Advocacy groups believe HMOs would fail on behavioral health
Sunday, April 16, 2017
An April 2 Other Voices column by MeridianHealth's Jon Cotton had fascinating comments on the question of whether Michigan should turn Medicaid behavioral health funding and clients over to the state's Medicaid Health Plans (MHPs).
This issue began February 2016, when Gov. Rick Snyder proposed such action take place by September 2017. The state has subsequently taken three major reviews of the issue; at each stage, the governor's proposal was rejected.
First, Lt. Gov. Brian Calley appointed a large workgroup in early 2016. Then the state's Department of Health and Human Services held affinity groups last fall, involving over 1,000 people. Finally, a 23-person DHHS Section 298 Workgroup issued reports to the Legislature in January and March.
The author of the April 2 column complained the state's MHPs had "a difficult time winning a seat at the table." Representatives of those plans were on the lieutenant governor's workgroup and the smaller DHHS Workgroup that followed. DHHS also assured that one of its affinity groups was for service payers.
In fact, the Michigan Association of Health Plans co-drafted most of the key recommendation adopted by the Section 298 Workgroup in December, and the MAHP voted for the final version of that recommendation. That recommendation stated that Michigan should retain a Community Mental Health system to lead behavioral health care and a Medicaid health plan system to lead other medical care. The recommendation ended by saying proposals for care coordination models or pilots could come from "competent, public, risk-based configurations."
(In making this recommendation, the Section 298 Workgroup didn't accept everything as is today. Over 70 other recommendations were sent to the Legislature. Many called for improvements to the publicly funded behavioral health system. There was also a recommendation for expansion and broadening of joint programs between Medicaid health plans and community mental health programs.)
The April 2 column also claimed that behavioral health interests opposed to the governor's recommendation must "believe that not only would managed care organizations succeed in managing the behavioral health benefit, but that we would be better at it."
Speaking for the state's leading behavioral health advocacy organizations, that is completely untrue. Advocacy groups, who were outnumbered 15-8 by providers and payers in the DHHS Section 298 Workgroup, and who have no financial stake in where money gets appropriated, aren't afraid of HMO success. Rather, we and the beneficiaries and families we represent believe the HMOs would fail:
- Medicaid health plans have been responsible for a limited "mild-to-moderate" mental health benefit for 20 years, and have done a poor job with it.
- Community mental health programs, being directly connected to government, are more transparent with greater public accountability.
- MHPs have limited experience with severe behavioral disorders or concepts like beneficiary involvement in planning; consumer self-determination; and social supports.
- Michigan has run a financial integration demonstration project in four regions for persons with both Medicaid and Medicare. Eligible people are automatically enrolled in MHP-like entities, with the option to subsequently un-enroll. After almost two years, over 60 percent of those the state automatically placed with MHP-like entities have disenrolled.
- Service coordination isn't achieved by financial integration at macro-administrative levels. It happens at local provider levels, and those providers will have contracts with CMH programs and MHPs, regardless of where the state first sends its money.
Most important are the voices of service recipients and their families. Last fall, 31 of the 45 statewide affinity groups involved consumers and families (767 people out of 1,113 total affinity group attendees). The consumers and families couldn't have been clearer that, overwhelmingly, they didn't want Medicaid health plans managing their behavioral health care. Those who comment on Section 298 for their own purposes conveniently omit this information. They also fail to acknowledge that no affinity group, including the ones for providers and payers, recommended adoption of the governor's proposal.
Legislators must ask if their responsibility is to the public or to well-funded and lobby-heavy private insurers who seek to control more money.
Advocates bring the unified voice of Medicaid beneficiaries and their families, whose lives are on the line.
Where Michigan goes will speak volumes about our state.