On this week’s episode of In Focus, host Ken Norris and WKTV Journal drills down into two important mental health issues in Kent County, first with the Be Nice youth mental health program, and then with the director of Network180, the county’s mental health provider and an organization currently cutting services due to state funding issues.
Christy Buck, executive director of the Mental Health Foundation of West Michigan, talks about the foundation’s Be Nice program, an effort to reach into local schools, and to reach local students on a personal level, with the message of how they can become part of the solution to youth suicide.
The program Be Nice is based on four elements/actions corresponding to the letters in NICE: Notice, Invite, Challenge and Empower. And, Buck stresses in part of the interview, the challenge part is a two-way challenge.
“It is absolutely a two-way challenge, and that sometimes is the sticking point, where, if I don’t challenge that person and empower them” then they will not respond, Buck said. “They need to understand, it is a physical illness. If you want to get better, you have got to take some steps towards that. You cannot force people. But when someone sees that you care enough to notice and invite (discussion), it leads to empowerment.”
The entire episode of “WKTV Journal: In Focus” airs on cable television in the Wyoming and Kentwood areas on Comcast WKTV Channel 26 and on AT&T Channel 99 Government channel.
The episode will continue its two week run Today, Thursday, Feb. 1, at 6:30 p.m. and conclude its run Tuesday, Feb. 5, at 6:30 p.m., and Thursday, Feb. 7, also at 6:30 p.m., on WKTV channels but all interviews included in episodes of WKTV Journal: In Focus are also available on YouTube at WKTVVideos.
As local health officials statewide seek to work with state officials to deal with funding shortfalls linked to state reimbursement for low income patients, Kent County’s community mental health provider, Network180, has begun belt tightening.
Having already made internal staffing reductions in reaction to a funding shortfall, Network180 executive director Scott Gilman said official notification began this week to its local partners that will have their funding reduced or eliminated — but that may be only the beginning of the local belt-tightening, he said.
“Even with the cuts, and we are currently looking at about $778K, we still have a $7 million deficit,” Gilman said to WKTV, adding that despite the funding deficit Network180 will be doing what it can to secure cash to make payments to providers. “We have to be really careful … We are the public safety net.”
Meanwhile, the Michigan Department of Health and Human Services (MDHHS) maintains its existing funding contract with the local Lakeshore Regional Entity, through which state funds flow to the local Network180, is sound and needs no adjustment.
“Rates paid in Kent County have been certified as actuarially sound for the state by an independent actuary, Milliman (USA Inc.),” Bob Wheaton, MDHHS public information officer, said to WKTV. “MDHHS pays Lakeshore Regional Entity a monthly payment for each Medicaid and Healthy Michigan Plan eligible individual in their geographic region; those payments vary according to the number of people eligible in a given month. … As stated above, rates have been certified as actuarially sound, so there are no current plans to adjust the rates.”
The Lakeshore Regional Entity manages a contract with MDHHS to provide services to Kent, Allegan, Lake, Mason, Muskegon, Oceana, and Ottawa counties.
Combined, Network180 and a spectrum of independent groups provide support to persons with developmental disabilities, mental and behavioral health problems including addiction and substance use, and the family members who access services for those needing mental health assistance.
Scott Gilman, CEO of Network180. (WKTV)
While the Lakeshore Regional Entity and other state mental health networks have been under financial strain for several reasons in recent years, the basic cause of the current funding shortfall, according to Gilman, is the difference in state funding between two Medicaid programs: the older, established Disabled, Aged and Blind (DAB) program and Michigan’s newer Healthy Michigan. Healthy Michigan provides $24 per person versus the $270 received from DAB, according to Gilman. That has lead to a $9.7 million shortfall for Network180.
“The issue is that thousands and thousands of people have transitioned, that makes the rate we are paid not longer valid,” Gilman said to WKTV.
Wheaton, with MDHHS, has slightly different numbers as to the funding differential — $271.13 and $39.05 — and also says the number of people who have transitioned between DAB and Healthy Michigan is not the source of the local provider problems.
“It is not correct that Healthy Michigan Plan beneficiaries are mostly people who used to receive DAB benefits,” Wheaton said. “Former DAB beneficiaries make up a small percentage of the 669,000 Healthy Michigan Plan enrollees.”
Wheaton was unable to give the specific number of people who transitioned from DAB. He did go into more detail on the state’s contract with the Lakeshore Regional Entity and other similar entities across the state.
“Lakeshore Regional Entity is responsible for providing all medically necessary specialty behavioral health services to Medicaid and Healthy Michigan Plan eligible individuals in their geographic region,” Wheaton said. “The contract between MDHHS is a shared risk contract between the Department and Lakeshore Regional Entity. An increase or decrease in the number of individuals eligible for Medicaid or Healthy Michigan is part of the risk component of the contract; additional numbers of eligible results in higher payments and reducing numbers of eligible results in reduced payments.
“The contract between MDHHS and Lakeshore Regional Entity is a shared risk contract. Lakeshore is solely responsible for the first five percent of costs above their revenue. The next five percent of costs above revenue are split equally with MDHHS and Lakeshore Regional Entity both responsible for 2.5%. Any costs exceeding 10 percent of revenue would be borne solely by MDHHS.”
But, Gilman points out, a big part of the current funding problem is that the Lakeshore Regional Entity has exhausted its reserves not only due to the DAB-Healthy Michigan issue but to a separate but recent state funding shortfall for autism-related services.
“The Department (MDHHS) and the legislature recognized the problem and fixed it for fiscal year 2018, but it resulted in a loss of savings last year fiscal (2017) of approximately $6 million,” Gilman said. “So the savings was depleted and then with the DAB issue on top of that the savings for the Lakeshore Regional Entity is depleted completely. The projection for the LRE is (that DAB-Healthy Michigan issue will cost) $10 million.”
The appropriateness of the current contract, and differences in opinions on the revenue shortfall, may well be the crux of the matter as discussions continue between local healthcare providers and state officials.
An independent study — funded by Lakeshore Regional Entity and eight of the state’s other nine Prepaid Inpatient Health Plans (PIHPs) — by the Grand Rapids based Rehmann Group estimated a $97 million state-wide revenue shortfall, and a $7.8 million loss for the Lakeshore Regional Entity.
WKTV’s Viebit service allows on-demand viewing of Wyoming and Kentwood government meetings, including the monthly Government Matters meeting. (WKTV)
WKTV Staff
news@wktv.org
Discussion ranging from national security to local mental health care were presented Monday, Jan. 8, as part of the Wyoming-Kentwood Chamber of Commerce’s monthly Government Matters meeting.
At the meeting, a representative of U.S. Sen. Gary Peters’ office talked about Sen.s Peters and Debbie Stabenow (both D-Mich.) attending the activation ceremony of the 272nd Cyber Operations Squadron at Battle Creek Air National Guard Base on Jan. 6. The 110th Attack Wing at Battle Creek “will bolster efforts to protect Department of Defense networks against cyber threats,” according to supplied information.
Also at the Government Matters meeting, Kent County Commissioner Harold Mast discussed the current funding shortfall for Network180, the county’s provider of support to persons with developmental disabilities, mental and behavioral health problems including addiction and substance use, and the family members who access services for those needing mental health assistance. Network180 is currently dealing with a nearly $10 million shortfall due to changes in State of Michigan reimbursement of Medicaid policies.
The monthly meeting brings together government leaders of all levels to discuss issues of importance and presents those discussions through WKTV’s live, delayed and on-demand broadcasts.
The Chamber’s Government Matters meetings include representatives of the cities of Kentwood and Wyoming, Kent County, local Michigan House of Representatives and Senate, and, often, representatives of other regional, State of Michigan and Federal elected officials. The next meeting will be Feb. 12 at Wyoming City Hall.
The meetings are on the second Monday of each month, starting at 8 a.m. WKTV Journal will produce a highlight story after the meeting. But WKTV also offers replays of the Monday meetings on the following Wednesday at 7 p.m. on Comcast Cable Government Channel 26. Replays are also available online at WKTV’s government meetings on-demand page (wktv.viebit.com) and on the chamber’s Facebook page.
The Kent County Family and Children’s Coordinating Council heard a presentation by Scott Gilman, executive director of Network180, on Jan. 2. (Supplied by Kent County)
Kent County’s community mental health provider, Network180, has already made internal staffing reductions and will likely cut funding from several community-service groups and projects after a now-started period of review and decision-making.
Combined, Network180 and a spectrum of independent groups provide support to persons with developmental disabilities, mental and behavioral health problems including addiction and substance use, and the family members who access services for those needing mental health assistance.
The bad news for Network180 employees, with more than 30 full-time equivalent positions cut — and the potential of more bad news of other providers — was detailed during a presentation Jan. 2 at the Kent County Family and Children’s Coordinating Council by Scott Gilman, executive director of Network180.
The basic cause of the funding shortfalls, according to Gilman, is the difference in state funding between two Medicaid programs: the older, established Disabled, Aged and Blind (DAB) program and Michigan’s newer Healthy Michigan. Healthy Michigan provides $24 per person versus the $270 received from DAB. That leads to a $9.7 million shortfall for Network180.
The scheduled and potential cuts will also be part of the agenda at a meeting of Network180’s Board of Directors, which is chaired by County Commissioner Harold Mast, whose district includes portions of both Wyoming and Kentwood.
Kent County Commissioner Harold Mast, right, at a recent Wyoming-Kentwood area Chamber of Commerce Government Matters meeting. (WKTV)
“We are going to be facing with roughly $11 million deficit for this fiscal year, which started in October, or we are going to start running out of cash in May and June,” Mast said Monday to the Wyoming-Kentwood Area Chamber of Commerce’s Government Matters meeting. “It is a complicated issue, (state) Sen. (Peter) MacGregor and, I know, (state) Sen. (Dave) Hildenbrand and a lot of other government officials, are trying to figure out what we can do to help it. But we are at a stage where we can’t continue to operate the way we are.
“It is not just our county, it is the seven counties in West Michigan, the Lakeshore Regional Entity. It is throughout the state,” Mast said Monday. “It is an issue of funding, the way the funding is given from the department of (Michigan Department of) Health and Human Services (MDHSS) for Medicaid eligible individuals. That has changed dramatically in the past year, and it just needs to get fixed. But in the meantime, we are running out of cash, so we are going to start cutting back some services.”
The Lakeshore Regional Entity manages a contact with MDHHS to provide services to Kent, Allegan, Lake, Mason, Muskegon, Oceana, and Ottawa counties.
“It is difficult for us because at the same time we are in a cost-cutting mode, we are also in a reinvention mode,” Mast said. “We really need to move forward … with an integration of physical and mental health, because that is what we need to perform better mental health services.”
And while funding for Network180, and groups and programs it funds, flow through the Kent County Commission, Mast admitted that, while there will be discussions on the situation, there is likely little the county can do to blunt the likely service cutbacks.
Mast said that likely only the state can solve the problem.
“Over the course of the last couple of months, as we saw it coming … we were confident until probably October, that the state was going to rectify what we thought was an easily solved issue,” Mast said to WKTV at the Jan. 2 meeting.
But “they have not recognized the discrepancy in the reimbursement rate. First of all they have resisted any acceptance of our study … they said even with that, you still have enough money. You should have enough money in your reserves. Well, we don’t … So we are at the cusp of a worse problem. All of a sudden its has come to a head, we have got to take some action, because we (Network 180) are going to run out of money … we are not going to be able to pay our bills.”
An independent study — funded by Lakeshore Regional Entity and eight of the state’s other nine Prepaid Inpatient Health Plans (PIHPs) — by the Grand Rapids based Rehmann Group estimated a $97 million state-wide revenue shortfall, and a $7.8 million loss for the Lakeshore Regional Entity.
And, Mast says, there is likely nothing the county commission can do to rescue Network180, and the Lakeshore Regional Entity it is a member of.
“We (the county commission) have not had that discussion, that would be a difficult discussion, I think, whether the county would be willing to ante up,” Mast said. “I our case, it would be $10 or $11 million. We would have to have some pretty good guarantees because that is local tax money. We have not had that discussion.”
The County Commission has not had any discussions on this issue, according to a Jan. 9 statement from the county. “There are still a number of regulatory issues that would need to be addressed (i.e. we may not be able to use County funds to supplant Medicaid funding). We continue to work with the State to find a resolution.”
There is some discussion, Mast added, that the Lakeshore Regional Entity might be able to get a commercial loan of some sort in the short term with the promise of state funding flowing in and paying the loans back. “But there is not guarantee of that,” he added.
Foster care in Michigan is often difficult to navigate and measuring outcomes is complicated. West Michigan Partnership for Children (WMPC) is the result of direct, intentional change in how child welfare services are delivered throughout Kent County. Representatives from Kent County, Michigan Department of Health & Human Services, Network180, the 17th Circuit Court and local child welfare agencies (including Bethany Christian Services, Catholic Charities West Michigan, D.A. Blodgett/St. John’s, Samaritas, and Wellspring Lutheran Services) are partnering to create WMPC in an effort to drive improved outcomes for children in the foster care system.
Kent County is the only county in Michigan with such a pilot, which officially launches on Oct. 1. Several other counties have expressed interest in the program. WMPC will pilot a performance-based contract, utilizing a case rate that incentivizes permanency while allowing for flexibility and creativity in funds. Staff will use software that allows for predictive analytics to project successful outcomes and flag cases that are at risk.
Kent County Interim Administrator/Controller Wayman Britt believes successful outcomes can be achieved through public/private collaborations between child and family focused agencies, school districts, foundations, business leaders and County staff who put the needs of displaced and vulnerable children first. “These agencies have been working together on improving these systems and outcomes for children for several years though the Kent County Families and Children Coordinating Council (KCFCCC),” said Britt. “Kent County is an innovator and leader in the State of Michigan as it relates to quality, outcome driven programs and services for children in the foster care and child protection systems. Forming West Michigan Partnership for Children is the most logical next step.”
Oversight will include a Child Welfare Advisory Committee made of judiciary members and court administration, community members, and representatives of County Administration. The committee will be tasked to do the following:
Review performance data of the Kent County Department of Health and Human Service (DHHS) Office for child protection investigations outcomes and in-home child welfare services, and WMPC for out-of- home child welfare services.
Provide constructive feedback to the KCFCCC, WMPC, and the Michigan Department of Health and Human Services related to performance trends and community support in order to improve outcomes.
