Michigan Association of Health Plans

Commentary: Time to let private insurers manage ‘broken’ Medicaid mental health system

Legislation reforming Michigan’s Medicaid system, that would integrate physical and mental health care, is an opportunity to greatly improve health outcomes of those served by that program.

In fact, the proposed legislation would make Medicaid operate like health insurance enjoyed by those in the private sector.

I say that having been engaged in Medicaid and behavioral services since 1991, first serving in the state budget office and then having helped launch our Medicaid managed physical care program in 1996. After leaving state government, I served as the head of the Michigan Association of Health Plans, retiring in 2016.

Nobody disputes that the status quo is failing Michiganders at a time of great need. Our experience with COVID-19 shows the need for dramatic changes to meet our behavioral needs.

Today, someone enrolled in Medicaid has his or her physical health services managed by a state-licensed health plan that oversees their physical health needs — hip replacement, diabetes and other chronic diseases, whatever problems they may have — often working with a variety of specialists to get the best possible outcomes.

To innovate and meet consumer needs, health plans use interventions that address social determinants of health, such as housing assistance, food security, non-emergency transportation and employing community health workers who have peer relationships with consumers.

But a person in Medicaid with mental health needs is put in an entirely different system, with little or no coordination with their physical health providers — even though data shows most persons with mental health concerns have physical health problems.

Historically, those with mental health needs were institutionalized in state-run hospitals, often poorly run, with little hope for treatment that would return them to society.

In the 1980s and 1990s Democratic and Republican administrations, following best practices nationally shifted treatment from institutions to the local Community Mental Health system.

That is where Michigan’s Medicaid recipients go today for psychiatric, drug rehabilitation, 24/7 residential services or other services. Because there are often too few providers, services vary from county to county and there continue to be cost overruns.

Senate Bills 597 and 598 would provide Medicaid patients an integrated system, care system that serves the needs of the “whole person.” This is what most of us already have access to from our employer-provided insurance.

This article originally appeared in Crain’s Detroit Business. Read more here.

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