Executive Order reductions. The governor’s recommendation brought funding for local public health essential services to the level it was ten years ago.

The governor’s proposed budget also eliminated funding for a pilot program that began in 2015 to improve child and adolescent health services by working with existing school-based clinics to develop satellite locations that will provide nursing and behavioral health services ($2 million in one-time funding).

Two of every $3 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 investments have not been made despite numerous emergency and ongoing needs.

  • The House and Senate concurred with the governor on funding for local public health departments, and put a $100 placeholder in the budget to continue discussions of the child and adolescent health services pilot program.
  • Final Budget: The Legislature adopted the governor’s recommendation for local public health department funding. It also removed the funding from the Department of Health and Human Services budget for the child and adolescent health services pilot program, but funding is included in the School Aid budget.

Vaccine and Immunization Education and Promotion

The governor included no new funding for immunization education and promotion.

  • House: The House also made no recommendation.
  • Senate: The Senate provided $500,000 in state funds for immunization education and promotion. Expenditure of these funds would be dependent on receiving private donations with a match rate of $1 of state funds for every $4 of private funds received.
  • Final Budget: The Legislature concurred with the Senate, added authority to spend the private funds, and designated that the project focus on vaccinations for infants and toddlers.

Services for the Aging

The governor’s budget continued funding of $84 million for senior in-home and nutrition services. The state continues working to become a “no wait” state for senior services.

The governor also recommended expansion of PACE (Programs for All-Inclusive Care for the Elderly) to Jackson County and Traverse City, funded through corresponding savings in nursing home costs.

  • The House and Senate concurred with the expansion of PACE.
  • Final Budget: The Legislature concurred with the PACE expansion but transferred the funding from Medicaid to the Aging and Adult Services Unit within the Department of Health and Human Services.

 

Happy 50th anniversary Medicaid

Today marks the 50th anniversary of the bill signing that created the Medicaid and Medicare programs. Michigan’s John Dingell was present at the signing in 1965, and in recent years continued to push for Medicaid expansion in Michigan that is helping so many more individuals today. (more…)

The House and the Senate Appropriations Committee Retain Special Rural Hospital Obstetrical Payment

Both the House and the Senate Appropriations Committee have rejected the governor’s proposal to eliminate the special hospital obstetrical payment and voted to retain it at its current level in their recommendations for the 2016 budget for the Department of Community Health (now the Department of Health and Human Services).

This special hospital OB payment, a legislative initiative, was included for the first time in the current budget year. An increased obstetrical payment to physicians also was implemented in the current budget year.

For the budget year that begins on Oct. 1, 2015, the governor recommended the elimination of the special hospital OB payment, saving $11 million in total funds, but saving only $3.8 million in state funds. The increased obstetrical payment to physicians was continued in the Executive Budget recommendation.

The Problem

Over the last few years, a number of Michigan hospitals have closed OB units due to low Medicaid reimbursement. When hospital OB units close, it impacts the entire community, not just those enrolled in Medicaid. There currently are 18 contiguous counties in northern and mid-Michigan with no hospital OB units. To stop the erosion of obstetrical services in Michigan hospitals, the Legislature created a special payment for qualifying rural hospitals in the current budget year.

Testimony has been provided year after year on the importance of access to delivery and emergency OB services for pregnant women and their babies within a reasonable geographic area. While the special hospital obstetrical payment will not remove any of the red X’s on the map, it is intended to prevent more counties from closing their OB units.

With around 50% of Michigan births paid by the Medicaid program, it is important to recognize the impact of reduced hospital OB availability on low-income women and their families. Many may face significant transportation issues. Requiring longer travel to reach needed care and delivery services puts women and their babies in jeopardy.

Retaining the special rural hospital obstetrical payment is critically important to low-income pregnant women and their babies, as well as to the communities where they live.

 

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…)

Next Page »