Michigan lags the nation as well as most of our midwest states in health outcomes, including life expectancy and reported poor physical and mental health. Additionally, for far too long, things like a person’s race or ethnicity, zip code, and immigration status have been some of the most troubling indicators of their health outcomes and have resulted in deep, long-lasting disparities in health. These have both created barriers to health access—such as living too far from the closest healthcare providers—as well as been some of the leading social determinants of health—like living in a community with aging infrastructure causing lead-poisoned water or groundwater contamination by PFAS. Poor health contributes to worsening educational and economic opportunity outcomes for the sick individual specifically as well as for the family or community that bears the time and financial cost of acting as the caregiver.
The 2023-24 budget includes a number of tools and policies to help address health outcomes for all Michiganders, but also focuses specifically on health disparities experienced by people based on their race or ethnicity, socioeconomic status, immigration status and zip code. This budget will serve as a way to test and improve these health disparities through improved access to healthcare and programs to support public health and other social determinants of a person’s health status.
Healthcare Access
Access to safe, affordable and convenient healthcare is necessary to improve health outcomes for all Michiganders. Traditional Medicaid programs and the Healthy Michigan Plan—Michigan’s version of Medicaid expansion—are some of the state’s main ways to help Michiganders with low incomes all over the state to afford basic health services. However, numerous programs within the state budget provide tools to improve access and reduce existing health disparities.
Included within the 2023-24 budget are:
- Improved support for direct care and non-clinical staff. The budget includes $140.1 million to support a $0.85 per hour increase in wages for direct care workers and non-clinical staff. This is less than the recommended increase in the governor’s proposal, which would have included a $1.50 per hour wage increase for direct care workers and a $3.85 per hour increase for non-clinical nursing facility staff (the governor’s recommended increase for non-clinical staff would have reflected the current $2.35 direct care wage increase plus the matching $1.50 per hour proposed increase). While less than the governor’s proposal, direct care workers and non-clinical nursing facility staff provide frontline care, including patient care and food and custodial services, to some of Michigan’s vulnerable residents and should receive appropriate wages.
- Increased investment in services that enable older adults and people with disabilities to remain in their homes rather than institutional settings, including the following:
- The 2022-23 supplemental creates a new Home- and Community-Based Services (HBCS) Projects Fund and allocates to it $379.4 million ($189.7 million in federal funds) to enhance and expand HBCS, including respite services, eligibility expansions, options counseling, training, supported employment, infrastructure projects, and presumptive eligibility for individuals awaiting a Medicaid eligibility determination.
- For 2024, the budget includes a $5 million one-time General Fund expenditure for area agencies on aging to improve services and support to unpaid family and informal caregivers.
- The 2024 budget includes the governor’s recommendation of $2.6 million ($906,500 General Fund) to increase the enrollment cap of the Program for All-Inclusive Care of the Elderly (PACE) in Kent County and open an additional PACE site in Alpena. PACE provides comprehensive medical and social services to older adults still living in the community.
- Increased investment to enhance maternal and child health coverage, expand evidence-based services to those expecting, including the following:
- $26.4 million ($6.4 General Fund) to fund the elimination of a five-year waiting period for lawfully residing children and pregnant people to access Medicaid and CHIP. This change will be made through taking up the federal Immigrant Children’s Health Improvement Act (ICHIA) option. Funding and implementing the ICHIA option will impact up to 4,000 children and thousands of pregnant people who will be able to access comprehensive health care through Medicaid and CHIP sooner. These groups would otherwise be eligible for the programs save for their immigration status.
- $10 million ($5 million one-time) to expand the CenteringPregnancy group prenatal session model through additional site grants.
- $10 million ($5 million one-time) to increase grant support to the local Michigan Perinatal Quality Collaboratives, building the capacity of the multi-stakeholder collaboratives to coordinate across nine regions and improve maternal and child health outcomes.
- $10 million to incentivize hospitals to improve maternal health outcomes through the Alliance for Innovation in Maternal Health (AIM), with a focus on pregnancy-associated (not related to the pregnancy) injury and death, substance use disorders and racial and health disparities.
- Expanded age of eligibility for the Children’s Special Health Care Services (CSHCS) program and additional funding for services. The final budget includes $17 million ($7.8 million General Fund) to allow young adults up to age 26 years old (previously 21 years old) with chronic conditions like sickle cell and cystic fibrosis to enroll in the CSHCS program. The total funding includes a financing adjustment to transfer $11.8 million in Medicaid funding because of the expanded eligibility. Funding will also support a method of care coordination that includes case management.
- Increased investment in behavioral health, via both certified community behavioral health clinics and support for behavioral health providers:
- $2.5 million (federal State Fiscal Recovery Funds, one-time) for recruitment and retention programs for behavioral health professionals.
- $5 million (one-time) for grants to students who enter into an accelerated social work degree program and agree to work for at least two years within the public behavioral health sector post-graduation.
- $279.7 million ($65.4 million General Fund) to expand the current 10 Certified Community Behavioral Health Clinics (CCBHCs) by 19 additional sites. CCBHCs provide 24-hour crisis response and coordinate with primary care and other health settings to provide screenings, treatment planning, intensive care management, linkage to other services, and more. Total funding also assumes $40.4 million in General Fund savings because Michigan participates in a federal Medicaid pilot to provide CCBHC services and is reimbursed at the enhanced federal matching rate. Michigan’s CCBHC demonstration launched in 2021 and was extended for four additional years through the Bipartisan Safer Communities Act of 2022.
Public & Environmental Health
Public health is constantly working—often behind the scenes—to protect us and our families. Public and environmental health services and programming prevent disease from occurring in the first place or provide resources to prevent its spread; promote physical, social and environmental health; and protect entire communities, along with our homes, from toxins. State-level investment that reaches the local level, along with innovative policies and programs, is key to strengthening Michigan’s capacity to respond to community-specific public health needs.
Including in the 2023-24 budget to help support public health are:
- Maintained support for community public health services, along with key investments to keep Michiganders healthy. Community public health services include local health programs and administrative services in addition to a variety of services such as epidemiology, emergency preparedness, laboratory services and PFAS (Per- and Polyfluorinated Substances) and environmental contamination response. The final 2024 budget includes a total of $463 million ($169.7 million General Fund) in funding for these public health services. Specific investments include:
- Increased funding to local health departments to provide essential services, meeting statutory state-local cost-sharing requirements. The final budget boosts essential local public health services funding by $25 million (General Fund), bringing total funding to $76.4 million ($71.3 million General Fund). All 45 of Michigan’s local health departments are mandated to provide seven essential services, which include: infectious disease control, sexually transmitted disease control and prevention, immunization, hearing screening and vision services, public water supply/private ground water supply, onsite sewage management and food protection. This investment will bring the state into alignment with the statutory cost-sharing requirement to reimburse local health departments for their spending toward these services at a 50-50 match—which has not been met for many years—furthering the reach of state public health dollars at the local level.
- Investment in Healthy Homes program expansion. The final budget includes a $22.5 million (General Fund) increase in support for home-based lead investigations, abatements, community-based testing and lab capacity with the goal of reduced childhood lead poisoning.
- One-time funding of $61.4 million (General Fund) for water quality projects in communities affected by lead-contaminated water. The funds will support public health, data sharing infrastructure, filter distribution and inspection, and faucet and full plumbing replacement activities. This is less than the governor’s recommendation of $100 million. Additionally, the budget includes more than $500 million between a current year supplemental and the 2023-24 budget to support water infrastructure projects, including the following:
- $233.2 million in federal funds for water infrastructure projects, including lead service line replacements and wastewater infrastructure improvements; and
- $280.5 million ($250 million in federal Investment in Infrastructure and Jobs Act (IIJA) funds) for local water infrastructure projects. This is in alignment with the governor’s recommendation.
- Investment in community violence prevention initiatives, including community-based tools to reduce gun violence, such as:
- $800,000 to establish an Office of Community Violence Intervention Services.
- $6 million in one-time grants to pilot community-based violence interventions, with a focus on preventing injuries and fatalities related to firearms use. This total is less than the governor’s recommended $10 million.
- $2.9 million ($2.2 million one-time, $725,000 ongoing) to the Department of State Police to expand law enforcement capacity to collect information and intelligence on gun crimes to prevent gun violence. $951,600 of the one-time total is from federal funding from the Department of Justice. This funding will be used to establish five National Integrated Ballistic Information Network testing locations across the state (Benton Harbor, Flint, Grand Rapids, Lansing and Saginaw) to process firearms evidence and enter it into the national database used by law enforcement agencies across the state. Ongoing funding will be used primarily for equipment purchases, including a five-year maintenance contract.
- Support for Michigan Coronavirus Task Force on Racial Disparities initiatives, albeit much of it one-time. The final budget includes a total of $49.5 million ($44.5 million General Fund) to go toward recommendations put forth by the Task Force. The Governor proposed $58 million ($52.5 million General Fund) to do so, $17 million of which was one-time funding. 2023-24 funding will include:
- $38.5 million (one-time) for mobile health units (which meet patients where they are and connect them to resources), support for community health programs and healthy community zones, and related IT improvements. This includes the Neighborhood Health Grant Program, which will transition more than 20 community-based COVID-19 testing sites into community health and wellness centers offering a range of health services. $5 million (General Fund) of this total is designated for a Healthy and Resilient Communities program to increase access to high-quality food and nutrition to communities in need.
- $11 million (General Fund) specifically designated for community health programs and healthy community zones. Healthy Community Zones are pilot programs designed to address leading causes of health disparities in marginalized communities. This will include $1 million for diversity, equity and inclusion training.
- Funding for an Rx Kids Flint pilot program. The final budget includes a $16.5 million one-time TANF allocation for Rx Kids Flint, which was among a variety of public health programs that received one-time funding. This funding structure will help draw down matching funds from foundations. The program will help support families in Flint by providing $7,500 total in cash payments, including a $1,500 payment to pregnant people and an additional $500 per month for infants, birth through 12 months. The pilot program will help test whether cash payments are a key to reducing the toxic stress and effects of poverty on kids, and may help scale a similar program statewide in the future. Despite there being no means testing to the program, this is an appropriate use of TANF funds due to the high concentration of child poverty in Flint, especially for children under the age of 5.
Emily Jorgensen joined the Michigan League for Public Policy in July 2019. She deeply cares about the well-being of individuals and families and has a great love for Michigan. She is grateful that her position at the League enables her to combine these passions and work to help promote policies that will lead to better opportunities and security for all Michiganders.
Jacob Kaplan 
Mikell Frey is a communications professional with a passion for using the art of storytelling to positively impact lives. She strongly believes that positive social change can be inspired by the sharing of data-driven information coupled with the unique perspectives of people from all walks of life across Michigan, especially those who have faced extraordinary barriers. 
Rachel Richards rejoined the League in December 2020 as the Fiscal Policy Director working on state budget and tax policies. Prior to returning to the League, she served as the Director of Legislative Affairs for the Michigan Department of Treasury, the tax policy analyst and Legislative Director for the Michigan League for Public Policy, and a policy analyst and the Appropriations Coordinator for the Democratic Caucus of the Michigan House of Representatives. She brings with her over a decade of experience in policies focused on economic opportunity, including workforce issues, tax, and state budget.
Donald Stuckey 
Patrick Schaefer
Alexandra Stamm 
Amari Fuller
Renell Weathers, Michigan League for Public Policy (MLPP) Community Engagement Consultant. As community engagement consultant, Renell works with organizations throughout the state in connecting the impact of budget and tax policies to their communities. She is motivated by the belief that all children and adults deserve the opportunity to achieve their dreams regardless of race, ethnicity, religion or economic class.
Megan Farnsworth joined the League’s staff in December 2022 as Executive Assistant. Megan is driven by work that is personally fulfilling, and feels honored to help support the work of an organization that pushes for more robust programming and opportunities for the residents of our state. She’s excited and motivated to gain overarching knowledge of the policies and agendas that the League supports.
Yona Isaacs (she/hers) is an Early Childhood Data Analyst for the Kids Count project. After earning her Bachelor of Science in Biopsychology, Cognition, and Neuroscience at the University of Michigan, she began her career as a research coordinator in pediatric psychiatry using data to understand the impacts of brain activity and genetics on children’s behavior and mental health symptoms. This work prompted an interest in exploring social determinants of health and the role of policy in promoting equitable opportunities for all children, families, and communities. She returned to the University of Michigan to complete her Masters in Social Work focused on Social Policy and Evaluation, during which she interned with the ACLU of Michigan’s policy and legislative team and assisted local nonprofit organizations in creating data and evaluation metrics. She currently serves as a coordinator for the Michigan Center for Youth Justice on a project aiming to increase placement options and enhance cultural competency within the juvenile justice system for LGBTQIA+ youth. Yona is eager to put her data skills to work at the League in support of data-driven policies that advocate for equitable access to healthcare, education, economic security, and opportunity for 0-5 year old children. In her free time, she enjoys tackling DIY house projects and trying new outdoor activities with her dog.
Amber Bellazaire joined the Michigan League for Public Policy as a policy analyst in June of 2019. Her work primarily focuses on state policy and budgets affecting Michigan’s Medicaid programs. Previously, Amber worked at the National Conference of State Legislatures tracking legislation and research related to injury and violence prevention, adolescent health, and maternal and child health. She also brings with her two years of Americorps service. As a full time volunteer, Amber had the opportunity to tutor high school students in Chelsea, Massachusetts and address issues of healthcare access and food insecurity through in-person outreach in Seattle, Washington.
Simon Marshall-Shah joined the Michigan League for Public Policy as a State Policy Fellow in August 2019. His work focuses on state policy as it relates to the budget, immigration, health care and other League policy priorities. Before joining the League, he worked in Washington, D.C. at the Association for Community Affiliated Plans (ACAP), providing federal policy and advocacy support to nonprofit, Medicaid health plans (Safety Net Health Plans) related to the ACA Marketplaces as well as Quality & Operations.
