It is hard to believe that we are going into another new year 2022. I want to wish everyone a blessed & happy New Year. There are some updates to be aware of on the proposed Michigan Behavioral Health Integration.
The Senate Government Operations Committee has passed Senate Bills 597 and 598 on behavioral health integration; however, the full Senate has not yet voted on the bills. This vote may occur as early as next month. The Senate Bills 597 & 598 appear to eliminate local control and local decision making. The new version of SB 598 could give our local mental health care decisions to out-of-state based for-profit insurance companies.
The big question that we must act is if these bills will improve the behavioral health care for Michigan’s most vulnerable citizens. In short, this proposal moves the management of the state’s Medicaid behavioral health dollars from the public sector, who has managed it very successfully since 1964 and, under managed care since 1997, to private for-profit health insurance companies (health plans).
The proposal breaks up the nationally recognized organized system of care centered around the state’s public Community Mental Health (CMH) system. The current system provides a comprehensive array of mental health supports and services (the widest in the country) to 300,000 of Michigan’s most resilient and vulnerable community members. The current system is built on the Michigan Mental Health Code – one of the most person-centered set of statutes in the country.
It appears that the overhead of the private health plans is 2.5 times higher than that of the public behavioral health plans (known, in federal terms, as Prepaid Inpatient Health Plans) who currently managed these Medicaid behavioral health dollars.
Further, it also appears that the private health plans have a poor track record in managing the portion of the Medicaid behavioral health care benefit that they currently manage. Those plans manage the office-based psychotherapy and psychiatry benefit for Michigan’s Medicaid enrollees. Unable to find psychotherapists and psychiatrists willing or able to serve them, under this privately-managed benefit (and for which the private health plans are paid), Medicaid enrollees turn to the public CMH system for care. The public health plan and CMH system then must use funds, which were to be used for persons with more serious mental health needs, to serve these persons unable to find care in the system managed by the private health plans.
Lastly, the proposal does not seem to integrate physical healthcare and behavioral healthcare, as it implies. Real integration occurs on the ground, where the client/patient is served. This proposal simply mingles Medicaid behavioral health care dollars with the Medicaid physical health care dollars already managed by the private health plans.