If you haven’t heard, there’s been serious discussion about making major changes to publicly funded mental health and substance use disorders in Michigan. The current system carves out money for those services and give it to 10 regional entities that contract for and oversee Community Mental Health services and substance use disorder services. The question is whether that should continue or whether the money and responsibility should be given to the HMOs serving Michigan Medicaid recipients.
It’s complicated.
There are ways in which it seems sensible and de-stigmatizing to have Medicaid recipients receive services just like everyone else—through their insurer.
On the other hand, the people served by the public system often represent the most severe and complex cases. In response to this severity and complexity, public systems has developed systems of care that include things like peer support, supportive housing, employment support, and mental health club houses. They also work with local communities and first responders on things like overdose rescue, and problem solving courts. It’s hard to imagine HMOs doing this kind of work.
There is a 298 workgroup and they just issued the following statement:
The Michigan Department of Health and Human Services (MDHHS) today submitted the interim report for the Section 298 Initiative to the Michigan legislature. The Section 298 Initiative is a statewide effort to improve the coordination of physical health services and behavioral health services. The interim report reflects the discussions of the 298 Facilitation Workgroup. The interim report contains a series of policy recommendations for the Michigan Legislature on improving the coordination of physical health and behavioral health services.
The MDHHS and the 298 Facilitation Workgroup also launched the next phase on the Section 298 Initiative today. The next phase of the initiative focuses on the development of recommendations on models and benchmarks for implementation.
As part of the next phase of the initiative, interested stakeholders can submit potential models for consideration by the 298 Facilitation Workgroup. MDHHS will accept model proposals submitted to MDHHS-298@michigan.gov using a standardized template from January 13, 2017 to February 3, 2017 at 5:00 p.m. The model proposal template can be found on the MDHHS webpage at www.michigan.gov/stakeholder298.
The model proposal process is not a request for proposal which will result in a direct contract or other formal engagement of the submitter(s): this process is a request for information which will contribute to the development of the Section 298 Final Report for the Michigan legislature.
For more information about the interim report and the model proposal process, visit www.michigan.gov/stakeholder298 or send an email to MDHHS-298@michigan.gov.
If you have opinions on the matter, please contact the workgroup and your legislators. (There’s still plenty of time. This has not been a fast moving process.)
recoveryreview.blog 
Another significant consideration for me is commercial insurers don’t recognize certified SUD staff which represents about 48 % of the behavioral health workforce in Michigan. The current Medicaid reimbursement rates have been criticized as inadequate to retain direct care workers from leaving the field. It is uncertain how the behavioral health provider will absorb increased labor costs.
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