LANSING — Michigan lawmakers are considering integrating mental and physical health care to make it more affordable, accessible and dependable for the state’s poorest citizens.
The proposal builds on Medicaid programs and has been the subject of two recent state Senate hearings. Medicaid treatment today separates physical and mental health, making it challenging for patients to get proper treatment as they’re unable to receive care by one professional.
Advocates want to reduce the stigma of receiving mental health treatment and increase follow-up treatments.
But critics worry that allowing private health insurers to provide services will channel some of Michigan’s $3 billion Medicaid mental health budget into the pockets of for-profit businesses.
Still, supporters of the legislation say they are encouraged.
“I have never before seen so much interest in a bipartisan manner at addressing behavioral health needs of our population than right now,” said Dominick Pallone, the executive director of the Michigan Association of Health Plans. “I think the pandemic has catalyzed policymakers around recognizing the need for major reforms and major improvements for behavioral health services.”
Similar measures have been adopted by 33 other states. The idea is to revamp the mental health code to maximize services for the Medicaid-qualified population, as most people with private insurance already receive this integrated care, said Sen. Mike Shirkey, R-Clarklake, a cosponsor of the bill. “It’s a systematic problem.
“A substantial amount of costs and problems associated with physical health (for those on Medicaid) are directly related to this mismanagement of mental health.”
Integrating care would bring all services under one roof, making the system much easier to navigate.
“People wouldn’t have to be ping-ponged between systems,” Jim Haveman, the former director of the Michigan Department of Community Health who helped write the code in 1995, said in a phone interview.
But Tom Watkins, a former director of the state mental health department, said it’s a misnomer to call the bill integrated care.
“What it is, is transferring $3 billion of public money to private, oftentimes profit-making companies,” Watkins said in a phone interview. “We should be focused on service for people, not profit for company.”
The reality is, public health care already is sponsored by private companies, said Shirkey.
“I categorically reject the straw man argument on private businesses,” said Shirkey. “It is already prominent in how we deliver health care, even in the public sector.”
Privatization is not the only concern. Community mental health agencies oppose the proposed legislation and instead recommend focusing on funding certified community behavioral health clinics.
Funding such services would open up the same services to all constituents, regardless of Medicaid or insurance status, said Julia Rupp, the CEO of HealthWest, the community mental health program in Muskegon County.
“The answer is not financial integration,” Rupp said at a recent Senate committee hearing. “I thought it was.”
HealthWest was one of three pilot projects around Michigan participating in the Section 298 program, which was a trial run for integrated mental and physical health care in 2018. This, however, was publicly funded financial integration, where Shirkey’s bills allow private companies.
People agree the system needs to be fixed to better serve Michigan residents, and the focus needs to be on healing the whole person, true integration, said Lisa Williams, the CEO of West Michigan Community Mental Health.
Yet, there’s nothing in the bills to limit community mental health services, Pallone said. All they’re doing is bringing in private companies, which must contract with community mental health, to compete. Not in terms of money, but in terms of care.
“We don’t want to do anything to exclude community mental health, but we want to give people the ability to choose if they don’t like their provider,” said Pallone.
The goal of these bills is integration, but advocates are really looking to better serve mental health patients on Medicaid.
“We don’t see mental health as a disease, we see it as a carve-out from health care,” Haveman said. “Mental health is a disease, and we need to treat it as so.”