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.
For specific dental coverage questions, please call the Michigan Medicaid beneficiary help line at 800-642-3195 (TTY: 866-501-5656) or email beneficiarysupport@michigan.gov to confirm your dental benefits.
“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 worked to pass, implement and protect the Critical Access Hospital program, which has created an important lifeline for 37 Michigan hospitals. And the MHA was successful in changing existing statue at the end of 2022 to make adoption of the new Rural Emergency Hospital designation possible for our members.
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.
Bill Wortz and Frank Foster of Public Affairs Associates present to the Legislative Policy Panel.
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.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association. *The budget has since been signed by Gov. Whitmer on July 20, 2022.
The fiscal year 2023 state budget approved by the Michigan Legislature provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout our state. We appreciate the work and consideration placed by lawmakers that continues to protect hospital priorities.
These priorities include maintaining funding for the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospitals which treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates which all support access to healthcare services in rural areas. Each of these areas are instrumental to keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.
We are also extremely happy to see new funding to improve and enhance state behavioral health facility capacity and to address the healthcare workforce. 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. The investment of state funds to expand access to bachelor of science in nursing degree programs at the state’s community colleges is a significant movement towards replenishing Michigan’s healthcare talent pipeline.
We look forward to a signed budget that provides the resources necessary for hospitals and health systems to care for all Michiganders.
The Michigan House Appropriations Committee reported out April 26 their budget recommendation for the fiscal year 2023 budget beginning Oct. 1. House Bill (HB) 5784 protects hospital priorities, including maintaining funding for the Healthy Michigan Plan, graduate medical education, disproportionate share hospitals, the rural access pool and obstetrical stabilization fund, and critical access hospital rates.
The committee recommendation also includes $264 million to expand capacity of behavioral health providers in Michigan. Of that appropriation, $85 million would be dedicated to enhancing state bed capacity for pediatric patients, $84 million would be provided to hospitals to expand various behavioral health programming, and the remainder would go toward other behavioral health care settings such as crisis stabilization units. In addition, the committee proposes increasing rates for Medicaid neonatal care services by 5%. The full House is expected to consider the committee proposals the week of May 2, and the MHA will keep members apprised of hospital budget priorities.
The full House of Representatives voted April 28 to support HBs 5968, 5969 and 5970, which would help guide Michigan’s use of new funding from the $26 billion national opioid settlement. This comes after the Senate passed identical legislation that was introduced as Senate Bills 993, 994 and 995. Either version of the bills could ultimately be sent to the governor’s desk for signature.
Michigan is estimated to receive $776 million from the settlement, and these legislative packages are intended to plan and prepare for the state to spend those funds wisely.The packages would create a new restricted fund for the state to house the settlement dollars, establish a new advisory commission appointed by the Legislature and governor to oversee spending, and prohibit future civil lawsuits related to claims covered by this fund. The MHA is currently working to identify treatment and prevention priorities for feedback on the spending of the funds and will keep members informed on the legislation’s progress.
Questions on these issues or other state legislation related to healthcare can be directed to Adam Carlson at the MHA.
State Budget Director Chris Harkins presents the FY 2023 executive budget.
The fiscal year (FY) 2023 executive budget recommendation was presented to the Legislature Feb. 9 by State Budget Director Chris Harkins.
The governor’s budget for the upcoming fiscal year protects key hospital priorities and includes the significant increase to outpatient Medicaid rates that took effect in October 2020. Key elements in the proposals for FY 2023 are:
The continuation of enhanced outpatient Medicaid rates. For FY 2022, the increase in rates is projected to result in the continuation of funding that translates to $250 million in net revenue for hospitals.
The executive budget recommendation protects critical access hospital funding, the rural access pool and the obstetrics stabilization fund from reductions.
Disproportionate share hospital payments and graduate medical education funding are also protected from reductions, continuing to reflect the MHA’s 2016 budget agreement.
The state’s obligation for the Healthy Michigan Plan is fully funded, and the executive recommendation continues funding for extended postpartum coverage of 12 months for new mothers who rely on Medicaid.
The executive budget recommendation also calls for additional investments in workers, education, and licensing that include:
$500 million of “Hero Pay” for essential workers, which includes those who were on the front lines during the pandemic.
$230 million for transformational educational infrastructure to improve and promote collaboration in higher education for health science and medical education.
$1.1 million to establish a task force and implement its recommendations dedicated to expediting and breaking down barriers to licensure for non-U.S. medical professionals
The executive budget recommendation is in addition to the $300 million for healthcare workforce recruitment, retention and training that the Legislature approved Feb. 9 (see related article). The MHA will work with lawmakers and keep members apprised as budget negotiations continue with the Legislature in the spring. As outlined in a media statement from MHA CEO Brian Peters, this was an important first step to preserve access to care in all hospitals across the state. Members with questions may contact Adam Carlson at the MHA.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Crucial healthcare funding sources remain protected in the fiscal year 2023 executive budget recommendation. We’d like to express our gratitude toward Gov. Gretchen Whitmer and her administration for their commitment supporting rural and critical access hospitals, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population.
Our hospitals are also experiencing a staffing crisis that requires multiple solutions. We are thrilled to see programs that would improve retention and recruitment of healthcare workers. The proposed Hero Pay recognizes the tremendous dedication and sacrifice of healthcare workers throughout the pandemic, while the talent pipeline will be expanded through additional investments in medical education and reviewing potential licensing flexibility for foreign-trained medical professionals.
Michigan’s behavioral health system is also stressed to its limits, and we’re encouraged to see a greater focus and financial resources toward providing potentially transformational improvements to the state’s behavioral health system that can address many of the challenges patients and families currently face.
We’d be remiss if we did not thank all lawmakers and state officials who have worked tirelessly over the past two years to provide relief and support to hospitals and health systems over the course of the pandemic. As we enter another budget cycle, we look forward to continuing to engage with the Michigan Legislature to advance the health of Michigan individuals and communities.
“We must find time to stop and thank the people who make a difference in our lives.” ― John F. Kennedy
