In 2016, Ottawa County residents approved a mental health millage. They were told that millage money was for “critical programming and services to our most vulnerable citizens” because services “are being reduced and in some cases discontinued.” The words used to advocate for the mental health millage were chosen very carefully. Millage money would be used for mental health initiatives, but likely not in the way most voters envisioned.
In 2013, the State of Michigan created the Healthy Michigan Plan (HMP), an insurance plan which offered consumers more direct access to private health care providers, and was easier to navigate than Medicaid. This change resulted in less funding for community mental health (CMH) organizations as many CMH consumers migrated to the HMP, resulting in more funding going directly to consumers. By 2016 the state was making additional changes that involved categorizing consumers and reimbursement based on the number and category of people served. In addition, state and Federal governments had created a new program called a Certified Community Behavioral Health Clinic (CCBHC). A CCBHC was not a clinic at all, but a new system of providing health care to the entire population.
To be eligible to receive government reimbursements for providing health care services under a CCBHC program, an entity such as a CMH has to receive certification. Certification involves ensuring the entity meets CCBHC requirements which include establishing relationships with entities that provide required services, data collection, data collection infrastructure, and building electronic infrastructure for sharing data. It just so happened, that right after the mental health millage was approved by Ottawa County voters in March 2016, CMHOC applied for a CCBHC grant. CMHOC board meeting minutes from April 25, 2016 state “CMHOC will submit a grant application to participate in the Michigan CCBHC (Certified Community Behavioral Health Center) grant through MDHHS.”
The establishment of Ottawa County Community Mental Health as a CCBHC would enable the government entity to continue to grow and recapture consumers that it had lost to the Healthy Michigan Plan.
What happened is that both the awarded grant money and the mental health millage money was used for establishing a CCBHC. In fact, the grant and millage money was intermixed on board financial reports. When comparing the millage programs to the CCBHC services handbook, the correlation becomes obvious.
According to section 2.C.9 of the Michigan CCBHC Handbook, “The CCBHC must provide care coordination across a spectrum of health services, including access to high-quality physical health (both acute and chronic) and behavioral health care, as well as social services, housing, educational systems, and employment opportunities as necessary to facilitate wellness and recovery of the whole person.”
“A Designated Collaborating Organization (DCO) is an entity that is not under the direct supervision of the CCBHC but is engaged in a formal relationship with the CCBHC and delivers services under the same requirements as the CCBHC.”
Per section 8.C.8.3 of the handbook, CCBHCs must have care coordination agreements for health care services, inpatient service coordination that provide psychiatric treatment and detoxification programs, and community service coordination that includes schools, child welfare agencies, Indian health, juvenile and criminal justice agencies, veterans, homeless shelters, employment services, services for elderly adults, providers of medications for treatment of opioid and alcohol dependence, and end of life care.
The following images show programs that received mental health millage funding in 2023.
The mental health millage initiatives just happen to be requirements for community mental health organizations to receive government funding through the Certified Community Behavioral Health Clinic (CCBHC). The organizations listed in the images appear to be the Designated Collaborating Organizations (DCOs). It appears that a lot of money has been spent on software purchases and updates to connect to the DCOs, and state and county systems for reporting data collection requirements.
When CMHOC requested mental health millage funding from the community in 2016, just as Kandu was closing, they said it would be used for “critical programming and services.” Most residents assumed it would be used to enable programs like Kandu to continue operations, not understanding that mental health millage money could not be used to pay for services covered by Medicaid. The millage passed because the community wanted to support people struggling with substance abuse, mental illness, intellectual and developmental disabilities, but the funding could not be used to support services already being funded by Medicare. It appears the true intent of the millage was misrepresented to the voters of Ottawa County. The millage appears to have been created to fund CCBHC initiatives that would lead to CMHOC being a certified CCBHC thereby enabling them to recapture lost consumers and continue growing. The deceitful plan is detailed in CMH board meeting minutes from 2014 to present.
The current mental health millage provides funding until 2026 when CMHOC will ask for a renewal. They have already formed a steering committee which will convey the need for renewing the mental health millage to the public.