Court Says Muskegon Co. Can’t Recoup $12.2M Medicaid Funding Deficit From State
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
Muskegon County and its mental health provider, HealthWest, cannot recoup a $12.2 million deficit from the state for Medicaid-funded services provided in 2018 and 2019, an appeal panel ruled.
In a unanimous opinion from Court of Appeals Judge Christopher Yates, the three-judge panel agreed with the Michigan Department of Health and Human Services’ analysis that it bore no responsibility to pay HealthWest, who had to seek payment from its prepaid inpatient health plan, Lakeshore Regional Entity.
“The State of Michigan and the DHHS channeled Medicaid funds at the same level to PIHPs in spite of their concerns about LRE, but LRE failed to compensate HealthWest for its Medicaid-funded services at the traditional rates and pace,” the published opinion reads. “Thus, plaintiffs have failed to show that they were the victims of any constitutional violation committed by either the State of Michigan or the DHHS.”
Judges Kathleen Jansen and James Robert Redford concurred.
Muskegon County filed its suit in the Court of Claims in March 2020, alleging LRE “failed to pay” because the state had “failed to provide sufficient and timely funding to Lakeshore” as statutorily mandated. The suit alleged that underfunding could be traced to a contract issue between the state and LRE, who had been told DHHS was canceling its contract allegedly because the facility lacked a risk management strategy and wasn’t able to cover contractual obligations for overspending.
During arguments before the court in February, the state acknowledged its obligation under statute to provide funding to HealthWest for non-Medicaid-funded services, but the state argued it’s not obligated to provide reimbursement for Medicaid-funded services provided. Rather, the state argued, that responsibility falls to LRE, who hasn’t paid HealthWest.
The county’s attorney, Laura Genovich, argued the state has a duty to use Medicaid funds to pay for Medicaid community mental health services. She said LRE has a surplus today that it wants to use to fund the liability, but the state won’t allow that.
HealthWest provides mental health care and other services in the areas of developmental disabilities, substance use, physical health and early intervention and prevention to over 7,000 children and adults with developmental disabilities, mental illness or substance use concerns, according to its website.
Senate Approves 1931 Abortion Ban Repeal
State laws impacted by Michigan’s now unenforceable 1931 abortion ban would be erased from the books under bills the Senate approved following consecutive party-line votes and multiple amendment efforts by Republicans to link the repeal with regulations.
The 1931 abortion ban made it a felony to administer miscarriage-inducing drugs or perform an abortion procedure. The law was put on the shelf by the U.S. Supreme Court’s 1973 Roe v. Wade ruling, but brought back to life after the Dobbs decision of 2022.
Gov. Gretchen Whitmer and Planned Parenthood were able to block the ’31 law from going into effect through legal maneuvers for several months. Then Proposal 3 was passed by Michigan voters in November and the 1931 abortion ban became virtually comatose once again. But the Michigan Democrats want to make sure it can never come back to life.
“Let me remind you, a person’s reproductive health care decisions, including abortion, is none of your business,” Sen. Erika Geiss (D-Taylor) said on the Senate floor. “Michiganders have spoken, and the most urgent and pertinent part of doing the people’s work to fulfill Prop. 3 is repealing the 1931 bans. The people demand it.”
On Mar. 1, the Senate Republicans introduced an abortion regulation package for the Proposal 3-era.
The Republican caucus in the chamber attempted to tie-bar the repeal to the package in different capacities, placing eight unsuccessful amendment efforts on the floor.
“This Legislature can and should still have a say,” said Sen. Thomas Albert (R-Lowell) on the Senate floor. “Voters were under the impression that they were restoring the status quo under Roe v. Wade when they supported Proposal 3. However, some of these bills before us today cement the fact that abortion supporters are moving well beyond Roe v. Wade.”
One Republican proposal would charge an individual who knowingly coerced someone into having an abortion with a felony punishable by up to four years in prison, a fine of up to $10,000 or both. Another Republican proposal would increase Michigan’s punishment against an abortion provider who knowingly terminates a “partially delivered living fetus” from up to two years in prison to up to four.
Republicans also pushed to connect the repeal with a “parental rights restoration act,” charging an abortion provider who served a minor without parental consent with a felony punishable by up to four years in prison, a fine of up to $10,000 or both. The caucus additionally called for pharmacists to be authorized to choose not to dispense abortion-inducing drugs.
“When voters approved Proposal 3 last year, they weren’t voting for unlimited abortion on-demand. They weren’t voting for partial birth abortion and they absolutely weren’t voting to end parental consent for minors having an abortion,” said Sen. Lana Theis (R-Brighton) before each Republican-led amendment was defeated.
As the lead sponsor of the Senate bills to revoke the 1931 abortion ban, Geiss said the amendment efforts were based on “junk science” and trying to create “unnecessary redundancies” when there are already existing statutes for medical safety.
“They are presenting some unhinged fear-mongering about things that are medically inaccurate and literally just don’t happen, but I will applaud the authors of these amendments on their persistence and creativity…wild imaginations that clearly are a reflection of having watched way too many gruesome B-movies on ‘Creature Double Feature’ on Saturday afternoons,” Geiss said. “Perhaps they should be writing scripts in Hollywood, not policy in Lansing.”
Sen. Ed McBroom (R-Waucedah Twp.) said in the last 10 to 15 years, the paradigm around abortion “has taken a dramatic shift,” describing it as similar to how slavery was viewed as something destined to phase-out in early American history until before the U.S. Civil War.
“They declared it was a moral good and imperative and a service to people, and suddenly good people were confronted with their moral laziness regarding it and abolition became an imperative,” McBroom said. “We have heard that abortion is a good thing – a moral, desirable thing that should be celebrated. The consequences of that shift are also comparable.”
Sen. Sarah Anthony (D-Lansing) addressed McBroom’s comparisons between slavery and abortion, stating there’s been tension in the United States about the control of Black bodies.
She said while listening and taking notes on the aforementioned comparisons to the country’s darkest chapters, she would be reminded “of this beautiful day in history,” when a record number of women in the Senate (60% of the Senate’s Democratic caucus is led by women) made their intentions quite clear.
“We stand behind the principles of freedom, we will denounce these comparisons to the American slave trade and do what women all over the state and country want us to do, which is to declare the control of our own bodies,” Anthony said.
New House Subcommittee Sets Michigan Mental Health Agenda
The Michigan House Subcommittee on Behavioral Health met for the first time today and heard from community clinics about what is needed to address mental health in Michigan.
Alan Bolter, associate director of the Community Mental Health Association, told the committee there were three areas that they would need to address that would solve 90% of the current complaints.
“Access to care, workforce, inpatient needs. Those are the absolute critical areas out there,” Bolter said.
The mental health subcommittee chair Rep. Felicia Brabec (D-Ann Arbor), a working therapist who holds a doctorate in clinical psychology, said the issue she would like to focus on first was getting the mental health workforce in place, because without it there is no access to care and all patient needs end up unmet.
“We just have too many people that we need to be able to help, and I think the work that we’ll be able to do here will have a great impact,” Brabec said.
Bolter said Medicaid makes up nearly 95% of the funding for the public mental health system, but Medicaid is not responsible for all the people on the program. He said the community mental health system cares for about 350,000 of the nearly 3 million on Medicaid.
“Typically, the stat that’s thrown out is that probably one in five individuals are suffering from some form of mental illness,” he said. “If you do the math — we have roughly 10 million people — you’re talking 2 million people across the state of Michigan alone.”
He said the program currently only deals with serious mental illness, people with intellectual developmental disabilities, seriously emotionally disturbed children, people with substance-use disorders, and crisis services, which respond to suicidal individuals and other emergencies.
Bolter said the bulk of mental health funding was spent on people with intellectual and developmental disabilities, who are roughly 50,000 of the 350,000.
He said the way community mental health programs work is through a social or community-based treatment plan. The treatment is tied to food assistance, schooling, law enforcement and housing.
“A lot of folks when they think about mental health care, it is talk-therapy, sitting on a couch or chair talking to a therapist, but it is far different from that,” Bolter said.
He said certified community behavioral health clinics and a health homes program could be the future of behavioral health care. He said the health homes were spread across northern Michigan as a way to get people help for opioid abuse.
“The health homes have provided some great outcomes across the state,” Bolter said.
He said the health home model has led to a decrease in relapses, hospital stays, and cost per patient, along with an increase in follow-up visits. He invited Brabec and the other 10 committee members to visit one of the health homes.
“We have different communities across the state and sometimes different approaches would be necessary in providing care,” Bolter said.
Rare Disease Advisory Council Proposed
Feb. 28 marks Rare Disease Advisory Day in Michigan after a House resolution passed, but it also provided an opportunity for Rep. Jason Morgan (D-Ann Arbor) to speak at a press conference about his experience with Becker’s Muscular Dystrophy and the need for a “Rare Disease Advisory Council in Michigan.”
Morgan, a freshman member representing District 23, said growing up poor in a rural area is hard. Growing up poor as a gay kid in rural Michigan is really hard, but growing up poor as a gay kid with an undiagnosed rare disease in rural Michigan was “really, really hard.”
Morgan said he knew something was wrong when he experienced extreme muscle pain at the age of 11 for seemingly no reason. A doctor diagnosed him with Becker Muscular Dystrophy when it was discovered his cousin was also experiencing similar symptoms, but Morgan said it took nearly two years.
Becker Muscular Dystrophy, often referred to as Becker MD or BMD, is a genetic disorder that gradually makes the body’s muscles weaker and smaller. Though it causes less severe problems than the most common type of MD, Morgan said the average life expectancy for a patient with BMD is only 42 years.
When he was diagnosed, at the ripe age of 13, Morgan was faced with questions like: “How can I accept that I would not live as long as most of my friends?”
He said he struggled until he was invited to attend a muscular dystrophy summer camp, where he saw “my peers thriving in spite of their diagnosis.”
Morgan said it helped him realize what was possible for those living with rare diseases, and eventually inspired him to run for office.
Now, he is introducing a bill to create a Rare Disease Advisory Council (RDAC) to create a publicly available list of rare diseases and identify the best practices to enhance educational resources, care, treatment and support for patients, loved ones and healthcare providers.
Morgan said the council would serve as an alternative to a committee made up of only one group of patients, stakeholders or department heads and bring everyone together. It would advise the state Department of Health and Human Services (DHHS) and other agencies in research, diagnosis and treatment processes.
He said the council will be purely advisory, and there is discussion of a small appropriation, depending on whether an existing appropriation is still on the table.
Morgan was joined at today’s press conference by Rep. Jenn Hill (D-Marquette), along with Laura Bonnell with the Laura Bonnell Foundation, which advocates for the cystic fibrosis community. Bonnell said her daughter lives with cystic fibrosis, and the family has struggled to receive care and pharmaceuticals, putting her life at risk.
Also present were Sarah Procario of the Hemophilia Foundation of Michigan, Alisha Brown of MichBio, an organization joining life sciences industry researchers and patients, and Dr. Wanda Shurney, a pediatrician and medical director at the Sickle Cell Association of America.
EPA’s Proposed PFAS Drinking Water Standards Lauded As An Important Public Health Milestone
The Great Lakes PFAS Action Network issued the following statement applauding an announcement by the Environmental Protection Agency of proposed national drinking water standards (Maximum Contaminant Limits or “MCLs”) for six PFAS chemicals: PFOA, PFOS, PFHxS, PFNA, PFBS and GenX. These chemicals have been used in a broad variety of products and are the source of widespread contamination throughout the Great Lakes region and the rest of the country.
“The EPA’s proposed drinking water standards are an important milestone in the fight to protect public health and will save lives in impacted communities on the front lines of the PFAS crisis,” said Tony Spaniola, co-chair of the Great Lakes PFAS Action Network. “This is an A+ decision by the Biden Administration for front line communities. We urge that the proposed drinking water standards be adopted and implemented with all deliberate speed.”
In 2016, the EPA set non-enforceable health advisories for PFOA and PFOS at 70 parts per trillion (ppt). Last year, in light of the growing understanding of the dangers of these chemicals, the EPA set updated advisories for PFOA and PFOS, which were near zero. The proposed limits for PFOA and PFOS are the lowest detectable levels with current detection methods, and EPA has proposed an ultimate MCL goal of zero for those two chemicals.
The proposed Maximum Contaminant Limits are:
PFOA – 4.0 ppt
PFOS – 4.0 ppt
PFNA, PFHxS,PFBS, GenX – 1.0 Hazard Index
“These proposed drinking water limits are a strong step toward addressing the PFAS crisis and protecting our health not just in Michigan, but across the country,” said Sandy Wynn-Stelt, co-chair of the Great Lakes PFAS Action Network. “Importantly, these proposed limits send a strong message to polluters, especially industries that use these chemicals, that there is no such thing as a ‘safe’ amount.”
According to the Michigan PFAS Action Response Team (MPART), there are currently more than 200 confirmed PFAS contamination sites in the state of Michigan with more than 11,000 suspected PFAS sites throughout the state.