The Michigan House of Representatives acted on a pair of MHA-supported bills during the week of March 20. In the House Health Policy Committee, members voted to report legislation to strengthen Michigan’s Healthy Michigan statute. …
MHA Executive Vice President Laura Appel joined U.S. Rep. Elissa Slotkin and other healthcare advocates March 23 as part of a virtual press conference organized by Protect Our Care to celebrate the 13th anniversary of …
As individuals and families across the state and country continue to face food insecurity, Michigan’s hospitals, health systems and community leaders are engaged in creating collaborative solutions. MHA CEO Brian Peters joined fellow food security …
The MHA collaborated with Wayne State University for the first-ever student-led advocacy day March 22. Science Policy Network-Detroit is a student organization at Wayne State that aims to advocate for science-related issues in …
The Department of Health and Human Services COVID-19 public health emergency expires May 11, 2023, which may significantly decrease the flexibility providers have become accustomed to. The MHA will host The End of the …
The Michigan Medicaid program has grown to nearly 3.2 million Michiganders, an increase of more than 700,000 when compared to pre-pandemic levels, due to federal statutory limitations on states’ abilities to remove people from the …
With the closure of nursing homes and long-term care facilities, hospitals and health systems need options to care for seniors. Dually eligible frail seniors are one of the most complex cohorts with multiple co-morbidities, frequent …
The MHA Excellence in Governance Fellowship is now available to healthcare board members looking for innovative, effective ways to lead their organizations as hospitals and health systems navigate financial strain and labor challenges. Applications are …
“Thursday marks the 13th anniversary of the signing of the Affordable Care Act– perhaps the most consequential healthcare legislation since LBJ’s passage of the Medicare Act in 1965. Except in healthcare circles, it will probably go unnoticed. …
Complicating matters, the political environment today is more complicated than in 2010 when the ACA became law. The economic environment is more challenging: the pandemic, inflation and economic downturn have taken their toll. Intramural tensions in key sectors have spiked as each fights for control and autonomy i.e. primary care vs. specialty medicine, investor-owned vs. not-for-profit hospitals, retail medicine & virtual vs. office-based services, carve-outs, direct contracting et al . Consolidation has widened capabilities and resources distancing big organizations from others. Today’s media attention to healthcare is more sophisticated. Employers are more frustrated. And the public’s confidence in the health system is at an all-time low. …“
Registration is now open for the MHA Keystone Center Safe Patient Handling Conference.
The MHA is issuing a request for proposal for a $50 million competitive grant program for Michigan healthcare entities to expand access to pediatric inpatient behavioral health services.
The MHA Health Foundation will host a four-part webinar series MHA Board Governance Education that outlines the trends affecting current and future strategic plans, techniques for effectively communicating with stakeholders on key issues and ways to build trust, drive engagement and develop relationships.
The MHA will host an in-person Human Resources Member Forumat the MHA Headquarters in Okemos from 8:30 a.m. to noon April 26, with a virtual option available as well.
The Root Cause Coalition is accepting requests for proposals to present at the 8th Annual National Summit on the Social Determinants of Health Dec. 3-5 in Kansas City.
MHA Executive Vice President Laura Appel joined U.S. Rep. Elissa Slotkin and other healthcare advocates March 23 as part of a virtual press conference organized by Protect Our Care to celebrate the 13th anniversary of the Affordable Care Act (ACA).
Appel emphasized the MHA’s long-standing support of the ACA and Michigan’s Medicaid expansion through the Healthy Michigan Plan, which provided millions of Americans with health insurance, provided access to care for millions of residents with preexisting conditions and saved billions of healthcare dollars. More than one million Healthy Michigan Plan beneficiaries are currently covered by Michigan’s Medicaid expansion program allowed by the ACA and more than 320,000 Michiganders receive coverage through the Health Insurance Marketplace created by the ACA. Appel also referenced the $10 billion reduction in Medicare payments that Michigan hospitals committed to experience in order to ensure state residents have access to expanded health insurance coverage under the ACA.
Additional speakers during the press conference included Laura Bonnell, CEO of the Bonnell Foundation, and Sarah Stark, a Type 1 diabetic who benefitted from the original ACA expansion.
Media representatives from The Detroit News, WWJ Newsradio 950, WOOD TV8 and WLNS-TV joined the press conference.
The MHA Legislative Policy Panel convened March 15 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals. The meeting was highlighted by a presentation on Medicaid redetermination from Brian …
During the week of March 13, the MHA provided testimony to both the Michigan House Appropriations Subcommittee on Health and Human Services and the House Health Policy Committee. Laura Appel, executive vice president of Government …
The MHA is issuing a request for proposal for a $50 million competitive grant program for Michigan healthcare entities to expand access to pediatric inpatient behavioral health services. The funding was appropriated by the …
The healthcare workforce is at higher risk of harm due to violence than other professional fields. Recent increases in workplace violence represent a major barrier to both staff and patient safety, prompting the need for …
The Michigan Department of Health and Human Services will implement a new service delivery model for adult dental benefits effective April 1, 2023. The following groups will be eligible: Medicaid beneficiaries ages 21 years and …
The Michigan Department of Health and Human Services will rescind certain COVID-19 telemedicine flexibilities beginning May 12, 2023, with the conclusion of the federal health public health emergency. Policy MMP 23-10 outlines flexibilities that …
Michigan state law will be updated beginning March 29, 2023, to allow pharmacists to dispense a non-controlled prescription written by a prescriber licensed in another state or province of Canada. Public Act 80 of 2022 …
One of the strongest predictors of health system performance is the quality of governance that shapes its response in an unstable environment. The March edition of Trustee Insights, the monthly digital package from the American …
“Last Thursday, the Biden administration released its proposed FY24 federal budget which is certain to spark political posturing by partisans on all sides and long-term speculation by political pundits and economists. At a high level, it includes… …
In total, healthcare spending represents 30% of the total outflow of federal funds in this budget compared to 29% in ’22 (Medicare 12%, Veteran’s Health 2% and Other Line Items 15%)—almost 50% more than Social Security and more than 100% above defense spending. …”
During the week of March 13, the MHA provided testimony to both the Michigan House Appropriations Subcommittee on Health and Human Services and the House Health Policy Committee.
Laura Appel, executive vice president of Government Relations and Policy at the MHA, provided testimony Mar. 15 to the House Appropriations Subcommittee on Health and Human Services. Appel provided an overview of the impact healthcare workforce challenges are having on state psychiatric care and the need for additional support.
“We share the frustration of families, caregivers and our colleagues at the Michigan Department of Health & Human Services when state psychiatric beds go offline,” said Appel. “We appreciate the Governor’s proposed investments and understand there are many needs in our state – I hope the subcommittee will consider an investment in healthcare for our most vulnerable residents among the highest priorities.”
Adam Carlson, senior vice president of Advocacy at the MHA, provided testimony Mar. 16 to the House Health Policy Committee in support of House Bill (HB) 4224, introduced by Rep. Julie Rogers (D-Kalamazoo). HB 4224 would repeal the Medicaid work requirement law that was passed in 2018. That legislation would require Michigan’s Medicaid beneficiaries to report employment or evidence of their search for work in order to maintain coverage.
“Ensuring coverage and access for our lower-income community members improves the health and wellness of our state, while having a positive effect on securing and maintaining employment,” said Carlson.
Members with questions about workforce funding or other state legislative action may contact Adam Carlson at the MHA.
The Michigan Department of Health and Human Services will implement a new service delivery model for adult dental benefits effective April 1, 2023. The following groups will be eligible:
Medicaid beneficiaries ages 21 years and older (including Healthy Michigan Plan).
Pregnant women enrolled in Medicaid Health Plans (MHP).
Integrated Care Organizations (ICO).
Program of All-Inclusive Care for the Elderly (PACE).
Health plans will be responsible for the beneficiary’s dental services, which must be obtained through the health plan’s dental provider network. The new model replaces Healthy Michigan Plan and pregnant women dental benefits. Therefore, questions regarding prior authorizations should be directed to the beneficiary’s health plan.
Dental benefits for Healthy Michigan Plan beneficiaries ages 19-20 will be provided by the Medicaid health plan. Beneficiaries not enrolled in an MHP, ICO or PACE will receive dental services through the Medicaid fee-for-service program. Beneficiaries enrolled in Healthy Kids Dental and under the age of 21 will receive dental coverage through Healthy Kids Dental.
“The country is lyric, the town dramatic. When mingled, they make the perfect musical drama” — Henry Wadsworth Longfellow
Having just returned from the annual American Hospital Association (AHA) Rural Health Care Leadership Conference, where I was joined by a strong contingent of MHA members and staff, the future of our rural hospitals has been top of mind.
When I was in graduate school at the University of Michigan many years ago, I recall clearly our discussions related to rural health. In short, we were taught that rural America was statistically older, poorer and sicker than the rest of the country – and this demographic and socioeconomic reality led to all kinds of challenges for those responsible for the health of rural populations and the viability of rural hospitals.
Fast forward to the most recent (2020) census and this dynamic remains true. In addition, we discovered that between 2010 and 2020, rural America actually lost population for the first time in history. Here in Michigan, the latest projections indicate that while the total state population will grow moderately over the next 20 years, the population in rural Michigan will remain flat or even decrease.
The operating environment has never been more difficult for healthcare organizations, for reasons we have documented at length in prior CEO Reports. This statement is particularly true for rural hospitals – 100 of which from across the country have actually closed since 2005. Many more have had to make the difficult decision to terminate service lines or otherwise scale back their operations to keep their doors open. What is driving these challenges? A few items come immediately to mind:
An older and poorer population translates into a higher percentage of government payors (Medicare and Medicaid), which traditionally do not fully cover the true cost of care.
The traditional volume-based reimbursement model that has been one of the cornerstones of American healthcare does not serve rural providers – which often lack sufficient volume – particularly well. The pitfalls of the volume-based model were on full display during the worst days of the COVID-19 pandemic, particularly when non-emergent procedures were suspended.
Recruiting physicians today most often involves recruiting a spouse as well; in other words, there must be a good job match for both parties to spur a relocation. Physician recruitment is more difficult in rural communities for the simple fact that there are fewer potential jobs for that spouse. In addition, the on-call coverage demands can be particularly significant in rural areas, because the number of available rotating on-call clinicians is simply fewer. I would be remiss if I didn’t mention the Merritt Hawkins firm, which is one of our original MHA Service Corporation Endorsed Business Partners, and is dedicated to working with our members to create solutions to some of the most vexing challenges of the day.
Lastly, it is no secret the country is in the middle of a behavioral health crisis, with a lack of available placements leading to behavioral health patients boarding in emergency departments throughout the state, awaiting placement in a more appropriate setting. Hospitals are experiencing higher costs caring for these patients, increasing security to protect other patients and staff, while receiving little to no reimbursement since these patients have yet to be admitted to an inpatient psychiatric unit. This lack of access is even worse in rural areas. For example, the Upper Peninsula only has one licensed child psychiatrist for the entire region.
The reality is that when we think about rural Michigan and the more densely populated areas of the state, we are all inextricably linked. There is no “us and them.” People from the big city travel every day to rural communities for conferences and events, meetings, sales calls, deliveries, vacations and visits with friends and family (and people from rural communities come to the big city for the same reasons). While we want to ensure the vibrancy of a hospital in a rural community so that the residents have access to quality healthcare, we should all want the same thing, because we never know when we might be on one of those sales calls or vacations and need that same access. This is not just theoretical, as I have countless stories about this phenomenon playing out in real life, and I suspect you do as well.
Moreover, hospitals are one of the largest – if not the largest – employers in many rural Michigan communities, playing a crucial role in the economic vibrancy of the state. Healthcare careers provide stable, good paying jobs and positively impact lives every day. Not only are hospitals important for access to care, but also as economic drivers. 121,000 total workers are associated with the healthcare sector in rural Michigan, including 81,000 direct jobs. These direct healthcare workers received $7.6 billion in total wages, salaries and benefits and contributed $1.4 billion in local, state and federal taxes. In addition, the existence of a hospital nearby is one very important item for businesses of all kinds when considering investment in a new factory, office or headquarters.
So, the vibrancy of our rural hospitals should be a priority. What is the MHA doing about it? As it turns out, we have done a lot. Beyond our advocacy on the traditional Medicaid and Medicare budgets, certificate of need, medical liability, workforce funding and many, many other public policy issues that affect all our members, here are just a few of our rural advocacy highlights:
We fought hard to secure passage of the Healthy Michigan Plan (our Medicaid expansion program) and have advocated for full funding in every budget cycle since. For the reasons cited above, this is particularly impactful for our rural hospitals.
We have worked very hard to protect the 340B drug pricing program, which is vital to many rural hospitals and their ability to provide access to care to all in their communities. Our work includes advocacy with both the state legislature and Congress, and even in the federal courts, where the MHA has filed amicus curiae briefs related to recent 340B cases.
The MHA successfully advocated for two new supplemental Medicaid payment pools that specifically benefit our rural members with implementation of the rural access pool in fiscal year (FY) 2012 and the obstetrical stabilization fund in FY 2015. Our advocacy efforts were also successful in securing Medicaid outpatient rate increases in FY 2020, the first increase in two decades, followed by an additional increase in FY 2021. These increases resulted in a 63% increase for critical access hospitals and a 21% increase for all other hospitals compared to Jan. 1, 2020, rates.
We successfully advocated for an extension of both the Medicare-dependent Hospital and Low-volume Adjustment programs during the 2022 Congressional lame-duck session, which provide critical support to many rural hospitals.
Finally, we have successfully advocated for passage and implementation of state legislation that modernizes the scope of practice for certified registered nurse anesthetists and allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care.
Our advocacy is also focused on ensuring our members can tell their story and connect with lawmakers, both at the state and federal levels. The MHA hosted its first ever Rural Advocacy Day last September in Lansing to facilitate conversation between rural hospital leaders and members of the Michigan Legislature. The MHA also accompanied members in February for the National Rural Health Association’s Rural Health Policy Institute event. MHA members met with Michigan’s congressional delegation and staff during the trip to discuss rural health issues facing Michigan hospitals. And if you haven’t yet had the opportunity to listen to the Rural Health Rising podcasts, I encourage you to tune in to our friend JJ Hodshire, the CEO of Hillsdale Hospital and an MHA Board member, as he does a fantastic job shining a light on a wide range of rural health issues – with an impressive set of special guests – in real time.
Successful advocacy and storytelling require teamwork. As mentioned above, for years we have partnered closely with the AHA and the National Rural Health Association. We have also enjoyed a close partnership with the Michigan Center for Rural Health (MCRH), and I am pleased to share Hunter Nostrant, CEO of Helen Newberry Joy Hospital, is a member of both the MHA Board of Trustees as well as the MCRH Board.
The mission of the MHA is to advance the health of individuals and communities, and in that context, we have always strived to represent all our members and communities. Each hospital is vital to the health of our great state. While the path forward may be difficult, I’m encouraged by the many rural hospital leaders – some of the nicest, and most talented people that I have met – that have developed innovative and strategic ways to address these challenges and position themselves to be able to care for their communities for years to come.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Gov. Whitmer and her administration demonstrated their commitment to protecting hospitals and supporting healthcare workers with the release today of the 2024 executive budget recommendation. Not only does it continue to protect vital funding pools in the state budget, but also provides health equity resources and includes significant workforce investments that should help grow the healthcare talent pipeline.
Important items included in the state budget include support for rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population. The investments to expand the Healthy Moms, Healthy Babies program and to implement recommendations from the Racial Disparities Task Force should help improve health outcomes and reduce disparities in care. The announced workforce development investments such as lowering the eligibility age for Michigan Reconnect are long-term strategies that should help fill the incoming talent pipeline as staffing challenges continue to impact hospitals and their overall patient capacity.
Actions like today show Gov. Whitmer is a healthcare champion and on behalf of Michigan’s hospitals, we thank her for helping Michigan advance the health and wellness of individuals and communities. The MHA is committed to working with lawmakers throughout the budget process to identify funding solutions that expand access to care, protect the viability of hospitals and assist healthcare workers.
The MHA Legislative Policy Panel convened Jan. 25 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals.
The meeting was highlighted by a presentation from MHA multi-client lobbying firm Public Affairs Associates on the new political landscape in Michigan. Managing Partner Bill Wortz and Partner Frank Foster recapped the recent election results, reviewed new legislative leadership and focused on the priorities of Democrats, who hold majorities in each chamber of the Michigan Legislature for the first time since 1984.
Moving to action items, the panel recommended the MHA support legislation to strengthen the Healthy Michigan Plan and remove provisions that are ineffective, administratively burdensome or create risk to the long-term viability of the program. The panel also recommended the MHA develop legislation to enable hospitals to bill and receive reimbursement for healthcare and other services provided to psychiatric patients awaiting behavioral health services.
In addition, the panel discussed Senate Bill 28, which seeks to enhance the definitions of and limit the use of seclusion and restraint, which was introduced by Sen. Sarah Anthony (D-Lansing).
The panel received updates on other issues including a federal update from federal lobbyist Carlos Jackson with Cornerstone Government Affairs, state budget negotiations and a recap of last year’s lame-duck session.
For more information on the MHA Legislative Policy Panel, contact Adam Carlson at the MHA.
“We must find time to stop and thank the people who make a difference in our lives.” ― John F. Kennedy
We have rightfully spent a lot of time in the past two years thanking the heroes who work in our hospitals and other healthcare settings for the incredible work they have done in the face of extreme challenge.
I want to take a moment now to thank another group of people who have recently helped our cause through their bipartisan actions; our elected officials in Lansing were extremely busy the last week of June passing the fiscal year 2023 state budget, which has since been signed by Gov. Whitmer. Our MHA mission is to advance the health of individuals and communities — and this budget absolutely provides significant help in that regard. While some elements of the new budget represent long-standing MHA priorities, others are new funding items that have the potential to reshape access to care and help our members and the patients and communities they serve.
Our MHA team does a tremendous job advocating for the importance of items such as the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospital funding, maximization of our robust provider tax program and Medicaid payment rates, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates. Every election cycle, new legislators are welcomed to Lansing and the MHA’s efforts never stop to ensure these decisionmakers are aware of the impact these budget items play in their communities. The bottom line is the financial viability of hospitals is increasingly reliant on these important programs, and the MHA is dedicated to protecting them.
Hospital closures continue to happen across the country. However, they have occurred at a much higher rate in states that have not participated in Medicaid expansion through the Affordable Care Act. Maintaining funding for our expansion program — the Healthy Michigan Plan — has been one of our top priorities, and the pandemic has made the importance of insurance coverage more important than ever. In short, when the pandemic hit and thousands of Michiganders lost their jobs, the Healthy Michigan Plan was there to ensure access to good healthcare.
Our hospitals that treat the highest numbers of uninsured and underinsured patients also qualify for disproportionate share hospital funding, which provides enhanced reimbursement to account for the higher costs of care. This pool is funded through hospital provider taxes that reduce the state’s general fund contribution to the overall Medicaid program.
Small, rural and independent hospitals can often experience financial challenges in a particularly acute way, thus items such as the rural access pool, obstetrical stabilization fund and critical access hospital reimbursement rates also support access to healthcare services in rural areas. Labor and delivery units typically do not contribute to positive margins, but they are extremely important for families and communities. The obstetrical stabilization fund provides additional means for hospitals in rural areas to maintain these services so expectant mothers can avoid driving exorbitant distances for these services. Lastly, the state also included $56 million in new funding to increase Medicaid reimbursement rates for primary care services, which will help individuals on Medicaid receive the necessary primary and preventative care that can help prevent hospitalizations and reduce overall healthcare costs.
Lastly, behavioral health investments have been at the forefront of our advocacy efforts for some time and we were very pleased to see new funding to improve and enhance state behavioral health facility capacity. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. Included is $50 million to expand pediatric inpatient behavioral health capacity, $30 million to establish crisis stabilization units and $10 million to fund the essential health provider loan repayment program to cover behavioral health professionals.
In total, the budget includes $625 million in new investments for behavioral health funding and investments in workforce. While this will not solve all the issues impacting hospitals, it provides needed resources and demonstrates the commitment of lawmakers to a healthy Michigan. This budget also signifies that our work must continue to advocate for the resources necessary for hospitals and health systems to care for all Michiganders. Once again, on behalf of the entire MHA family, I want to acknowledge and thank both Governor Whitmer, as well as lawmakers in the state House and Senate, for their support of this latest state budget. And I would also encourage anyone who cares about access to quality, affordable healthcare to engage in the process, share your stories and input with those who can make a difference going forward. But also remember to say thank you when they support our cause.
Gov. Whitmer signed July 20 the fiscal year 2023 state budget. Included in the 2023 budget agreement is $625 million in new investments for behavioral health funding and the healthcare workforce. This includes:
$50 million to expand pediatric inpatient mental and behavioral health capacity throughout the state.
$30 million to establish crisis stabilization units for mental and behavioral healthcare.
$10 million to fund the essential health provider loan repayment program to cover behavioral and mental health professionals.
New and ongoing funding of $3.5 million to support the statewide trauma system.
$56 million to increase Medicaid reimbursement rates for primary care clinician services.
Additionally, the state budget provides the resources necessary for hospitals and health systems to continue advancing the health of individuals and communities throughout Michigan. Specifically, the budget reflects the protection or enhancement of many MHA priorities, including:
Maintains funding for the Healthy Michigan Plan.
Protects funding for the graduate medical education of physician residents.
Supports disproportionate share hospitals.
Continues funding for the rural access pool and obstetrical stabilization fund.
Each of these funding sources are instrumental to keeping hospitals financially secure, particularly those serving vulnerable and underserved populations. MHA CEO Brian Peters released a statement July 1 applauding the healthcare focus of this budget and highlighting significant investments toward rural and behavioral health. These new appropriations will allow hospitals to continue and expand upon service lines that are in increased demand due to the pandemic.
The governor also made several line-item vetoes that do not directly impact hospital priorities when signing the budget, including vetoes of funding the administration argues is anti-abortion.