5 Things Michigan: Upcoming BH integration work, Becky Cienki, ‘No fault’ reform


Eli Kirshbaum


I’m happy to introduce our new Reporter covering Michigan, James Sklar! James is based in Lansing and has a seasoned background in policy advocacy and law. You’ll be seeing his byline more as he continues his coverage for us in Michigan. Welcome, James! We are so thrilled to have you joining us.

This edition of “5 Things” includes insight about how behavioral health integration might again come into play this year with anticipated reforms of dual eligible policy, the Michigan Health Endowment Fund’s Becky Cienki’s recent work, and information about how the 2019 reforms to Michigan’s “no fault” laws have impacted Michigan patients and its potential to be revisited in 2023.

Thanks for reading!

Eli Kirshbaum
State of Reform


1. BH integration could again be point of focus in 2023 with dually eligible demonstration

In accordance with recent CMS guidance concerning dual eligible demonstrations, Michigan is planning to transfer its current Dual Special Needs Plans to Integrated Dual Eligible Special Needs Plans by 2026. With this work on the horizon, behavioral health integration will again be on the table in 2023, according to HMA Managing Principal Dave Schneider—albeit in a different form than it was in 2022.

Michigan will either implement fully integrated or highly integrated dual eligible special needs plans. FIDE SNPs would cover primary, acute, and long-term care, and (unless chosen to be carved out) behavioral health care. HIDE SNPs would cover either long-term services and supports benefits or behavioral health. Schneider anticipates some of the same policy concerns from the same groups of stakeholders since moving BH funding out of PIHPs could again be considered.


2. Registration for 2023 Michigan conference now live!

We’re already well underway with planning for our 2023 conferences, and thrilled to say that registration is now open for the 2023 Michigan State of Reform Health Policy Conference! The event will be held in person at the Lansing Center.

We’re so excited to return to Lansing next year for what’s sure to be our best conference in the state yet! Our team is currently in the process of planning the panel schedule and list of speakers, which will include some of the most knowledgeable folks in Michigan health policy. Keep your eyes out for further updates, and don’t forget to register to join us!


3. What They’re Watching: Becky Cienki, Michigan Health Endowment Fund

In this edition of “What They’re Watching,” Michigan Health Endowment Fund’s Behavioral Health Director Becky Cienki discusses her priority areas of nutrition, behavioral health, and healthy aging. The Fund provides policy guidance and funding to improve healthcare for the state’s underserved populations.

In 2021, the organization allocated a total of $33 million in grants to fund 170 projects throughout Michigan. “Some of those projects focused on things like food security at a local level, and others really address larger systemic opportunities to look at social determinants. For example, being able to connect housing information with health information and being able to alert providers about opportunities to provide more intense case management.”



4. Will ‘no fault’ reform be revisited in 2023?

After the passage of SB 1 in 2019—which aimed to lower Michigan’s highest-in-the-nation auto insurance rates—thousands of Michiganders haven’t had the resources to access care for their automobile-induced injuries. The 2019 no fault law reforms cut reimbursement for car crash injury treatment to healthcare providers by 45%, and while well-intended, have raised scrutiny among stakeholders due to these consequent gaps in care.

Since the reforms were passed, insurance companies have cut payments to long-term care providers by 45%, forcing many to close. Almost 8,000 auto accident survivors have lost their healthcare coverage and over 4,000 healthcare workers have lost their jobs following the reforms. While current House Speaker Rep. Jason Wentworth said earlier this year that no fault law wouldn’t be taken up again next year, some lawmakers have recently indicated their openness to revisiting it in 2023.


5. Employer-sponsored insurance in 2022

The country’s largest firms (over 1,000 workers) provide employer-sponsored insurance coverage for 57% of the entire ESI population, despite representing only 0.4% of all firms in the US. Citing findings from the Kaiser Family Foundation’s annual ESI survey, as well as a companion Health Affairs article from its authors, State of Reform Columnist James Capretta provides an overview of some of the survey’s most valuable findings about the insurance model that so many Americans rely on.

The survey highlighted that ESI premiums are notably high compared to the average employee wage—40% of the approximate average worker wage in the third quarter of 2022, $55,640. Capretta noted that ESI family coverage premiums have increased only slightly in recent years, with an average annual growth rate of 3.6%. However, he also predicts a sizeable premium increase in 2024, since insurers likely set their 2023 rates prior to becoming fully aware of inflationary impacts.