Macomb County officials are resisting an attempt by the state of Michigan to renew their contract with the county’s Community Mental Health agency that could cost the agency millions of dollars by reducing CMH’s savings from that of Medicaid, including going back and taking money. from previous years.
The county’s Board of Commissioners earlier this month passed a resolution to appeal to the state Department of Health and Human Services seeking to change the language of CMH’s one-year contract renewal, which provides many health services. mental health and substance abuse.
CMH currently has a reserve fund of at least $43 million, but the state Department of Health and Human Services wants to change its contract to reduce CMH’s Internal Services Fund for its National Health Plan fund. Prepaid Patient Beauty accounted for 7.5% of its total of $269 million. . That would reduce savings by more than $20 million. That action, known as a “clawback,” would result in a $23 billion loss for Macomb CMH and put the facility at risk each year to receive Medicaid funding and possibly had to cut back on services, CMH officials said.
Richard Carpenter, CMH’s chief financial officer, said it would be irresponsible for CMH to agree to the new language and said a potential “clawback” could be be illegal and “not enforced” by the government.
“We are being asked to sign a contract that will give away our right to maintain this fund,” Carpenter said. “Signing such a contract, I don’t think there will be any responsibility.”
Instead of an “arbitrary” caption, the amount that can currently be held in the reserve fund is “based on accounting principles and actuarial principles” that CMHs across the country agree on, Carpenter said.
County Commissioner Phil Kraft, who also chairs the county’s CMH board, said CMH officials are alarmed by the proposed language change. Drafting a decision on this issue at the county board in July, telling fellow commissioners that it is “very important.” The board approved it by one vote.
The district board’s resolution says the government’s proposal:
- “It is wrong to say the motive of unnecessary profit on the part of the government agencies instead of realizing that it is a legal transfer of responsibility of the government from the Government to the Districts for the provision of services ;
- Limits ISF financial assistance to less than the appropriate amount” … and is “regarded as the best practice of government agencies as proposed by the Government Financial Officers Association;
- Exaggerating and attempting to limit its ability to function as a PIHP and manage its risk effectively; and
- Can (if enforced) require MCCMH to return the money it has rightfully received and retained from the previous contract period.”
DHHS said in a written response provided by attorney Lynn Sutfin that the proposal is “under review” but that the Internal Services Fund “is intended to cover the PIHPs’ portion of the shared liability risk, and that portion is 7.5%.”
“We share the goal of ensuring that funds are available to provide quality services to our beneficiaries and responsible management of Medicaid costs,” DHHS officials said. “Although the proposal will not be included in the first FY25 contract, we intend to discuss the rules and structure of the ISF in the coming months for possible changes to the contract.
“The Michigan Department of Health and Human Services appreciates comments from the Prepaid Patient Health Plans FY2025 Amendments to the Internal Service Fund portion of the contract.”
Upon hearing of the proposal, Sheriff Anthony Wickersham expressed concern because his office works with the department to respond to and treat county residents with mental health and substance abuse issues. He noted that the public approach is to increase services for people with these problems.
“Any reduction in mental health services is ridiculous,” Wickersham said. “Now is not a good time to talk about cutting mental health services.”
He said any reduction would “increase problems in our community and the prison itself. Law enforcement officers deal with people with mental health issues every day. ”
The centerpiece of the new $229 million prison project and expansion is a new four-level Central Addition and Assessment Center to improve treatment delivery for those incarcerated and in need of services.
Macomb’s concerns are supported by the Lansing Mental Health Association, said the organization’s CEO Robert Sheehan, who acknowledged that 7.5% would be too low.
“We are surprised and disappointed that the government wants to keep it (the reserve fund),” Sheehan said in an interview. “The problem with reducing it to 7.5% is that after one bad year … there would be no money for the next year,” thus forcing organizations to cut services.
He said there should be a “reasonable rate” of around 15%.
The proposed new language would apply to 10 PIHPs/Public Mental Health Centers across the country. Officials from two other agencies – the 10th District made up of Genesee, Lapeer, St. Clair, Sanilac areas, as well as the Upper Peninsula Health Plan – also passed a resolution of opposition, Sheehan said.
The contract will run through the state’s 2025 fiscal year, which begins Oct. 1.
CMH is one of the largest organizations in the state, with a budget of more than $270 million and a workforce of more than 350.
Carpenter and CMH interim CEO Traci Smith said while the roughly $43 million in savings may seem like a lot of money to provide services, it’s not.
“The last three or four years have been relatively good years and we’ve put money into that savings so that when the bad years come, we have enough money,” Carpenter said.
Macomb CMH has a lot of money because of Medicaid premiums that will increase significantly from 2020 to 2023 when the state did not remove anyone from Medicaid because of the COVID-19 epidemic. However, the state ended that plan in July 2023, forcing Medicaid recipients to reapply.
Now, in one year the number of Medicaid enrollees in Macomb County has dropped by 23.4%, from 264,548 enrollees to 202,516 last June, thereby reducing Medicaid revenue (PHIP), from the federal government and across the country, officials said.
Smith noted that Medicaid payments will not be enough to fund services because “our most expensive patients are at risk of losing coverage.”
Most of CMH’s clients are at or below 130% of the federal poverty level, but the agency also serves those above that level.
CMH served about 18,000 people last year, officials said.
Officials said there was no immediate concern about service cuts.
“Ultimately we will ensure the provision of services for the citizens of Macomb County in some shape or form. We want this to come to a conclusion as quickly as possible,” said Smith.
But there is concern about the future.
“We’re in the process of getting everyone off Medicaid, and we’re still in the middle of that process,” Carpenter said. “We don’t know where the depth is. Until the right is fixed, our income will continue to decline.
“We have this issue of cuts as the cost of services continues to rise, and we don’t know when that will stop. This money will be a safety net, a backstop to ensure infrastructure.” ongoing services.
The needs of our patients, the needs of our customers are undiminished. If anything, with the opioid epidemic, with anxiety levels and other mental illnesses, some caused by this epidemic, some caused by other factors in the community, it causes the need for services to go up. ”
Smith mentioned the ongoing issue of high rates of opioid addiction in the state.
He said: “The community is suffering, and the level of crisis is increasing.
In addition to mental health and substance abuse services, CMH provides services to children with emotional problems, developmental disabilities, disabilities, autism, veterans for service delivery and those in need. general health care, among others.
Originally published:
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