Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The Mental Health Code states that Community Mental Health Service Providers are required to distribute Recipient Rights Booklets to each recipient receiving services. To place an order with CMHA please visit our websites bookstore page.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

After last week’s announcement that the U.S. Department of Justice will investigate whether Michigan’s state-run psychiatric hospitals are keeping patients for unnecessary amounts of time, community mental health advocates hope the new federal focus will bring attention to underlying issues that have been impacting the system for years.

Community Mental Health Association of Michigan CEO Robert Sheehan said he sees the DOJ investigation as a positive for Michigan’s mental health system, with the potential to push lawmakers towards solutions to the root causes of excessive hospitalizations, like staffing issues and the complex care required for patients with cognitive impairments and severe mental health conditions.

“This could move the state to say that we have a direct care worker crisis, which the Direct Care Worker Coalition has been saying for over a decade, and there’s no other way to solve this besides getting qualified people in who have the skills,” Sheehan said. “It takes a lot of skills to deescalate, to avoid using physical management, it takes an incredibly skilled staff member, and if you pay fifteen bucks an hour, most people can work at lots of other jobs that are less complex.”

Examining the contributing factors of longer psychiatric hospital stays, Sheehan said the complexity of care needed for those with serious mental health issues and the lack of direct care workers to offer that help outside of the hospital setting makes it difficult for people to access the level of treatment they require.

Beyond that, beds in intensive crisis stabilization treatment centers are paid for out of the General Fund as opposed to Medicaid, which Sheehan said further limits access for people hoping to transition out of longer-term hospital stays.

“Our members actually have a hard time placing people in state hospitals who need them, because the beds are full of people who can’t get out,” Sheehan said. “It’s called a flow through problem, which means there’s no way to enter. So, our members are struggling with people in local hospitals really don’t belong there.”

Sheehan said he imagines the DOJ investigation will turn up largely what community mental health organizations in Michigan already know: despite best efforts to move people out of psychiatric hospitals and back into their communities, institutional boundaries make it difficult.

Most direct care workers in Michigan are making about $15 per hour, a minimum wage they’ve lobbied to see increased. Sheehan said in order to make a dent in the number of patients in state-run hospitals, direct care workers in community mental health facilities would have to see a wage increase of up to $28 per hour or higher, with competitive benefits.

“It becomes kind of obvious that people are sitting there because they don’t have a place to go, and there’s a lack of beds. And DOJ, I think, would say, ‘what’s causing you as a state not to have enough beds out in the community?’ And I think it’s pay,” Sheehan said. “You’d have to really increase the pay to get people in. We’re talking about a boost. People have asked us if we understand how much this is going to cost. And I say, because you’ve underfunded it for so long, it’s hard to catch up in one fell swoop.”

Direct care worker minimum wages have seen increases in the past several years to hit the $15 threshold, but Sheehan said more effort is needed from lawmakers. He hopes the DOJ investigation prompts further action.

“At this pace, (if we) keep coming back and getting Dixie cups worth of water to fight a forest fire, we’re going to be back a lot of times,” he said. “Well, I think DOJ will say you can’t use the Dixie cup anymore.”

The CMIP for FYs 2024 – 2028 is divided among four main themes that align with CMS’ strategic plan:

• Protect Programs: CMS’ primary program integrity goal is to protect sustainability of Medicaid and the Children’s Health Insurance Program (CHIP) for future generations. CMS strives to be a responsible steward of public funds and ensure accountability of states, providers and plans that participate in Medicaid and CHIP. CMS uses risk-based approaches to prioritize and evaluate program integrity vulnerabilities and develop appropriate mitigations to reduce fraud and abuse while protecting Medicaid enrollees from harm.
• Engage State Partners: Effective Medicaid program integrity efforts require CMS and states to work in close partnership. CMS engages its state partners throughout the program integrity development and implementation process while being mindful of the uniqueness of each state’s size, delivery systems, and level of risk.
• Advance Equity: CMS works to design, implement, and operationalize policies that support health for all the people served by Medicaid and CHIP, such as by ensuring that individuals remain enrolled when they meet eligibility requirements and have access to covered benefits.
• Drive Innovation: CMS drives innovation to tackle health system challenges and emerging program integrity risks, creating a stronger, better Medicaid program.

• An expansion to the state’s Disaster and Emergency Contingency Fund (DECF), the pot of money used to give assistance to parts of the state hit by natural disasters.
• The creation of the Innovation Fund the Governor proposed in her budget recommendation. The money would help universities and nonprofits invest in tech startups with all returns on investment being reinvested back into the program to support additional startups. 
• A mortgage assistance program through the Michigan State Housing Development Authority (MSHDA).
• A Public Safety Trust Fund to provide additional law enforcement support for local governments.
• Additional data privacy protections.

Asked to address the Governor’s lame duck priorities, Communications Director Bobby LEDDY said, “Our job remains the same no matter who is in the White House or the state House. 

Senate Majority Winnie BRINKS (D-Grand Rapids) said the list of Lame Duck priorities is still being hashed out and that the “pieces now on the chessboard are being determined.” 

The restaurant community wants to see how legislators might address Michigan possibly outlawing the sub-minimum wage standard for tipped employees, as instructed by the state Supreme Court’s adopt-and-amend ruling in July. But Brinks said she is still taking input and feedback on that topic. 

She explained there’s a long list of things that many people would like to get done this term, “but at the end of the day, it’s not as easy as it looks from the outside.” 

…when she introduced the bills that the outdated and unenforceable statute language about workforce engagement requirements — which also undermine the state’s efforts to drive down health care costs by expanding access to primary care — need to be removed.

“Medicaid is health care, and everyone should have access to affordable and quality health care,” Rogers said. “These burdensome requirements merely posed a bureaucratic hurdle in front of otherwise eligible individuals who could end up receiving expensive care in the emergency room rather than receiving preventive medical care.”

As of March 13, 1 million people enrolled in the Healthy Michigan Plan. Access to health care increases primary care usage, reduces dependence on emergency rooms and strengthens our economy. Now that these burdensome provisions are no longer valid and enforceable, it is time to remove this outdated language.

Rep. Greg MARKKANEN (R-Hancock) and Rep. John ROTH (R-Interlochen), who both voted against the bill, released statements in opposition to its passage after session.  

“Most families include at least one person who is working a full-time job to provide for their loved ones; it only makes sense that people receiving government assistance should also be required to hold down a job,” Markkanen’s statement reads. “Luckily, most people receiving government assistance are doing everything they can to earn a steady income so they can eventually not need the help. Unfortunately, some need an extra push to become employed and active members of society.” 

Both statements mentioned the exemptions for the work requirement currently in place, such as for a parent taking care of a child in the absence of the other parent.  

They also said ways to fulfill the work requirement are not limited to traditional employment but can also include unpaid internships, education training, community service and substance-use disorder treatment.  

Roth said he is in support of the Supreme Court reversing its decision.

“It shouldn’t surprise anyone that Democrats are running to get rid of this law right after significant Republican victories,” Roth said. The writing is on the wall. Hopefully, the Supreme Court will soon reverse their decision and allow us to enact these meaningful work requirements – which again, are meant to help, not hinder, Medicaid recipients.” 

The approved changes made to the State Plan for July 1, 2024, to September 30, 2024, are listed below:

Supplement to Attachment 3.1-A Pages 13a continued (p.9) (SPA 24-0007)

Supplement to Attachment 3.1-A Pages 36 and 36a (SPA 24-0005)

Supplement 1 to Attachment 3.1-A Pages 1-H-1 to 1-H-6 (SPA 24-0004)

Supplement 1 to Attachment 3.1-A Pages 1-I-1 to 1-I-5 (SPA 24-0006)

Supplement 1 to Attachment 3.1-A Pages 1-J-1 to 1-J-5 (SPA 24-0009)

Attachment 4.19-B Page 2c.2 (SPA 24-0010)

Attachment 4.19-B Page 4 (SPA 24-0004)

Attachment 4.19-B Page 4a (SPA 24-0006)

Attachment 4.19-B Page 4b (SPA 24-0009)

Attachment 4.19-B Page 6f (SPA 24-0015)

Attachment 4.19-B Page 9b (SPA 24-0007)

Attachment 4.19-D Section I Page 1 (SPA 24-0012)

Attachment 4.22-B Pages 1 and 2 (SPA 24-0016)

These page changes were made as a result of the approval of:

CSHCS Medical Complexity New TCM (SPA 24-0004)

NEMT clarification (SPA 24-0005)

Integrated Care Coordination with Wraparound TCM (SPA 24-0006)

Parent Support Partner Services (SPA 24-0007)

Recuperative Care TCM (SPA 24-0009)

Incontinence Volume Purchase Contract and Non-Sterile Gloves Rates (SPA 24-0010)

Penalty Policy – Nursing Facilities (SPA 24-0012)

Vaccine Administration Rate (SPA 24-0015)

Paternity Confinement Expenses End (SPA 24-0016)

Medicaid Model Data Lab (MMDL) and MACPro SPAs:

SUD-HH Update (ABP SPA 24-1002)

Recuperative Care TCM (ABP SPA 24-1003)

SUD-HH Update (SPA 24-1501)

Although approved, the MMDL and MACPro SPAs are not currently incorporated into the traditional State Plan. They are submitted and approved using CMS on-line processes and States are awaiting CMS direction as to how these types of SPAs will be incorporated into the State Plan.  The SPA approval packages are or will be very soon available on the website at State Plan Amendments (michigan.gov).

Erin Black, Federal Liaison, blacke@michigan.gov

The conference attracts over 400 attendees. We bring together board members, CEOs, COOs, CFOs, medical directors, clinical directors, case workers, supports coordinators, and children’s supervisors from Michigan CMHSPs and Provider Agencies. We also have strong attendance from others within the public mental health and substance use disorder systems.

Come be a part of this conference by showcasing your agency’s successful programs!

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The Mental Health Code states that Community Mental Health Service Providers are required to distribute Recipient Rights Booklets to each recipient receiving services. To place an order with CMHA please visit our websites bookstore page.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

• An expansion to the state’s Disaster and Emergency Contingency Fund (DECF), the pot of money used to give assistance to parts of the state hit by natural disasters.
• The creation of the Innovation Fund the Governor proposed in her budget recommendation. The money would help universities and nonprofits invest in tech startups with all returns on investment being reinvested back into the program to support additional startups. 
• A mortgage assistance program through the Michigan State Housing Development Authority (MSHDA).
• A Public Safety Trust Fund to provide additional law enforcement support for local governments.
• Additional data privacy protections.

Asked to address the Governor’s lame duck priorities, Communications Director Bobby LEDDY said, “Our job remains the same no matter who is in the White House or the state House. 

Senate Majority Winnie BRINKS (D-Grand Rapids) said the list of Lame Duck priorities is still being hashed out and that the “pieces now on the chessboard are being determined.” 

The restaurant community wants to see how legislators might address Michigan possibly outlawing the sub-minimum wage standard for tipped employees, as instructed by the state Supreme Court’s adopt-and-amend ruling in July. But Brinks said she is still taking input and feedback on that topic. 

She explained there’s a long list of things that many people would like to get done this term, “but at the end of the day, it’s not as easy as it looks from the outside.” 

…when she introduced the bills that the outdated and unenforceable statute language about workforce engagement requirements — which also undermine the state’s efforts to drive down health care costs by expanding access to primary care — need to be removed.

“Medicaid is health care, and everyone should have access to affordable and quality health care,” Rogers said. “These burdensome requirements merely posed a bureaucratic hurdle in front of otherwise eligible individuals who could end up receiving expensive care in the emergency room rather than receiving preventive medical care.”

As of March 13, 1 million people enrolled in the Healthy Michigan Plan. Access to health care increases primary care usage, reduces dependence on emergency rooms and strengthens our economy. Now that these burdensome provisions are no longer valid and enforceable, it is time to remove this outdated language.

Rep. Greg MARKKANEN (R-Hancock) and Rep. John ROTH (R-Interlochen), who both voted against the bill, released statements in opposition to its passage after session.  

“Most families include at least one person who is working a full-time job to provide for their loved ones; it only makes sense that people receiving government assistance should also be required to hold down a job,” Markkanen’s statement reads. “Luckily, most people receiving government assistance are doing everything they can to earn a steady income so they can eventually not need the help. Unfortunately, some need an extra push to become employed and active members of society.” 

Both statements mentioned the exemptions for the work requirement currently in place, such as for a parent taking care of a child in the absence of the other parent.  

They also said ways to fulfill the work requirement are not limited to traditional employment but can also include unpaid internships, education training, community service and substance-use disorder treatment.  

Roth said he is in support of the Supreme Court reversing its decision.

“It shouldn’t surprise anyone that Democrats are running to get rid of this law right after significant Republican victories,” Roth said. The writing is on the wall. Hopefully, the Supreme Court will soon reverse their decision and allow us to enact these meaningful work requirements – which again, are meant to help, not hinder, Medicaid recipients.” 

The approved changes made to the State Plan for July 1, 2024, to September 30, 2024, are listed below:

Supplement to Attachment 3.1-A Pages 13a continued (p.9) (SPA 24-0007)

Supplement to Attachment 3.1-A Pages 36 and 36a (SPA 24-0005)

Supplement 1 to Attachment 3.1-A Pages 1-H-1 to 1-H-6 (SPA 24-0004)

Supplement 1 to Attachment 3.1-A Pages 1-I-1 to 1-I-5 (SPA 24-0006)

Supplement 1 to Attachment 3.1-A Pages 1-J-1 to 1-J-5 (SPA 24-0009)

Attachment 4.19-B Page 2c.2 (SPA 24-0010)

Attachment 4.19-B Page 4 (SPA 24-0004)

Attachment 4.19-B Page 4a (SPA 24-0006)

Attachment 4.19-B Page 4b (SPA 24-0009)

Attachment 4.19-B Page 6f (SPA 24-0015)

Attachment 4.19-B Page 9b (SPA 24-0007)

Attachment 4.19-D Section I Page 1 (SPA 24-0012)

Attachment 4.22-B Pages 1 and 2 (SPA 24-0016)

These page changes were made as a result of the approval of:

CSHCS Medical Complexity New TCM (SPA 24-0004)

NEMT clarification (SPA 24-0005)

Integrated Care Coordination with Wraparound TCM (SPA 24-0006)

Parent Support Partner Services (SPA 24-0007)

Recuperative Care TCM (SPA 24-0009)

Incontinence Volume Purchase Contract and Non-Sterile Gloves Rates (SPA 24-0010)

Penalty Policy – Nursing Facilities (SPA 24-0012)

Vaccine Administration Rate (SPA 24-0015)

Paternity Confinement Expenses End (SPA 24-0016)

Medicaid Model Data Lab (MMDL) and MACPro SPAs:

SUD-HH Update (ABP SPA 24-1002)

Recuperative Care TCM (ABP SPA 24-1003)

SUD-HH Update (SPA 24-1501)

Although approved, the MMDL and MACPro SPAs are not currently incorporated into the traditional State Plan. They are submitted and approved using CMS on-line processes and States are awaiting CMS direction as to how these types of SPAs will be incorporated into the State Plan.  The SPA approval packages are or will be very soon available on the website at State Plan Amendments (michigan.gov).

Erin Black, Federal Liaison, blacke@michigan.gov

CMHA’s Annual Winter Conference, Celebrate Abilities…Inspire Possibilities, will take place on February 3-5, 2025, at the Radisson Plaza Hotel in Kalamazoo, Michigan.

The conference attracts over 400 attendees. We bring together board members, CEOs, COOs, CFOs, medical directors, clinical directors, case workers, supports coordinators, and children’s supervisors from Michigan CMHSPs and Provider Agencies. We also have strong attendance from others within the public mental health and substance use disorder systems.

Come be a part of this conference by showcasing your agency’s successful programs!

These stories, along with the growing list of solutions journalism stories centered around the work of Michigan’s public mental health system, can be found at: https://cmham.flywheelstaging.com/newsroom/

This partnership, with the Issue Media Group (IMG), is built around the concept of “solutions journalism” – providing news about innovative and concrete ways that communities, across Michigan, are addressing the needs of their residents along a number of dimensions – healthcare, economic development, education, the arts, to name a few. Solutions journalism investigates and explains, in a critical and clear-eyed way, how people try to solve widely shared problems. While news sources and many of us typically define news as “what’s gone wrong,” solutions journalism runs counter to that definition by covering the innovative responses to identified needs and problems.

This partnership ensures that the work of Michigan’s public mental health system is highlighted in IMG’s large suite of solutions journalism-focused publications.

If your organization would like to be a part of this effort, via the purchase of a partnership share and the active participation in the generation of stories for these local and statewide electronic newspapers, contact Bob Sheehan at rsheehan@cmham.flywheelstaging.com or Paul Schutt at paul@issuemediagroup.com

You can subscribe, at no cost, to these publications, on the websites of each of these publications. The list of partner publications and their websites are provided below:

Second Wave – Michigan
Capital Gains – Lansing
Catalyst Midland
Concentrate – Ann Arbor/Ypsi
Epicenter – Mount Pleasant
Flintside
Metromode – Metro Detroit
Model D
Route Bay City
Rural Innovation Exchange
Second Wave -Southwest Michigan
The Keel – Port Huron
The Lakeshore
Upword – UP

Look for more articles like this over the coming year.

This morning, I was thinking about some of the changes I have seen in the public mental health system in my forty-eight years as a person served. I was trying to decide which change was the most noticeable and had the most positive effect on my life. Was it DBT, changes in how I wrote my PCP, Drop-In Centers or Clubhouses, the closure of sheltered workshops, CBT or something else? While the specific items listed each had a notable impact on my life, it was something else that was the most influential. That change was the introduction of Certified Peer Support Specialists. Master’s Level Social Workers have been and are very important to my treatment and recovery – I would not have survived without their expertise and support. Certain aspects of what I need to grow are out of their realm, however. Exercise classes, money management, writing for recovery, gardening: all enrich my life, and the lives of other persons served, but Social Workers do not provide such services. We depend on Certified Peer Support Specialists for them.

Very few social workers are also persons served. Certified Peer Support Specialists, on the other hand, have, by definition, lived experience with a mental illness. Many continue to deal with behavioral health issues. Unlike the majority of social workers, they can offer suggestions for coping with symptoms that they have actually tried and found to work. They know what it is like to be presented with a diagnosis, to take medications with unpleasant side-effects, and, perhaps, to know what it was like to have to take medications they felt were unnecessary. They have a special relationship with others of us served by the public mental health system because of our shared experiences. Along with that, the Peer Supports are living proof that it is possible to cope with symptoms and the rigors of treatment, and that recovery is possible. When they work with social workers and other clinical staff, we – the persons served – win.

In my CCBHC, Peer Supports meet people one on one to teach interpersonal skills, encourage community engagement, act as emotional supports, help the person served run errands, help with scheduling appointments, make sure the person served keeps appointments, find housing, and fill out paperwork, among other things. They accompany persons served to medical appointments. The Peer Supports lead groups to teach skills such as cooking, money management, and real-life math; various exercise groups; groups to encourage creativity. They put on community events such as the Back to School Bash and the 5-K Walk, Run, Roll,  and many other activities. That is a lot. They are a very important part of the agency.

Certified Peer Support Specialists perform different duties in various areas around the state. I have a few ideas that I would like to see universally employed throughout our public system. I believe some of them are being used already in some places, but I don’t know about the others.

The first two places I would like to see Certified Peer Support Specialists in universal use are mobile crisis units and Emergency Departments when pre-screens for inpatient admissions are being conducted. I believe both of these are practiced in some places. I advocate for Peer Supports in Mobile Crisis Units because the person is in crisis and being surrounded by strangers asking questions and perhaps law enforcement, can be very frightening in the best of times. When in a mental health crisis, the fear is often exaggerated. Having a person there who has been in a similar situation and can understand the feelings of the person everyone is trying to help in a way that only experience can provide, would, I think, often be useful.  I would like to see Peer supports in the ED because, looking back, I would really have liked to have someone who had experienced what I was going through to talk to and to tell me what to expect. Being in an ED with the commotion and noise, doctors, nurses and sometimes the police all milling around and asking personal questions is bewildering at best and frightening otherwise. I would have appreciated having had someone who had been through it available to inform me as to what was happening and what I could expect.

Related to an admission pre-screen is the Assessment for receiving services at a CMH, CCBHC, OHH, or BHH. I do not know whether anyone does this or whether it is allowed, but I would like to see Peer Supports involved in the Assessment processes. The CPSS would be there as a guide. He or she would introduce themselves, welcome the prospective person served to the facility and then describe to the person what is going to happen to them during the assessment. If more than one examiner is involved in the process, the Peer Support would tell the person who they would be seeing and why they had to see more than one person. The Peer Support would also explain that some questions may be asked more than once, that that is necessary, and instruct the person to simply answer the questions to the best of his or her ability. I think this would be helpful to the person being assessed and would possibly reduce some of his or her anxiety, thereby resulting in more consistent answers to questions and better data.

Finally, I think Certified Peer Support Specialists could be useful in the Person-Centered Planning process. I have read a number of my friends PCPs over the years and wondered how in the world they got away with stating their goals as they did. The one that amazed me the most was, “I don’t want to be depressed.” This is not a PCP-worthy goal, in my opinion. None of my friends’ goals were S.M.A.R.T.: Specific, Meaningful, Achievable, Relevant, and Time-bound. This is a small sample, but I do not think it is exceptional. I think PCPs would be more effective if people were trained in how to write goals before the day of their PCP. I also think it would be helpful if they, and, if possible, their supports, were asked to think about what they believe ought to be addressed before the day they get together to write the PCP. The CPSS would be responsible for teaching the person served to write S.M.A.R.T. goals, encourage them to consider what they think is important in life and to begin to form aspirations for the coming year or six months, It also would be helpful if the Peer Support could contact the supporters who will be attending the person’s PCP meeting, perhaps via a letter or an email, to explain the PCP process. These actions by the Peer Support Specialist would speed along the actual planning meeting, save the case manager/supports coordinator time, and I hope, result in more meaningful plans.

Certified Peer Support Specialists are a special member of the treatment team, straddling both the world of clinician and person served. I think we should take advantage of all they have to offer.

Weekly Update subscribers can now search for past articles by using the search bar, located in the archives column, next to each week’s publication. This search feature can filter past articles in which the searched word appears. Next time you would like to re-visit a previously published article – give it a try!

As you might have already noticed, the publication of our newsletter will look a little different. We are delighted to introduce a newly designed version of our weekly update email! We’ve revamped our newsletters to make them more user-friendly and accessible. Get the latest news, insights, and updates to our public mental health system with even greater clarity and ease.

With this improved layout, you’ll find it simpler to search for keywords** and to navigate through each publication chronologically. One specific item to note, the creation of these newsletters are now solely constructed and published on the CMHA website. The email blast will now be condensed to only include article titles and a teaser sentence. Each article in the email is linked to the publication on our website where the entire document can be viewed in full. Once on this page, to access the months previous articles, simple follow the linked path located under the main navigation bar.

The Weekly Update home page now includes collapsible headers. To quickly see the previous week’s update just click on that week’s date. To the right, you will see an Archives column that will include all previous month’s editions.

Our goal is to enhance your reading experience while keeping you better informed and making it easier for you to access necessary information and resources. We’re excited for you to experience these enhancements and hope they make your weekly updates more engaging and informative.

**To search for text within a webpage use the “Control Find” keyboard shortcut. Press and hold Ctrl+F on your keyboard to open a search bar.

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The Mental Health Code states that Community Mental Health Service Providers are required to distribute Recipient Rights Booklets to each recipient receiving services. To place an order with CMHA please visit our websites bookstore page.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

Meet the Team

CMHA Board of Directors

Contact your Legislators

The approved changes made to the State Plan for July 1, 2024, to September 30, 2024, are listed below:

Supplement to Attachment 3.1-A Pages 13a continued (p.9) (SPA 24-0007)

Supplement to Attachment 3.1-A Pages 36 and 36a (SPA 24-0005)

Supplement 1 to Attachment 3.1-A Pages 1-H-1 to 1-H-6 (SPA 24-0004)

Supplement 1 to Attachment 3.1-A Pages 1-I-1 to 1-I-5 (SPA 24-0006)

Supplement 1 to Attachment 3.1-A Pages 1-J-1 to 1-J-5 (SPA 24-0009)

Attachment 4.19-B Page 2c.2 (SPA 24-0010)

Attachment 4.19-B Page 4 (SPA 24-0004)

Attachment 4.19-B Page 4a (SPA 24-0006)

Attachment 4.19-B Page 4b (SPA 24-0009)

Attachment 4.19-B Page 6f (SPA 24-0015)

Attachment 4.19-B Page 9b (SPA 24-0007)

Attachment 4.19-D Section I Page 1 (SPA 24-0012)

Attachment 4.22-B Pages 1 and 2 (SPA 24-0016)

These page changes were made as a result of the approval of:

CSHCS Medical Complexity New TCM (SPA 24-0004)

NEMT clarification (SPA 24-0005)

Integrated Care Coordination with Wraparound TCM (SPA 24-0006)

Parent Support Partner Services (SPA 24-0007)

Recuperative Care TCM (SPA 24-0009)

Incontinence Volume Purchase Contract and Non-Sterile Gloves Rates (SPA 24-0010)

Penalty Policy – Nursing Facilities (SPA 24-0012)

Vaccine Administration Rate (SPA 24-0015)

Paternity Confinement Expenses End (SPA 24-0016)

Medicaid Model Data Lab (MMDL) and MACPro SPAs:

SUD-HH Update (ABP SPA 24-1002)

Recuperative Care TCM (ABP SPA 24-1003)

SUD-HH Update (SPA 24-1501)

Although approved, the MMDL and MACPro SPAs are not currently incorporated into the traditional State Plan. They are submitted and approved using CMS on-line processes and States are awaiting CMS direction as to how these types of SPAs will be incorporated into the State Plan.  The SPA approval packages are or will be very soon available on the website at State Plan Amendments (michigan.gov).

Erin Black, Federal Liaison, blacke@michigan.gov

Historic Voter Turnout

The November 2024 general election was record setting with 5,666,805 showing up, based on unofficial numbers. That number is 87,488 more voters than voted in 2020. More than 2.2 million absentee ballots were cast, 1.2 million voted in-person early, and more than 2 million voted in person on Tuesday, November 5.

Turnout rose in 74 of 83 counties, and the counties that saw declines were notable as key Democratic voter centers like Wayne, Muskegon, Kent and Kalamazoo counties.

The 37 counties with the largest increases in turnout from 2020 are all Republican-heavy counties, led by Kalkaska (10 percent), Lake, Montmorency and Montcalm (9 percent) and Crawford and Allegan (8 percent). Turnout in key Democratic counties like Kent (-1 percent), Wayne (-2 percent) and Kalamazoo (-4 percent) proved key to President-elect Donald Trump defeating Vice President Kamala Harris. Another key Democratic center, Oakland County, saw almost no change in turnout with only a nominal increase from 2020.

Presidential Race

In Michigan, former President Donald Trump defeated Vice President Kamala Harris by a little over 80,000 votes and capturing 49.7% of the vote. In a race that spared absolutely no expenses, where the two campaigns spent over $276 million dollars this cycle in Michigan alone. Trump ended up winning 74 of Michigan’s 83 counties. Trump did win or is projected to win most, if not all, of the other significant battle ground states including; Pennsylvania, Georgia, North Carolina, Wisconsin, Arizona, and Nevada. He is also the first Republican presidential candidate since 2004 to win the National Popular Vote.

US Senate Race

Michigan’s U.S. Senate race was an absolute barn-burner with U.S. Representative Elissa Slotkin narrowly defeating former U.S. Representative Mike Rogers. Slotkin’s victory continues Michigan Democrats dominance in the U.S. Senate. Slotkin defeated Rogers by roughly 18,000 votes making it one of the closest races in the entire country.  Both parties combined in the Michigan US Senate seat race to spend just over $200 million dollars. The seat currently occupied by democrat Debbie Stabenow, who announced her retirement in the beginning of last year.

US House

There were no shocking results in Michigan’s Congressional races. The 7^th Congressional district was undoubtably impacted by Trump’s success which saw a Democratic seat flip. Below are the results of the races we highlighted in Winds of Change:

• 3^rd Congressional District: Democrat Hillary Scholten defeated Republican Paul Hudson by a margin of 53.5% to 43.8%.
• 7^th Congressional District: Republican Tom Barrett defeated Democrat Curtis Hertel Jr. by a margin of 50.3% to 46.6%. (republican flip)
• 8^th Congressional District: Democrat Kristen McDonald Rivet defeated Republican Paul Junge by a margin 51.3% to 44.6%.
• 10^th Congressional District: Republican John James defeated Democrat Carl Marlinga by a margin of 51.1% to 44.9%.

Kristen McDonald-Rivet was the only democrat to pull out a win in Michigan’s toss up congressional seats against her republican opponent in the 8^th Paul Junge. McDonald-Rivet’s win will put the Michigan Senate chamber at a 19-18 democratic majority rather than its current 20-18 majority. A special election (if and when the Governor calls for a special election) in this swing senate seat will likely leave the Michigan Senate at an 19-19 tie, creating an interesting dynamic to watch in the months ahead.

Michigan Supreme Court

The Michigan Supreme Court races were the outlier of the evening, where democrats secured a 5-2 majority on the Michigan Supreme Court, by securing wins for both Justice Kyra Harris Bolden and newcomer Kimberly Ann Thomas. They defeated their Republican opponents Patrick O’Grady and Andrew Fink by significant margins. Last minute spending in these races proved to turn the tide, despite Republican wins across the board, with Harris and Thomas outspending their opponents in paid media by nearly $6 million to $330,000.

Michigan House of Representatives

The Michigan House of Representatives flipped back to Republican control with republicans claiming victory in 58 seats. Despite the sizable difference in spending with House Democrats spending over $50M to Republicans $30M they could not curtail the republican momentum that occurred.

Republicans had an extremely friendly environment in 2024 and they took advantage of it to take back majority after just one legislative session. The state House was expected to be close, but Republicans pounced on four seats held by Democrats and were able to defend all their vulnerable members. Michigan is poised to enter a new era of divided government in 2025, with a Republican House, but Democratic Senate and Governor.

Below is a run-down of the key races from last night’s House election, including the four seats the GOP was able to flip to capture majority:

• 27^th House District: Republican Rylee Linting defeated Democratic incumbent Jamie Churches. (republican flip)
• 44^th House District: Republican Steven Frisbie defeated Democratic incumbent Jim Haadsma. (republican flip)
• 46^th House District: Republican incumbent Kathy Schmaltz defeated Democrat Daniel Mahoney.
• 54^th House District: Republican incumbent Donni Steele defeated Democrat Shadia Martini.
• 58^th House District: Republican Ron Dobinson defeated Democratic incumbent Nate Shannon. (republican flip)
• 103^rd House District: Democratic incumbent Betsy Coffia defeated Republican Lisa Trombley.
• 109^th House District: Republican Karl Bohnak defeated Democratic incumbent Jenn Hill (republican flip)

New House Members

With new term limits where members can serve up to 12 years in a single chamber there are fewer new faces and even some returning faces from legislatures past. Only 13 new members will join the chamber in January with 2 of those members Nancy Arno-Jenkins and Tim Kelly having served in prior terms. Below is the extensive list of “new members” who will help makeup the 103^rd legislature.

• Portage (HD 40) Matt Longjohn (Christine Morse)
• Ann Arbor (HD 33) Morgan Foreman (Felicia Brabec)
• Grand Rapids (HD 81) Stephen Wooden (Rachel Hood)
• Hamtramck (HD 7) Tonya Myers Phillips (Abe Ayiash)
• Hillsdale (HD 35) Jennifer Wortz (Andrew Fink)
• Port Huron (HD 64) Joseph Pavlov (Andrew Beeler)
• Lenawee County (HD 34) Nancy Arno-Jenkins (Dale Zorn)
• Twp (HD 93) Tim Kelly (Graham Filler)
• Petoskey (HD 107) Parker Fairbairn (Neil Friske)
• Marquette (HD 109) Karl Bohnack (Jenn Hill)
• Sterling Heights (HD 58) Ron Robinson (Nate Shannon)
• Downriver (HD 27) Rylee Lingting (Jaime Churches)
• Battle Creek (HD 44) Steve Frisbe (Jim Haadsma)

On Thursday, November 7 the Republican and Democratic legislative caucus’ held meetings to elect their new leadership for the upcoming legislative session. Rep. Matt HALL (R-Richland Township), this term’s minority leader, will take the Speaker’s gavel come January, bringing an end to the first speakership Democrats had since Republicans took control in 2010.

When speaking with reporters, the first thing he mentioned as a priority is to hold session more frequently. “I think that one of the reasons the Democrats lost their majority is because they were too afraid of losing it, and they didn’t have session, and they didn’t take tough votes,” Hall said.

Next, he mentioned establishing a more permanent structure for funding roads by prioritizing it first in the budget and re-dedicating revenue from pork projects. He added that he wouldn’t support a tax increase on gas as an added revenue stream. “Governor Whitmer ran on fixing the roads, so I would hope that she would be willing to work with me to solve this problem,” Hall said.

When it comes time for budget season, Hall said his caucus will be looking at government-funded programs and evaluating their return on investment, and consider eliminating what isn’t working before trying to fund new projects.

The caucus’ education plan that was introduced in September, which includes additional funding for school safety and mental health grants, is another policy he’d like to hit the ground running with in January. 

The House Republican Campaign Committee’s ten-point “Mission for Michigan” is a document Democrats will want to familiarize themselves with, as Hall said the easiest way for bills to make it through the chamber will be to align with those principles. 

Rep. Bryan POSTHUMUS (R-Rockford), who has served as minority floor leader under the Democrats, is set to become majority floor leader in the next legislative session, ending Rep. Abraham AIYASH (D-Hamtramck)’s run as the chamber’s first Muslim majority floor leader.

He said his first priority is to bring back statesmanship and decorum to the House floor. He didn’t mention specific examples from this session that were contrary to those values. Posthumus also mentioned the Mission for Michigan criteria going into the 103rd Legislature. For now, he said he’s hoping lame duck will actually be lame. 

Rep. Rachelle SMIT (R-Shelbyville) was elected to serve as speaker pro tempore. The former municipal clerk has a reputation among the caucus for being efficient without being controversial and making connections, sources tell MIRS.

Reps. Ranjeev PURI (D-Canton) and John FITZGERALD (D-Wyoming) were elected to be minority leader and minority floor leader come January. Puri served as whip under the Democrats’ majority.

“It’s an extremely humbling moment to be selected by your peers. If you ever want a crash course in humility, try calling your peers and asking for a leadership vote on no sleep,” Puri said, immediately mentioning that he and Fitzgerald will do whatever they can to win a majority for their caucus again in 2026.

Puri said he ran a leadership campaign based on elevating the voices of every member of the Democratic caucus. He said he’ll do that by re-envisioning how the caucus is made up and trusting more members to help make decisions. 

Speaking of re-envisioning the caucus, Rep. Carrie A. RHEINGANS (D-Ann Arbor) proposed caucus rule changes received discussion in caucus today, Puri said, but were tabled for discussion at a later date. 

The rule changes are to elect all leadership positions, create a Rules Committee, allow any member to call for a vote of no confidence against a member in leadership, and adopting the Hastert Rule to prevent a bill from being put on the board. The proposed changes would only impact the caucus operations of the majority party, which the Dems no longer have.

But, while the Dems have the gavel for a few more weeks, Puri said he hasn’t become privy to lame duck priorities that will be put forth by Speaker Joe TATE (D-Detroit), who didn’t run for any leadership positions for the minority.

The remainder of leadership positions for Democrats weren’t announced today, given that only the minority leader and minority floor leader are elected by the caucus and the rest are appointed.

Other Republican leadership positions announced include: 

• Rachelle SMIT (R-Shelbyville) for speaker pro tempore
• Jay DEBOYER (R-Clay) for associate speaker pro tempore
• Brian BEGOLE (R-Perry) for assistant majority floor leader
• Mike HARRIS (R-Clarkston) for majority whip
• Joseph A. ARAGONA (R-Clinton Township) for chief deputy whip
• Ken BORTON (R-Gaylord) for caucus chair
• Representative-elect Nancy JENKINS-ARNO for caucus vice chair

Mental Health Association Sounds Alarm On Funding Gap 

The state’s mental health providers are facing significant financial shortfalls that mean difficult budget-balancing decisions will need to be made in the weeks and months to come without state action, the Community Mental Health Association of Michigan said Thursday.

A statement from the group said the public mental health system is funded based on the number of people covered by Medicaid each month, not the actual number of people receiving public mental health services.

As the state has redetermined Medicaid eligibility, the number of people served by Medicaid has decreased. The association said public mental health providers are facing a $52 million deficit, which is an improvement from the $93 million shortfall they were facing before the Department of Health and Human Services provided more funding.

“We are at a critical juncture where, without immediate Medicaid funding increases, the fiscal stability of mental health providers across Michigan will be severely compromised,” Robert Sheehan, CEO of the Community Mental Health Association of Michigan, said in a statement. “With dwindling financial reserves and limited relief on the horizon, the ability of providers to ensure access to mental health care for thousands of Michiganders and their families is at serious risk. Without prompt action to adjust Medicaid funding to the levels originally determined for this fiscal year, many organizations will be forced to lay off staff, reduce the intensity of care, and limit services, placing our most vulnerable community members at further risk.”

Sheehan called on the Legislature and Governor Gretchen Whitmer to take swift action, saying rate adjustments are needed now.

“Without these adjustments, the ability of mental health providers across Michigan to continue delivering essential services will be severely compromised,” he said. “This is about more than finances – it’s about ensuring that residents in communities statewide can access the mental health care they rely on.”

Sen. Jeff Irwin (D-Ann Arbor) said the funding gap is something the Legislature needs to pay close attention to and make every effort to address.

“I think this has been a long standing problem and … not only do we need to make sure that the resources are there for our mental health system to provide the services necessary in the community,” Irwin said. “But I think there’s also probably some work that we could do to … fix some of the bureaucratic elements that are leading to some of these gaps.”

Irwin, who chairs the Senate Housing and Human Services Committee  and serves on the Senate Health and Human Services Appropriations Subcommittee in the Senate, noted there can be problems with the computer coding of individuals receiving care that categorizes them as needing less care and therefore less funding, when they actually have higher care needs.

Mental Health Association Sounds Alarm On Funding Gap 

The state’s mental health providers are facing significant financial shortfalls that mean difficult budget-balancing decisions will need to be made in the weeks and months to come without state action, the Community Mental Health Association of Michigan said Thursday.

A statement from the group said the public mental health system is funded based on the number of people covered by Medicaid each month, not the actual number of people receiving public mental health services.

As the state has redetermined Medicaid eligibility, the number of people served by Medicaid has decreased. The association said public mental health providers are facing a $52 million deficit, which is an improvement from the $93 million shortfall they were facing before the Department of Health and Human Services provided more funding.

“We are at a critical juncture where, without immediate Medicaid funding increases, the fiscal stability of mental health providers across Michigan will be severely compromised,” Robert Sheehan, CEO of the Community Mental Health Association of Michigan, said in a statement. “With dwindling financial reserves and limited relief on the horizon, the ability of providers to ensure access to mental health care for thousands of Michiganders and their families is at serious risk. Without prompt action to adjust Medicaid funding to the levels originally determined for this fiscal year, many organizations will be forced to lay off staff, reduce the intensity of care, and limit services, placing our most vulnerable community members at further risk.”

Sheehan called on the Legislature and Governor Gretchen Whitmer to take swift action, saying rate adjustments are needed now.

“Without these adjustments, the ability of mental health providers across Michigan to continue delivering essential services will be severely compromised,” he said. “This is about more than finances – it’s about ensuring that residents in communities statewide can access the mental health care they rely on.”

Sen. Jeff Irwin (D-Ann Arbor) said the funding gap is something the Legislature needs to pay close attention to and make every effort to address.

“I think this has been a long standing problem and … not only do we need to make sure that the resources are there for our mental health system to provide the services necessary in the community,” Irwin said. “But I think there’s also probably some work that we could do to … fix some of the bureaucratic elements that are leading to some of these gaps.”

Irwin, who chairs the Senate Housing and Human Services Committee  and serves on the Senate Health and Human Services Appropriations Subcommittee in the Senate, noted there can be problems with the computer coding of individuals receiving care that categorizes them as needing less care and therefore less funding, when they actually have higher care needs.