This edition of “5 Things We’re Watching” in Michigan health policy features a conversation on some current policy initiatives with a health policy expert at the University of Michigan, an update on the state’s CCBHC program, and Gov. Whitmer’s health-related remarks in her recent State of the State address.
With the 2022 legislative session underway, we plan to cover some of the health bills being discussed by lawmakers this year. If there are any specific bills or subject areas you’d like us to cover, please don’t hesitate to let us know! Your input here is incredibly valuable.
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State of Reform
1. Q&A: UM health policy expert Nancy Baum
The impacts of Medicaid redetermination on Michiganders’ health coverage is top-of-mind for Nancy Baum, health policy director with the Center for Health and Research Transformation at the University of Michigan. In this Q&A, Baum discusses the impending end of the public health emergency, CHRT’s current projects, and the legislative effort to privatize PIHPs.
Concerning Michigan’s SIP legislation, Baum said efforts to integrate the financing for physical and behavioral health might not necessarily result in the integration of the actual delivery of care. “I think that what you see here is an important philosophical difference between whether there should be a publicly funded behavioral health system or whether Medicaid health plans could do a better job in terms of ultimately getting that care integrated at the delivery level,” she said.
2. CCBHCs proving effective in first months
MDHHS’s Certified Community Behavioral Health Clinic demonstration program has been in effect since Oct. 1, and MDHHS’s Jon Villasurda says the program is proving successful at providing BH care to underserved Michiganders. The two-year program consists of 13 clinics that provide services like mobile crisis teams and holistic physical/behavioral health screenings.
Villasurda told State of Reform that 13,000 of the up to 300,000 eligible Michiganders are currently receiving services through the pilot program. The CCBHCs and MDHHS are conducting public outreach campaigns to increase engagement, but are taking the state’s health care workforce strain into account to ensure they don’t overload the clinics.
3. Whitmer highlights health priorities in State of the State
Gov. Whitmer delivered her State of the State address last week, highlighting her administration’s focus on improving access to mental health services and lowering the price of prescription drugs. She specifically called for the expansion of the Michigan State Loan Repayment Program to bolster the mental health workforce, and for the passage of HB 4346, which would limit the out-of-pocket cost of insulin to $50 per month.
Monique Stanton, president and CEO of the Michigan League for Public Policy, told State of Reform the governor’s prioritization of BH care is critical to opening the dialogue around expanding access to this care and to curbing the state’s high overdose rate.
4. Opioid task force to embed equity into work
The Michigan Opioids Task Force released an RFP last month for a consultant to develop and lead a new Racial Equity Workgroup within the task force. The consultant will work to incorporate community voices into the task force’s decision-making process and to provide on-the-ground accounts of the opioid epidemic’s impact on underserved communities.
“In order to disrupt and dismantle [unhelpful] practices, we will have to do something different. And part of that requires us to include those who we are seeking to provide assistance to,” said Michele Harper, former director of the Office of Race, Equity, Diversity, and Inclusion at MDHHS. Interested applicants must submit their proposals by 5pm EST on Feb. 7. The anticipated start date is March 1.
5. Budget neutrality rules for section 1115 waivers
Now an integral part of 1115 waiver consideration, the requirement that state waiver proposals don’t exceed spending that would have occurred without the waiver hasn’t always been the norm. In this analysis, State of Reform columnist Jim Capretta breaks down the “budget neutrality” rule that CMS uses in its waiver approval process, explaining that federal statute doesn’t mention this criterion at all.
Budget neutrality first became a standard during the Reagan administration, Capretta says, due to concerns that states would use waivers to leverage more federal funding. He also explains that many states apply for 1115 waivers to pursue programs that don’t need waiver authority, like managed care initiatives, because using a waiver allows them to direct the saved money from the program to cover additional services and populations under Medicaid.