An Update on Behavioral Health Integration

May 14, 2019

 

One of the most frustrating issues facing policymakers in Lansing today remaining is deciding how to improve access and outcomes for individuals with behavioral health needs throughout Michigan.  Lawmakers have already done excellent work in removing statutory barriers to clinical information sharing and addressing provider shortfalls by incentivizing new clinician training and retention programs for underserved areas, amongst a myriad of other successful legislative initiatives. However, for those served by the Medicaid program in Michigan today, our state continues to lag behind other states in our efforts to truly provide services to the whole person.

Despite years of talk, Michigan continues to have one entity responsible for the physical health of Medicaid enrollees, and a separate unconnected entity responsible for the behavioral health of the same person. Section 298 of the state’s annual omnibus budget has for several years attempted to rectify this by instructing the state to move to a system that truly serves the person. Numerous studies have shown the benefits in improved physical and behavioral health outcomes that can be attained through integrating at a financial, operational, and clinical level.  And yet in Michigan, we still debate this approach. While Lansing debates, Rome is burning:  https://www.bridgemi.com/michigan-health-watch/mounting-debt-threatens-west-michigan-medicaid-mental-health-agency 

For the first time ever, a PIHP, Community Mental Health Partnership of Southeast Michigan, entered into the third level of their risk contract with MDHHS in FY 2018. That means they overspent their agreed upon capitation rates by so much that the state is financially liable for a large portion of it. Also in FY 18, another PIHP, Lakeshore Regional Entity, completely exhausted its risk reserves, despite receiving multiple supplemental bailouts from the Sfate.

It is apparent that the status quo is not producing the best health outcomes for Medicaid individuals with physical and behavioral health needs, and it is certainly not producing the best returns for taxpayer investments. It has been argued by some that a change to the status quo might result in “the erosion of the safety net services” provided by CMHs to non-Medicaid recipients. However, it is abundantly clear that it is actually the current process that is siphoning state and local funding away from services and supports from those in need that are not eligible for Medicaid. When a PIHP overspends on Medicaid, they often divert non-Medicaid resources to cover their shortfall – causing the very “safety net services” to be defunded. In FY 18 this overspending on Medicaid by the PIHPs was more than $77 million.

There is a better path forward. A path that helps to improve the overall health of Medicaid beneficiaries and would put an end to the diversion of state and local funds otherwise intended for safety net services. Licensed Medicaid health plans stand ready to better manage the behavioral health needs of this population. In order to be successful, Medicaid health plans must be allowed to control a network of CMH and non-CMH providers who would be required to meet all applicable provider standards under the Mental Health Code. Medicaid health plans must also be allowed to hold ultimate authority and responsibility for utilization management, and they stand ready to partner with CMHs to procure care coordination and other administrative services when needed. 

Finally, any effort to treat the healthcare needs of the whole person needs to have an agreed upon the pathway to success and expansion. Preselected metrics should be developed as an objective way to measure improvements to the health and satisfaction of the Medicaid member. If these positive outcomes are achieved, we shouldn’t put policy-makers back into the quagmire of debating an approach that is proven successful.

 

By Dominick Pallone, Executive Director of MAHP