The Referral Circle - CMH Funds Non-Profits thru the Mental Health Millage and Non-Profits Refer People to CMH
Revenue generated by Community Mental Health Ottawa County (CMHOC) is largely dependent on the number of people enrolled in Medicaid. In other words, the more people enrolled, the more revenue generated. It appears CMHOC is using the mental health millage in part to build a network of government agencies and non-profits that refer people to CMHOC. As the number of people reported as serviced by CMHOC grows, that data can be used as justification for expanding services and outreach programs, resulting in ever growing county government.
Community Mental Health Ottawa County is the largest provider of services for people with intellectual and developmental disabilities (I/DD), severe mental illness, and substance use disorder (SUD) in Ottawa County. According to the April 24, 2023, board meeting packet, CMHOC receives over $49,000,000 per year in funding from state and Federal programs for mental health services.
CMHOC is primarily paid based on the number of people signed up to receive Medicaid services, rather than being paid based on services provided. This provides incentive to enroll as many people as possible. Medicaid - Capitated funds are fixed, pre-arranged payments. If Medicaid - Capitated money received by the county is not spent on services, the county retains the excess in the general fund. For example, in 2021, CMHOC had a projected budget surplus of $7,100,000. Although large surpluses could indicate the county found cheaper ways to meet patient needs, it can also indicate that the funds are not being directed to services that patients are entitled to.
According to CMH Executive Director Lynne Doyle at the April 24, 2023, CMHOC board meeting , “There will no doubt be a change in enrollment, and that’s important to us, [] because, our Medicaid rates are based on enrollment numbers in each county. So, if we lose people off Medicaid enrollment, our Medicaid rates will be impacted.”
Signing up as many people as possible to receive Medicaid services maximizes revenue for CMHOC. Perhaps this is part of the reason CMHOC outreach efforts seem to focus on engaging what might be considered target-rich environments, such as the Hispanic community and schools, and why non-profit organizations like the Momentum Center — that provide community engagement for people with I/DD, mental illness, and substance use disorder (SUD) — track the number of people who have signed up to receive Medicaid services after they become members of the non-profits. Referrals are so valuable that there are many laws designed to prevent businesses and organizations from providing referrals from which they benefit.
Barbara Lee Van Horssen, the Experi-Mentor at the Momentum Center, mentioned referring members to CMH during her presentation at the June 26, 2023, Ottawa County Community Mental Health board meeting,
(5:12) “We have a high focus on prevention and early intervention. We refer members to Community Mental Health (CMH).” A few minutes later she added, (9:08) “We also know that about 11% of our members started receiving CMH services after they joined the Momentum Center.”
In recent years, the number of children being referred to CMH has skyrocketed. During the May 22, 2023, CMH meeting, Supervisor of Children & Family Services Ann Heerde stated, (8:00) “The number of families coming to CMH to access services for birth to 21 is growing. Those are monthly averages, so fiscal year 2020 we averaged 23 youth coming in our door from the access center. This fiscal year so far, so the past seven months, we are averaging 34 youth coming in our door from the access center. Obviously, that is a fairly significant growth.”
CMHOC started planting staff in the Ottawa Area Intermediate School District (OAISD) back in 2017. According to CMH board meeting notes it was CMHOC’s idea to pursue offering services to schools through the use of millage funding. In January 2017, Lynne Doyle of CMH scheduled a meeting with the ISD.
In March 2017, a plan was in the works to place community health professionals in school buildings in Ottawa County.
In August 2017, the Ottawa Community School Network was created.
In 2023, the Ottawa County School Network (OCSN) received $142,000 in funding from the mental health millage. This partnership is likely the source of many of the youth referred to CMH.
So, both the Momentum Center and the Ottawa Community School Network (OCSN) are sources of referrals for CMH, and both happen to be heavily supported by the mental health millage. The meeting packet from the May 22, 2023, CMH meeting shows other community partners of the Children and Family Services division of CMH.
It seems other community partners of CMH that provide referrals also receive funding from grants and the mental health millage.
Here are more organizations that benefited from the Mental Health Millage.
It seems likely that these mental health millage beneficiaries also provide referrals to CMHOC. Therefore, it appears CMHOC has built a large network of government organizations and non-profits who are largely funded through the mental health millage, and in turn provide referrals to CMHOC, ultimately generating revenue for CMHOC. This is a win-win situation for these government organizations and non-profits, but seems to be a big loss for the taxpayers of Ottawa County.
One must ask some simple questions. Who benefits the most from referrals and community partnerships? Is it the taxpayers and people of Ottawa County who need mental health services, or is it the web of county and community partners that provide those services?