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Mental health providers say they were shortchanged by state Medicaid

Detroit Wayne Mental Health Authority Chairman Herbert Smitherman, M.D., said Detroit Wayne has lost $15 million in revenue the past two years. He said DWMHA has sufficient reserves now, but payment reductions over time could lead to an “enormous impact” on patients.

Anya Eliassen, CFO at Oakland Community Health Network, said the revenue shortfall for Oakland’s DAB population is $9.5 million for fiscal 2016 and 2017. “It was higher in 2017 and as more and more people coming in, it is getting worse for 2018,” she said.

Eliassen said another problem is that some DAB-eligible recipients who have been enrolled mistakenly through Healthy Michigan will be coming up to their 48-month maximum coverage this spring.

Under Healthy Michigan, beneficiaries lose full coverage after four years and must contribute a percentage of coverage costs or buy insurance through the Obamacare exchange.

“We are trying to send them back through (MDHHS) to get on the right Medicaid program, but it is difficult,” she said.

Marianne Huff, a former mental health executive and longtime advocate, said the shortfall is hitting across the state, especially in West Michigan.

Jeff Brown, CEO of Lakeshore Regional Entity in western Michigan, said Lakeshore has not only lost $10 million over two years, but it has nearly exhausted its reserves.

Brown said two years ago, Lakeshore had 53,500 per month enrollment for region and was paid $257 per member per month DAB enrollee. This year, however, enrollment dropped by 1,392, leading to a $7 million decline in revenue in 2017, Rehmann said.

“We are finishing our year-end finance report a month early so we can give to state legislators and others to show what our deficit is,” Brown said. “We are hoping for relief, but we have few options.”

But if the PIHPs run out of reserve funds, Zeller said, the state must reimburse the PIHPs for any shortfalls.

“Beyond the 5 percent reserve, the state must cover all costs beyond that,” Zeller said.

Zeller said all the PIHPs need to do is notify the state. “They would alert us, and we would cover it by getting the appropriation,” she said.

When told the state would cover the losses, Sheehan reacted with skepticism. “When has the state ever covered any losses?” he said. “For 20 years, the state never stepped in once.”

Alan Bolter, associate director with the Michigan Association of Community Mental Health Boards, said the state should step in now with money to fix the shortfall. “They should fix it on the front end to avoid the administrative burden and headaches that are already happening on the west side.”

Article source: http://www.crainsdetroit.com/article/20180211/news/652676/mental-health-providers-say-they-were-shortchanged-by-state-medicaid