Michigan Budget: Mental Health a Priority

Story first appeared on LSJ.com

When Gov. Rick Snyder unveils his budget proposal Thursday, many expect him to address what has become a hot-button issue nationwide — an underfunded mental health system.

In the wake of a Dec. 14 shooting spree at a Connecticut elementary school, administration officials say Snyder likely will seek at least $5 million in new spending for programs aimed at identifying emotionally troubled youths.

But the real question Thursday is whether Snyder will back a plan for Michigan to join a federal expansion of Medicaid authorized in the Affordable Health Care Act. Snyder is expected to reveal whether he supports the expansion, which could inject about $6 billion in federal funding into Michigan for health and mental health services within the first three years.

Mental health advocates say the new funding could begin to reverse an underfunded mental health system in Michigan that has left many without help. Since 2004, the state has slashed community mental health funding by about 31 percent to $274 million — a reduction of $124 million.

Advocates estimate 250,000 people statewide who suffer from serious mental illness in Michigan aren't getting the services they need, and nationwide, Michigan ranks near the bottom in the amount it spends per mental health patient on publicly funded hospital beds.

“We have too many people with schizophrenia or bipolar disorder or major depression who are not getting treatment, and because of that, their symptoms are not being controlled,” said Mark Reinstein, president and CEO of Mental Health Association in Michigan. “We have far too many people left to their own devices.”

Stiff resistance
But regardless of what Snyder announces Thursday, a proposed Medicaid expansion would face stiff resistance in the Republican-controlled House, where Republican leaders worry Michigan one day would be forced to foot most of the bill for expanded Medicaid.

Currently, 1.9 million Michigan residents receive Medicaid, and the state pays about $4.8 billion, or 40 percent, of its approximately $12 billion annual Medicaid budget. The federal government pays the rest.

Under the federal health care law, states would pay nothing for the first three years and ultimately 10 percent of the Medicaid expansion after three years — or about $200 million annually. It would add an estimated 500,000 to Michigan’s Medicaid rolls.

“We’re cautiously skeptical, appropriately skeptical,” Republican House Speaker Jase Bolger said. “We have significant concern as to whether it is affordable in the long term. … The federal government has quite a history of dangling carrots and then abandoning states and then leaving them to pay for these things.”

Critics also question whether the state should commit to a new annual $200 million expenditure given its recent attempts to cut spending, and they argue it’s difficult to scale back public assistance once it’s offered.

Snyder has given few clues as to whether he’ll ultimately support an expanded Medicaid. But he has said he is concerned whether Michigan has enough doctors to handle the 500,000 people who would be added to Medicaid rolls under an expansion.

However, a study released last week concluded there were enough Michigan doctors to handle the new patients. The report found that 81 percent of physicians statewide could add patients who would become newly insured under a Medicaid expansion, according to the Center for Healthcare & Transformation, a group formed by the University of Michigan and Blue Cross Blue Shield of Michigan to study health care issues in Michigan.

Reinstein said the injection of new Medicaid funding for mental health would be especially helpful in Michigan, which is one of only seven states that don't require insurers to cover mental ailments in the same fashion as physical ones. The federal health care act expands Medicaid eligibility to families of four with an income of up to $30,656, and individuals with an income of up to $14,856.

'Good first step'
Mental health advocates say expanding Medicaid is critical because they question whether $5 million for new youth mental health programs is enough to address the need. Administration officials say Snyder likely will propose a new program to train doctors, teachers and others who frequently come into contact with children and young adults to identify emotionally troubled youth and direct them to the help that they need.

“It’s not sufficient money, given that (Michigan) has made due with a mental health budget that has been cut consistently for the last 10 to 12 years,” said Malisa Pearson, executive director of the Lansing-based Association for Children's Mental Health. “But it’s a good first step.”

Pearson said the association now is expanding its own program to educate teachers and other professionals in Michigan on identifying troubled youth, and that two certified instructors will offer seminars later this year. Once troubled youths are identified, she said, the goal is to direct them to mental health counseling, ideally in a home setting.

These troubled youths typically aren’t violent to others, but many become suicidal, Pearson said.