Michigan's 16 Medicaid health plans today called on the state Legislature to go further than a state panel recommended on putting Michigan on the path to giving the HMOs a greater role in the state's $2.4 billion Medicaid behavioral health system.
Earlier this month, the Michigan Department of Health and Human Services issued a 91-page interim report to the Legislature that outlines recommendations developed through a nine-month meeting process that involved health plans, mental health agencies, providers and families and clients.
However, MDHHS also recommended pilot projects to test different delivery and financing models, but details on the types of projects were withheld pending requested suggestions and the final report, which is expected to be completed by March 15.
"We applaud the work done by the Section 298 group, and recognize it has opened new lines of discussion that can only be valuable as we move forward," Dominick Pallone, MAHP's executive director, said in a statement. "But at the end of the day, the report offers few real solutions and has so far missed an important opportunity to encourage pilot programs that we believe will demonstrate that MAHP members can deliver improved services to one of the most vulnerable groups in our society."
It is unclear from MAHP's statement what exactly the association wanted MDHHS to do differently, other than possibly issue stronger language about plans to use pilot programs to test integration of behavioral and physical health. It also seems to suggest that the state interim report falls short in recommending unified financing mechanisms to fund an integrated system.
MAHP called the status quo "unacceptable," and said its report raises "important issues omitted in the proposed "Section 298" report. It said legislation is critical to improve the state's "much-maligned mental health system by integrating physical and behavioral health services through Medicaid."
However, MDHHS's interim report specifically asks organizations involved in mental health care to submit suggested pilot models for integration of physical and behavioral health systems. Crain's has learned that several Medicaid HMOs have developed the outlines of pilot studies and will present them to MDHHS at the appropriate time.
The MAHP report also noted that the state's report, which was developed by more than 1,000 stakeholders and dozens of meetings, offers "few substantive changes, and its recommendations do not adequately address the workgroup's charge by the state to create a roadmap for effective and efficient integrated financing models."
For example, MAHP said MDHHS' 298 Interim Report does not address the administrative or financial solutions needed to move toward an integrated system. MAHP also said it does not provide for pilot or model programs that could show how integration through managed Medicaid insurers.
MAHP said the state continues to suggest two separate systems to deal with multiple behavioral health issues, including drug addiction or serious depression. This, said the HMOs, is likely to cause "conflicting or inadequate treatment of both."
Though MAHP does not state clearly that it wants to take over the $2.4 billion Medicaid behavioral health system, the HMOs suggest something close to it. The report said that "integrating these operations under a managed care system would allow for a case manager to ensure proper treatment of all issues, with a goal of improving services and avoiding unnecessary treatment."
Early last year, Gov. Rick Snyder's proposed 2017 state budget included a provision that could have allowed the state's managed care organizations to manage the $2.4 billion Medicaid behavioral health funding. Currently, 10 prepaid inpatient health plans, which are operated by the public mental health system, manage the funding and contract with providers.
Mental health advocates strenuously objected to HMOs taking over the entire system and the issue has been contentious all last year between the two sides and the state.
MAHP's report also calls for pilot programs involving managed Medicaid providers, incentives for "early adopters" in approving pilot programs that include system and payment integration as well as clinical integration and continuation of policies that allow use of equally effective generics or substitutions for expensive drugs prescribed by clinicians.
"We know other states are moving toward integration so they can continue or expand services in a time of fiscal constraint," said Pallone. "If Michigan ignores this opportunity, we could see fewer services or reduced access for those who we all know deserve better."
"Michigan HMOs propose pilot projects to reform mental health system" originally appeared in Crain's Detroit Business.