While legislators have been focused on the debate surrounding Medicaid work requirements, they have also been busy debating the state’s budget. The Michigan Department of Health and Human Services (MDHHS) is one of the largest state departments and is responsible for the health and safety of Michigan residents—in particular the state’s mental health system, public health, and Medicaid. Moving through the budget process, we at the League hope that the legislature will prioritize programs that improve the health of Michigan residents—instead of pursuing political policies that may end up harming people, especially those currently enrolled in the Healthy Michigan Program.
- Governor: In his budget proposal, the governor continued financial support for the Healthy Michigan program. Implemented in 2014, Healthy Michigan (Michigan’s Medicaid expansion program) extended healthcare to over 670,000 Michiganders with low incomes. The Healthy Michigan Plan has been positive for our state economy, hospitals, and most importantly those enrolled in the program. Currently, the federal government pays 93% of the costs of the Healthy Michigan Plan. For the 2019 budget year, the governor provided the state General Fund dollars needed to fully fund the program.
- Senate: While the Senate continued to support the program in concept, it removed $60 million intended to be used for premium assistance payments. Beginning April 1, 2018 enrollees above 100% of the federal poverty line who do not comply with healthy behavior requirements (outlined in PA 107 of 2013) must enroll in Medicaid coverage through the federal exchange, with the state Medicaid financing requirements still applying. Corresponding budget language would require the Department of Health and Human Services to submit a waiver to the federal government prohibiting Healthy Michigan funding from being used to support Medicaid coverage or premium assistance on the federal health care exchange. Essentially, this language would cap the amount of time an individual could be insured through Healthy Michigan to 48 months, and states that completion of a healthy behavior requirement does not qualify an enrollee for continued enrollment. There is some question whether this language is legal.
- House: The House continued support for the Healthy Michigan Plan, but does remove $1.7 million to discontinue gift cards given to Healthy Michigan enrollees above 100% of the federal poverty level for completing a health risk assessment.
PUBLIC HEALTH INVESTMENTS
- Governor: With the ongoing Flint water crisis, a hepatitis A outbreak, and polyfluoroalkyl substances (PFAS) water contamination, the governor recommended full-year funding for PFAS cleanup and additional funding to local public health departments to help address emergency health threats including vapor intrusion, drinking water contamination and hepatitis C.
- Senate: The Senate agreed with the governor on PFAS needs including laboratory capacity, environmental health toxicology and response. The Senate does not include funding for local health department response grants intended to expand local public health support for other emerging public health threats.
- House: The House agreed with the governor.
WAGE INCREASES AT STATE PSYCHIATRIC HOSPITALS
- Governor: Psychiatrists at our state psychiatric hospitals are paid significantly less than our Great Lakes neighbors, and the MDHHS—with the approval of the Civil Service Commission—has proposed an increase in wages. The investment, which is included in the governor’s 2019 budget, is expected to cost the state $1.4 million. This wage increase will allow the state to attract and retain high-quality psychiatrists and reduce waiting lists at the hospitals.
- Senate: The Senate concurred with the governor on salary increases.
- House: The House concurred with the governor.
FLINT WATER CRISIS FUNDING CONTINUES
- Governor: As Flint continues to deal with the effects of the ongoing water crisis, the governor reduced MDHHS assistance by $16.9 million but provided one-time funding for food and nutrition services, health services at child and adolescent health centers and schools, lead poisoning prevention and lead abatement.
- Senate: The Senate agreed with the governor.
- House: The House concurred with the Executive, but uses prior year funding to support the one-time $2.9 million General Fund increase.
BEHAVIORAL HEALTH INTEGRATION
- Governor: A hot topic during the past few budget cycles was the integration of behavioral health and physical health proposed by the governor through budget boilerplate language. The 2019 budget encourages the department to continue pursuing the pilot projects it was directed to take on this year. The MDHHS identified the pilot sites in March: Muskegon County Community Mental Health and West Michigan Community Mental Health, Genesee Health System, and Saginaw County Community Mental Health Authority. The Department continues to work on implementation of these pilot projects.
- Senate: The Senate concurred with the governor but changed pilot design from two to three years and created new language that allows health plans to contract directly with service providers in the pilot project areas.
- House: The House concurred with the governor and retained language regarding legislative intent and sharing of performance metrics.
LEAD PREVENTION BOARD
- Governor: In 2016, the governor created the Child Lead Poisoning Elimination Board, which was charged with designing a long-term strategy to eliminate child lead poisoning. For 2019, the governor includes $1.25 million to carry out the recommendations of the board, including expanded home testing, a statewide database and a requirement to test all children for lead exposure.
- Senate: Senate concurred with the governor.
- House: The House reduced funding by half to $625,000.
MEDICAID WORK REQUIREMENTS
- Governor: The governor did not include budget language regarding Medicaid work requirements.
- Senate: The Senate included punitive language that would withhold salaries for certain department staff—25% until the waiver proposed in SB 897 is submitted, and another 25% until the waiver is approved by the federal government.
- House: The House agreed with the governor.