Very like Michigan’s no-fault auto insurance coverage system, the group psychological well being system is seen by some as a mannequin to the nation that focuses on retaining folks of their properties and communities — and out of psychiatric hospitals.
And like Michigan’s once-mandatory limitless medical profit for injured drivers, a complete psychological well being system additionally is expensive — and people pressures have gotten worse in recent times.
In some corners of the state, the publicly run behavioral well being system was awash in purple ink earlier than the pandemic.
In 2019, MDHHS yanked a contract for the Lakeshore Regional Entity that oversees the move of behavioral well being Medicaid funding to seven counties in West Michigan as a result of the PIHP had run up a $16 million structural deficit.
Throughout that very same time interval, the four-county PIHP that distributes $163 million yearly in Medicaid {dollars} to behavioral well being suppliers in Lenawee, Livingston, Monroe and Washtenaw counties mentioned it racked up practically $42 million in deficit spending in fiscal years 2017, 2018 and 2019, in accordance with court docket data.
To get by, the Washtenaw County Neighborhood Psychological Well being Company lined a $10 million shortfall in 2019 with “native funds meant for different functions … placing different county obligations in danger,” in accordance with a lawsuit filed towards MDHHS final yr looking for a state bailout.
On the finish of 2018, Macomb County Neighborhood Psychological Well being had lower than $200,000 in its threat reserve fund — a dangerously low amount of money readily available for a well being care group with a $250 million annual finances.
All instructed, 9 of Michigan’s 10 PIHPs had structural deficits of practically $93 million in 2018, in accordance with monetary knowledge compiled by the Michigan Affiliation of Well being Plans, the commerce group for personal well being insurers within the Medicaid managed-care enterprise.
For critics of the general public well being system, together with the non-public insurance coverage firms vying for a slice of Michigan’s $20 billion Medicaid pie, the persistent deficits level to a system of care the place every tax greenback travels by way of a number of layers of presidency.
Having Medicaid sufferers in want of therapy for psychosis or a managed substance dependancy results in a “finger pointing over who’s answerable for paying” for behavioral and bodily well being issues that always intersect, mentioned Dominick Pallone, government director of the Michigan Affiliation of Well being Plans.
“On the finish of the day, we’re attempting to make the Medicaid profit feel and look much more like a industrial profit,” mentioned Pallone, whose group represents 12 main well being plans.
Michigan’s 10 regional PIHPs are an animal of the state, unlicensed public insurance coverage and managed care entities created by statute in 2011.
They obtain a set quantity of {dollars} from the Michigan Division of Well being and Human Companies to contract with 46 group psychological well being authorities that embody single counties in populous southern Michigan and a number of counties Up North.
The paperwork of Michigan’s public psychological well being system comes with a contract that is some 700 pages lengthy.
“When the cash involves us, it additionally comes with numerous necessities — and numerous these necessities simply value cash,” mentioned Dave Pankotai, CEO of Macomb County Neighborhood Psychological Well being.
