Budget Only Pays DHHS Officials’ Wages If Feds Approve Medicaid Waiver

Department of Health and Human Services Director Nick Lyon and his fellow unclassified employees would only be paid next year if the feds approve Michigan’s Medicaid expansion waiver as Republican lawmakers argue it was written, according to a Senate subcommittee spending plan approved April 17.

Sen. Mike Shirkey (R-Clarklake) and DHHS Subcommittee Chair Peter MacGregor (R-Rockford) argue the “Healthy Michigan” waivers the federal government approved do not reflect 2013 law that requires beneficiaries to pay more in co-pays and annual premiums after four years on the program.

SB 0856 puts a firm four-year cap on the Healthy Michigan program and withholds unclassified employees’ salaries unless the program that expands Medicaid to those between 100 and 133 percent of the federal poverty line follows expanded requirements.

And if Lyon and his top lieutenants don’t make that happen, $294,000 in their salaries and wages doesn’t get appropriated.

“Sometimes departments need motivation in making sure we get the best product out,” MacGregor said.

MacGregor added that he anticipates further discussion with the administration, but as he sees it, the federal waivers that allowed for the creation of Healthy Michigan doesn’t follow the state law Republicans passed. Either the law has to change, the waiver has to change, or both.

In the meantime, Sen. Curtis Hertel Jr. (D-East Lansing) said passing the Senate DHHS Appropriations Subcommittee would effectively kick 10,000 Healthy Michigan recipients off the program and onto the exchange. Such a move would be a $60 million ($4 million General Fund) savings.

“You’re cutting them off health care is what you’re doing,” Hertel said.

Lyon attended the subcommittee hearing and had a lengthy chat with Shirkey after the Fiscal Year 2019 budget passed to the full Senate Appropriations Committee. Afterward, Lyon noted that this is the “opening round.”

“We have an approved waiver in place and there’s always room for improvement and negotiations,” Lyon said.

The budget is $123 million ($25 million General Fund) below the governor’s recommendation, but much of the reduction is based on a substantial drop in various caseload adjustments.

Other highlights from the $4.5 billion spending plan included:

– Another $10 million for local health departments to respond to public health threats

– The restoration of $8 million to counties the Governor had recommended cutting

– A $3 million increase for Centers for Independent Livings

– Another $3 million for aging community services

– A rejection of the governor’s $2-a-month rate increase for the Family Independence rate

– A requirement that certain new autism cases only qualify for state funding if the patient receives a second opinion.

Shirkey Looks To Align Medicaid, Food Stamp Work Requirements

After 16 years of waivers, the entire state of Michigan is expected to join other states in October by requiring able-bodied food stamp recipients work at least 20 hours a week, go through at least 20 hours of work training or volunteer to keep the benefit.

The Department of Health and Human Services announced this federal requirement is expected to go on line for the non-disabled between age 18 and 49.

Kent, Oakland, Ottawa and a few other counties started work requirements for food stamp recipients last year, since their unemployment rate fell below the point where they no longer qualified for the waiver.

The Supplemental Nutrition Assistance Program (SNAP) requirement, put in place under former President George W. Bush, was frozen in time during President Barack Obama’s tenure under the argument that the Michigan’s unemployment rate was too high. But with a Republican back in the White House and Michigan’s unemployment rate down in the 4- to 5-percent range, the types of waivers the feds are accepting are narrowing and Michigan has run out of rope.

The development is particularly relevant now that Sen. Mike Shirkey’s (R-Clarklake) Medicaid work requirement bill, SB 0897, cleared the full Senate and received its first hearing in the House Appropriations Committee May 2.

Buried inside the bill is a requirement that the upcoming food stamp-to-work program requirements mirror the reporting requirements for Medicaid recipients. The two social welfare programs would run parallel to one another with likely overlap as far as the recipients, or at least that is what Shirkey is envisioning.

One item that has not been changed yet is the 29-hour work requirement work requirement in Shirkey’s bill. The food stamp work requirement is 20 hours and the expectation is that Shirkey’s bill will be pared back to match that number.

Shirkey conceded to MIRS there would be some “bending” on the number of hours able-bodied recipients would have to work to maintain their benefits and he sees some “tweaking” of the language dealing with exemptions. Other than that, he said, there are no major outstanding roadblocks left.”

Mary Mayhew, senior fellow for the Opportunity Solutions Project and a leading contender to be the next governor of Maine, spoke to the Medicaid/food stamp connection between the two programs in today’s written remarks to the House Appropriations Committee.

“Before we can implement work requirements for able-bodied parents on Medicaid, we need to once and for all fully restore the work requirements for childless, able-bodied adults on food stamps/SNAP as a matter of basic fairness,” Mayhew said. “Michigan has been on a voluntary 16-year-old waiver of the federal SNAP work requirement. If this waiver were a person, it would be old enough to drive.”

Rep. Kim Lasata (R-Berrien Springs) has legislation, HB 5368, which makes the food stamp work requirement permanent with no more waivers.

Shirkey and other advocates see overlap between the two programs. If an able-bodied resident needs to work 20 hours to keep his or her food stamps, what is the big deal about working 20 hours to keep his or her Medicaid?

Gilda Jacobs, CEO of the Michigan League for Health Policy, doesn’t buy the argument there is much overlap. A Michigan resident could be on Medicaid for a variety of reasons, but not qualify for food stamps or need food stamps, she said. Also, there’s a cap on food assistance that is not applicable for the federal health care program.

“If you have a chronic disease, you have a chronic disease,” she said. “You can’t cap it. So, these are two different things that we’re talking about. I think you need to bifurcate these two issues, look at them separately.”

One of the more notable developments in the May 2 House Appropriations Committee meeting on SB 0897 was the appearance of Rep. Lee Chatfield (R-Levering) alongside Shirkey at the testimony table. Chatfield, like Shirkey, is the presumed next Republican leader of his chamber’s caucus.

Together, they presented a powerful message that this is something the Republican majority is serious about pushing before year’s end, at the latest.

“Sen. Shirkey and I have been in conversations about this for the last several months,” Chatfield said. “I have double blue-backed a bill with him and offered my assistance once his bill made it to our chamber.

“When you’re talking about the economy of our state and growing our workforce, it needs to be No. 1 in importance. It’s one of the chief way of accomplishing and continuing the comeback of our state.”

Shirkey told MIRS he has “no concerns” about being able to work with Gov. Rick Snyder on the remaining few issues he wants resolved in order to move the package.

“He’s not signed off on the legislation, but he has absolutely signed off with a commitment to get something done,” Shirkey reported, adding, “I’m very confident with my working relationship with our governor. This is of no concern to me whatsoever.”

Shirkey also said he thinks the governor wants to see the final numbers on the administrative costs associated with the jobs program. With the House Fiscal Agency pegging it at between $25 and $45 million he observed, “If we are even partly successful,” that will pump an additional $1 to $2 billion “into new economic activity into state coffers,” which far exceeds the cost to the state.

Jacobs said she thinks the GOP effort is driven by stereotypes and election year politics.

“There continues to be the stereotype that people who are on assistance are sitting at home watching TV and collecting benefits (and) it’s also an election year. People want to go home and say, ‘I moved people off their benefits’ . . . This is ideologically driven.”

Rep. Fred Durhal III (D-Detroit) added another wrinkle to the alleged GOP motivation, claiming it’s part of a “back door” effort to eliminate what’s left of the Affordable Care Act.

“This is another hidden agenda to put a knife into the ACA a.k.a. Obamacare because they failed at the federal level to do it” and now they have moved to the states to finish the job.

While Shirkey argued he is doing this to save the Medicaid expansion program Healthy Michigan, Durhal responded “those bills do nothing to save Healthy Michigan.”

House Appropriations Committee Chair Rep. Laura Cox (R-Livonia) explained the committee did not vote today because “we’re going to work to see if we can make this bill perfect enough for the governor to sign.”

Asked about the list of more than 20 social safety-net groups opposed to the legislation, with some saying it will hurt the poor, the Chair countered, “That’s not the intent of the bills and you know that.”

Lawsuit Claims DHHS Unconstitutionally Confines People In Psychiatric Hospitals

Two Michigan residents filed a federal lawsuit May 2 alleging the state’s Department of Health and Human Services and its psychiatrists and contractors kept them institutionalized rather than providing alternative appropriate treatment.

The lawsuit, filed in U.S. District Court on behalf of Darryl Pelichet and Bonn Washington, alleges DHHS “filed petitions for continuing treatment orders that were facially invalid and presented false or misleading testimony to Probate Court.”

It also alleges that DHHS’ policy to automatically file a petition in probate court for one year of involuntary hospitalization for every person who is found not guilty by reason of insanity has “caused an unknown number of Michigan residents, including plaintiffs, to spend years of their lives unnecessarily and unconstitutionally confined in state-operated psychiatric hospitals.”

DHHS spokesman Bob Wheaton said the department hadn’t seen the lawsuit as of late on the afternoon of May 3 and they do not generally comment on pending litigation.

Pelichet, 38, who has been diagnosed with schizoaffective disorder, was 24 when he punched a Farmington police officer during an acute psychotic episode.

Washington, 43, also has been diagnosed with schizoaffective disorder. In 2005, he assaulted a Washtenaw County sheriff’s deputy during a psychotic episode after new medication exacerbated his symptoms.

Both men were found not guilty of their individual crimes by reason of insanity and both were committed to the Center for Forensic Psychiatry for treatment.

Both Pelichet and Washington have responded to medications and both were eventually placed on “authorized leave status,” which allowed them to leave the Center, according to the court filing.

At various moments in their lives, however, DHHS petitioned the courts to re-hospitalize Pelichet and Washington for violating their contracts—which essentially placed them on probation or parole-like conditions—for testing positive for marijuana.

The court filing alleges both men were confined at a psychiatric hospital with “little-to-no” substance abuse treatment.

The court filing also alleges psychologist Charles Stern, who was an independent contractor with Walter P. Reuther Psychiatric Hospital, falsely testified that Pelichet refused to take his psychiatric medication and that he had been violent during his admission to the hospital.

A subsequent Office of Recipient Rights’ investigation confirmed Stern made “incorrect and misleading” statements, the court filing shows.

DHHS again filed a petition seeking to hospitalize Pelichet in October, but he successfully fought that order when a jury took less than 30 minutes to reject the petition.

In addition to Stern, the defendants listed included: DHHS Director Nick Lyon and Walter P. Reuther Psychiatric Hospital staff including director of psychology Lisa Medoff, director of social work Laurie Albert, chief of clinical affairs Hanumaiah Bandla, hospital director Mary Clare Solky and psychiatrist Aruna Bavineni.

Defendants also include seven members of the Center’s “NGRI Committee” and contractors Hegira Programs Inc. and Carelink Network Inc.

Physicians Pointing To Unintended Consequences In Sex Assault Reform Bills

Doctors might avoid certain exams if they become concerned those procedures could be confused with sexual assault, physicians told the House Law and Justice Committee April 24 as it continued its hearings on a series of sexual abuse reforms in the wake of the Larry Nassar case.

That could result in delayed treatment or unnecessary trips to specialists.

Family physicians are perfectly well trained to conduct pelvic exams, Dr. Betty Chu, president-elect of the Michigan State Medical Society, told the committee. But if they become uncomfortable conducting the procedure, they might send a patient to an obstetrician.

A doctor uncomfortable performing a rectal exam might send a youngster with stomach pain to the emergency room, where that same patient may wait several hours to be seen, Kalamazoo physician Dr. Glenn Dregansky told the committee. “That is something we would like to avoid,” he said.

“It frightens me that I could make a documentation error and face a felony,” Dregansky said. He pointed out that a failure to keep good records already is considered a violation of professional standards.

“I’m opposed to the whole criminalization of your record keeping. I think it is inane. I think it is stupid. And the criminalization of doctors for a failure to keep records is incredible to me,” said Rep. Rose Mary Robinson (D-Detroit).

The discussion was about bills that were on the agenda as the committee is working its way through a long series of bills regarding sexual assault reform.

But the doctors aren’t avoiding the issue.

“To your question, how do we prevent another Larry Nassar? I really don’t know, but he was a medical care provider. He was a physician. So, in my own opinion, I believe it is incumbent upon the medical profession to come up with some good ideas how to prevent that,” Traverse City pediatrician Dr. Robert Sprunk told the committee.

The committee took up three bills, HB 5539, which would add sexual assault and rape in to the OK2Say program and HB 5785 by Rep. Kim Lasata (R-St. Joseph), to add instruction about what constitutes sexual assault or dating violence into sex education program in public schools.

“From September 2014 to December 2017, OK2Say received a total of 10,734 tips. Of that total, 323 had been regarding sexting, 227 for sexual misconduct, 91 for sexual assault, and 82 for dating violence. So why specifically include sexual abuse, assault or rape? Because one in four girls and one in six boys will be sexually abused before they turn 18. Yet sexual assault and sexual misconduct combined represented less than 3 percent of the tips in 2014. And statistics show only 12 percent of child sexual abuse is ever reported to authorities,” LaSata told the committee.

Having sex education programs is optional in public school districts, but if they have it in the curriculum, they would have to include instruction on what a healthy relationship looks like.

That brought an objection from Rep. Martin Howrylak (R-Troy) and a tense exchange.

He said his family doesn’t believe in sex outside marriage, and if the instruction about what constitutes a healthy relationship contradicts that, it would violate a parent’s right to raise his child as he decides. LaSata countered that there is an opt-out clause in the bill.

Howrylak: “I understand that, but if I’m not fully aware of exactly what is being taught, ex post facto, I can’t tell the kid . . .

LaSata: “That is up to your school district. Do you know what is taught now in your school?”

Howrylak: “I’m telling you that you are adding something in here with my tax dollars that potentially can be in violation of what I believe is morally right.”

LaSata: “Then opt out.”

Howrylak: “Then don’t take my tax dollars. I’m asking you to fix your bill and stop arguing with me.”

LaSata: “Maybe you could send your kid to a parochial school.”

Rep. Stephanie Chang’s (D-Detroit) HB 5791 would require the Michigan Department of Education to develop age-appropriate information for school districts about how to recognize sexual assault, explain assault is not the victim’s fault, and explain what assistance is available and what actions victims can take. Chang said her bill is similar too, but different from those offered by LaSata.

Emma Ann Miller, a 15-year-old survivor of the Michigan State University scandal, testified in support of the bill.

“This legislation will hopefully not only give others a voice, it will educate them on what to say. It isn’t enough to have a voice, to have an opportunity to speak,” Miller said. “Simply accusing someone of sexual assault won’t be enough to garner action. One would think that it would. One would think that an accusation of sexual assault by a child would, or should, get a reaction like yelling fire in a crowded theater. But we know that isn’t true. We know from history that a child who accuses an adult of sexual assault will be a called a liar and many other worse things.”

Robinson noted to Chang that her bill addresses the victims of assault, but it doesn’t address the real problem, the predators.

Chang countered that she believed it would be problematic to try to identify potential perpetrators.

“We are not trying to address the real problem, the real elephant in the room. What do we know about the make-up of sexual predators? What triggers? Is it childhood abuse on the predator? Is it the environment? Is it genetic? Is it a chemical imbalance? None of these bills address what the real problem is. Everybody’s upset about Nassar, but who is Nassar? How did he become the monster? How did he become the person he became?” Robinson said.

Rep. Klint Kesto (R-Commerce Twp.), chair of Law and Justice, said the committee would be back at it Wednesday in a hearing after House session, the committee’s fourth hearing on the package in two weeks.

Lansing Lines is a cooperative feature presented by MIRS, a Lansing-based news and information service and Healthcare Michigan.