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Despite Veto, Section 298 Will Continue In Some Fashion

Thursday, October 3, 2019   (0 Comments)
Posted by: Algeria Wilson
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Despite Veto, Section 298 Will Continue In Some Fashion

The entirety of Section 298 in the Department of Health and Human Services budget, the section which set off some of the bitterest controversy in the budget over the last few years as the state looked at a way of integrating Medicaid management for both physical and behavioral health, was cut from the 2019-20 budget in a line-item veto by Governor Gretchen Whitmer, yet state officials and others said the program will continue.

In fact, work is still continuing – and should be completed shortly – on a memo of understanding between the Medicaid health plans and the community mental health associations on an integration program and the three pilot programs authorized in earlier budgets.

Even mental health advocates who cheered Ms. Whitmer's veto of the section said they were committed to "develop a holistic health care approach to service that would pioneer an alignment of mental, physical and social outcomes in our state's Medicaid system."

And Dominick Pallone, executive director of the Michigan Association of Health Plans, said DHHS officials made it clear, even if it was not stated directly, at a Medicaid operations meeting Tuesday that vetoing Section 298 along with the 47 vetoes in SB 139 (PA 67) was a negotiating tactic to get Republican legislative leaders to help develop compromises.

In a telephone press conference, DHHS Director Robert Gordon said Section 298 had always been conceived as a pilot program and the state would make a decision based on the pilot program's performance how to go forward with integrating management of Medicaid funding for physical and mental health.

In fact, former Governor Rick Snyder had initially proposed the budget section to move the state toward statewide implementation of the integration. The outcry against the proposal from the mental health community, as well as family members of mental and behavioral health patients, worried about private companies overseeing care, was so immediate and outraged the Legislature simply told Mr. Snyder's administration they would not act on the proposal. That led to long discussions which finally resulted in overall standards for an integration plan and then eventually to a call to undertake three pilot programs.

The budget the Legislature passed, Mr. Gordon said, put the integration plan "on auto pilot." If the pilot programs met certain benchmarks, then the state would move into enacting a statewide integration plan.

Mr. Gordon said the state needs to find new ways to get help for those needing behavioral treatment as well as physical health care, and "we need to think about new ways to provide" for the overall support and management of that care.

Not mentioned by Mr. Gordon was a controversial provision in the budget allowing health plans in the pilot projects to work with providers other than those in community mental health. Mental health advocates said the provision could have meant thousands of patients were left with no care, but Mr. Pallone said the provision would help assure more effective care for patients.

Robert Sheeran of the Community Mental Health Association of Michigan, along with several other community mental health officials, issued a statement praising Ms. Whitmer's veto they said which stopped a provision "that would have significantly favored for-profit health plans in our state."

The statement also said, "We still believe that the public mental health system and innovative and forward-looking private sector partners can design a groundbreaking behavioral health initiative that could fundamentally redefine the way local providers coordinate physical and mental health care and achieve sound health outcomes for our state's most vulnerable and resilient citizens – and we want to ensure the project is implemented correctly."

But that will have to include, "Keeping the integrity of the state's nationally recognized and locally governed public mental health system intact and strong."

However, Mr. Pallone said the ability of health plans to work with a variety of providers is critical from his organization's standpoint.

In fact, without that flexibility, Mr. Pallone said, "it's a deal breaker. We cannot have exclusivity with CMH."

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