Michigan First Delayed Again


    GRAND RAPIDS — Foot-dragging in Lansing and Washington, D.C., is setting off some nail-biting in Grand Rapids

    Gov. Jennifer Granholm’s Michigan First plan for health care coverage for the uninsured, which for the second year in a row has failed to meet an April 1 launch deadline, is stalled in federal hallways. The state budget — for both the remaining half of the current fiscal year and for 2008 — is ensnared in a Lansing stalemate.

    Meanwhile, network180, the agency in Kent County responsible for coordinating services for about 20,000 people with mental illness, developmental disabilities and substance-use disorders, is bracing for hits to its $106 million budget — or maybe not.

    “It’s a bit complicated. Nobody knows what’s going to happen,” said Paul Ippel, network180 executive director. That uncertainty dogs mental health service providers in particular, as part of the Michigan First negotiations encompasses $300 million in the state’s general fund that pays for their clients.

    “It just creates tremendous inefficiencies in the system, because we are trying to guess what’s going to happen,” Ippel said. “We’ve had increases in funding and cuts in funding in the past. When we know what’s happening, we can plan for that.”

    Network180 contracts with 27 local, nonprofit organizations, funneling Medicaid and state general fund money for their services, Ippel said.

    T.J. Bucholtz, spokesman for the state Department of Community Health, said the Granholm administration still hopes Michigan First will have a spring start.

    “Our negotiations with the federal government are continuing. We’re on the phone almost every single day with them now on this program,” he said. “We didn’t make the April 1 deadline, but we’re still hoping to have this in place in the spring.”

    The state is negotiating with the federal Department of Health and Human Services and the Center for Medicare & Medicaid Services about the use of designated federal and state money in crafting Michigan First. Gov. Granholm proposed Michigan First in 2006 to provide health insurance options through commercial carriers for about half of the state’s 1.1 million uninsured.

    Part of Michigan‘s request is that the federal agencies recognize that the state pumps $300 million in general fund money to cover mental health services for the uninsured who don’t qualify for Medicaid. But if Michigan First is implemented without that condition, Ippel said, the $300 million general fund allocation for the state’s 44 community mental health agencies is likely to be absorbed into the program.

    Lynda Zeller, president of Kent Health Plan and of the state-wide county health plan association, said Michigan First may still become a reality. She noted that the state Senate has a pending bill that is similar to Michigan First.

    “The good news is that there are still discussions going,” Zeller said. “In the meetings I have been in, it’s pretty clear that everyone is still committed to trying to move this forward.”

    But to Greg Dziadosz, president of network180 contractor Touchstone Innovare, who already has seen his mental health agency’s budget shrivel by 8 percent over two years, any tinkering with the general-fund allocation looms on the horizon.

    Without it “about 10 percent of our clients would lose services. It would be pretty devastating to a large number of people,” said Dziadosz.

    Touchstone Innovare provides case management, medicine management and outpatient therapy annually to about 2,600 people with severe mental illness. About 40 percent of them also have substance use disorders, Dziadosz said. The agency already has cut back on services to cope with its shrinking $10 million budget, most of which comes from its contract with network180, he said.

    Ippel said it can take months for agencies to respond to budget cuts.

    “If a person is in a home or a program, we’re not going to stop providing the service,” he said. “Slowing the door, the entryway, is the only way you can reduce services.”

    Network180 does have a fund balance that could see it through the current fiscal year, Ippel said. He is more concerned about the state budget result for 2008.

    The agency is forging ahead with plans for progress, knowing that mid-stream adjustments are possible, he said. For example, network180 would like to improve access to its services to minority and other under-served segments of the community; create a system with more continuity to serve children; and provide substance-abuse prevention and housing for those coming out of institutions or shelters.

    The agency is considering building a $4.9 million addition to its building at

    728 Fuller Ave. NE

    , leased from KentCounty for $1. The addition would house the AccessCenter, the first stop for clients, which now is located on

    Lake Drive

    . Ippel said network180 is considering a $1 million fundraising campaign for the 2008 project.

    “Those are priorities for us moving ahead,” Ippel said. “We are going to have to figure out a way to do those, and we may re-prioritize how we use existing resources to make sure we’re serving all members of the community.”     

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