The short answer is that the mental health millage is approximately $4 million of taxpayer money collected annually for use by Community Mental Health – Ottawa County (CMHOC). The money is essentially a blank check that can be used for just about anything other than services covered by Medicaid.
Between 2013 and 2015, the State of Michigan modified the way funding was distributed to community mental health (CMH) organizations and individuals in need of mental health care, which resulted in less funding for CMH organizations, but nearly the same amount of money to residents. In 2013, a new form of government insurance called the Healthy Michigan Plan (HMP) was created which functioned similarly to private insurance. Rather than seeking services through CMH departments, people on the HMP could seek care directly from providers. This change reduced the amount of funding received by CMH departments, and Ottawa County after cutting approximately one-third of the CMH workforce, responded by encouraging the passage of a mental health millage to help make up the difference and stop the hemorrhaging of employees. Ottawa County was one of the first counties in the state to pass a mental health millage and it became a model for other counties.
To lobby the community for millage money, CMHOC explained that “critical programming and services to our most vulnerable citizens are being reduced and in some cases discontinued.” Unfortunately, this statement was misleading and depends on the definition of critical. Mental health millage money would not be used for the critical services reimbursable by Medicaid. In addition, Medicaid was still covering essentially the same critical services. The state had modified the system in a way that largely cut CMH organizations out of the loop, empowering citizens to obtain the services they needed by going directly to private service providers. Prior to 2013, Michigan CMH departments received funding that flowed from the Federal government, to the Michigan Department of Health and Human Services (MDHHS), to the prepaid inpatient health programs (PIHP). The funding was provided through the Medicaid program for people with mental illnesses, substance use disorders, people who were disabled, aged, and blind, and those that needed temporary assistance, but the funding was not earmarked by patient category.
In 2013, the Healthy Michigan Plan (HMP) was created to enroll more uninsured Michigan residents into Medicaid. The Healthy Michigan Plan was funded from the same pool of Federal dollars as the Michigan prepaid inpatient community mental health programs (PIHP) for uninsured residents. As money was being redirected to the Healthy Michigan Plan, the MDHHS reduced the number of PIHP centers and reorganized the way Medicaid funding was being distributed to the PIHP. After all, they only had so much money.
In 2017, new procedures involved categorizing populations, and funding was distributed based on enrollment and categorization. As a result of the changes, Ottawa County, part of the Lakeshore Regional Entity PIHP, along with Allegan, Kent, Mason, Muskegon, and Oceana counties received less funding than in previous years for mental health programs. MDHHS decreased funding to the PIHPs because, as more uninsured residents enrolled in the HMP, there should have been fewer uninsured residents needing the services provided by the PIHP, and subsequently at the CMH level. Another result was that specialty behavioral health systems, Pine Rest for example, began to receive more Medicaid funding as newly enrolled HMP patients were now eligible to seek services at these facilities instead of only through county mental health departments.
In addition to providing access to private health care providers, consumers were enrolling in the HMP because it was easier to navigate than Medicaid. CMHOC experienced a reduction to funding because public dollars were now being distributed more directly to consumers through the Healthy Michigan Plan. Sometimes this is referred to as the disabled, aged, and blind (DAB) problem. Again, this means CMHOC revenue from Medicaid funding for disabled, aged and blind (DAB) residents decreased as some residents in this category registered under the Healthy Michigan Plan. The total amount of public funding for mental health care remained relatively stable, but money was now moving more into private mental health care. After some reduction in staff and services, CMHOC began to advocate for a mental health millage to supplement its lost Medicaid funding. So, this is the rub:
Residents were under the impression that the mental health millage money was “critical” for those in need of mental health support and would cover “gaps” in the system. However, voters did not understand that the millage money cannot be used to cover Medicaid services, as that funding had been rerouted more directly to consumers under Medicaid within Health Plan Michigan. So, in essence, CMHOC found an avenue to increase their funding profile and forge a path to transform mental health care and increase societal dependence on government assistance through various psychosocial and support services.
The mental health millage is funded from 2016-2026. In September 2023, CMHOC established a millage steering committee that will monitor the millage funds and advocate for millage renewal.