Michigan Advance published a story July 9 on the healthcare priorities included in the fiscal year 2024 state budget. Adam Carlson, senior vice president, advocacy, MHA, is quoted multiple times in the story regarding funding specific to hospitals and health systems.
Topics covered by Carlson include hospital security, behavioral health and health equity. The budget included both new funding to support trauma center and inpatient psychiatric services, as well as continued support for long-standing programs crucial to access to healthcare services throughout Michigan.
“We’re in the middle of a behavioral health crisis,” said Carlson regarding the $33 million towards increased Medicaid rates for inpatient psychiatric facilities. “Given the size of the problem, it’s not going to solve it. We’ll still have a shortage of beds, but ideally it will lead to better patient outcomes.”
The MHA Behavioral Health Boarding Survey was also mentioned in an article from Bridge published July 13 which focuses on a new behavioral health unit in northern Michigan as it seeks to address the need for more behavioral health services in the region.
“Plans are only good intentions unless they immediately degenerate into hard work.”— Peter Drucker
The theme of the 2022-2023 MHA program year was telling our story. With focus and passion, we told the stories of our hospitals and health systems, the challenges and adversity they face, and how they still provide high quality and accessible healthcare to their communities. This theme was intended to ensure that we as healthcare leaders continue to help those who don’t live and breathe healthcare understand the ways we are working to meet the most pressing needs, but also the support we need from other sectors to continue to offer strong and daily access to care for all. Our theme served to frame the four distinct pillars of our association strategic action plan, which included the financial sustainability of hospitals, workforce restoration and well-being, the behavioral health crisis and continued efforts towards achieving health equity.
I’m pleased to share we made significant progress in telling our story and achieving tangible, impactful results under each of the four strategic pillars, which is summarized in the latest MHA Annual Report. This work evolved around the ending of the COVID-19 public health emergency, a pandemic that tried our member organizations, and especially their healthcare workers, like nothing has before in most of our lifetimes. A large part of our success in making this transition and achieving so many significant outcomes was due to the MHA Board of Trustees, who I want to thank for their strong leadership and commitment to advancing the health of individuals and communities. I particularly want to express my gratitude to our outgoing Chair, T. Anthony Denton, for his steadfast leadership throughout this year.
Key to our efforts to safeguard the financial viability of hospitals is our continued focus on the state budget. Not only were we successful in continuing existing supplemental payment pools such as for Disproportionate Share Hospitals, Graduate Medical Education, Rural Access and Obstetrical Stabilization, but we also secured a Medicaid outpatient hospital rate increase. Collectively, these victories generated hundreds of millions in funding for Michigan hospitals. Long a priority of our association, the MHA also successfully advocated to ensure the Healthy Michigan Plan (our Medicaid expansion program) is fully funded. Our advocacy team continues to be one of the most respected in Lansing, as we saw several MHA-supported bills signed into law while experiencing a 100% success rate in making sure none of the 10 bills we opposed became statute.
Our work on behavioral health continues, as there remains a need to expand the number of behavioral health professionals and facilities to provide better access to care. The MHA secured both $50 million in the fiscal year 2023 state budget for expanding pediatric inpatient capacity, while adding an additional $10 million to create Psychiatric Residential Treatment Facilities to alleviate state hospital capacity issues. Much of the feedback we have received is the need to add quantitative data to the conversation to demonstrate to lawmakers and stakeholders the degree of the crisis. For several months, our team has been collecting data weekly on the number of patients waiting for a behavioral health bed in Michigan hospitals. This demonstrates the degree to which patients are having difficulty finding care, while also showing how many patients are utilizing hospital resources while the facility receives no reimbursement due to not having an acute care diagnosis billing code.
Lastly, we will not rest as our members continue to address health disparities to ensure health equity. The MHA Keystone Center works closely with the Michigan Alliance for Innovation on Maternal Health (MI AIM) to help address disparities and reduce the risk of maternal death. This past program year, their efforts resulted in 77% of Michigan birthing hospitals participating in MI AIM, 94% of which are compliant with the pre-partum assessment and 89% are compliant with the post-partum assessment. Our work with the MHA Public Health Task Force also continues as they explore strategies for collaboration that can improve data collection and public health initiatives.
Of course, there are always other items that come up that require MHA attention and effort that are not always known during the development of the strategic action plan. Responding to the shortages of chemotherapy drugs cisplatin and carboplatin and working with Michigan’s Congressional delegation is just one example of the value of association membership and how quickly we can mobilize our relationships in a time of crisis. Other wildcards include our work on licensing Rural Emergency Hospitals, tracking and increasing awareness of candida auris infections and expanding hospital bed capacity.
As we concluded our program year during our Annual Meeting on Mackinac Island, we were able to honor a true healthcare champion with our Meritorious Service Award in U.S. Sen. Debbie Stabenow. She announced earlier this year she will not seek an additional term in office and this award is the highest honor our association can bestow on an individual for their years of work towards enabling the health and wellness of individuals and communities. We have worked closely with Sen. Stabenow from her time in elected office in the Michigan Legislature to Congress and she will leave an extraordinary legacy for which the MHA family will be eternally grateful. We also had an opportunity to honor a number of other outstanding individuals for their contributions to Michigan healthcare.
Above all else, I want to take this opportunity to thank all MHA staff for their many contributions which made it another successful program year. The challenges we confront in healthcare are daunting and constantly evolving, but my confidence in our team at the MHA has never wavered, as they continue to display their exceptional commitment to their work and embody the MHA culture of member service and value creation every single day.
Now as we formally begin our 2023-24 program year on July 1, I am excited for the leadership of our new Chair Shannon Striebich. We offer our congratulations to her and look forward to working closely together. A year from now, I am confident we will once again be able to report on the successful outcomes we were able to achieve through our unity, collaboration and plain old fashioned hard work.
The release of the Michigan Senate and House Appropriations Health and Human Services Subcommittee budgets April 25 include broad investments in healthcare and specific investments advocated for by the MHA. The state budget is at a pivotal point in the process, as individual legislative chambers are releasing budget recommendations following the executive budget recommendation Feb. 8 by Gov. Whitmer. After the adoption of the legislative subcommittee budgets, the state House and Senate are expected to pass their individual chamber appropriations recommendations before preparing to negotiate a final conference budget. The MHA anticipates a negotiated budget passing in June.
The MHA advocated for the state to make a significant investment in maximizing Michigan’s federal Medicaid match. Each segment of the proposal presented a distinct opportunity to leverage federal funding in support of access to care and alleviating financial stresses on hospitals. Included in the proposal were increases in reimbursement for labor and delivery; inpatient psychiatric services; outpatient rates; and the creation of new funding to support Level I and II trauma centers. Overall, the MHA crafted a budget request that has the potential to produce significant funding investments in services that directly contribute to increased access to care for the state’s residents.
The Senate subcommittee responsible for the Department of Health and Human Services appropriations released their subcommittee budget with inclusion of approximately $40 million in funding to support Medicaid reimbursement increases in labor and delivery, inpatient psychiatric rates and outpatient services; and an additional $30 million in funding to support Level I and II trauma centers. Further, over $16 million in funding was allocated to MHA member hospitals to support opportunities for increasing access to behavioral health, rural access and capital improvements.
The House subcommittee included $60 million to support Level I and II trauma centers and $33 million to support an inpatient psychiatric reimbursement increase. In addition, the House included over $33 million to support MHA member hospital requests benefiting behavioral health, women’s health, pediatric access and capital improvements.
Both chambers also included significant funding to support the Gov. Whitmer’s Healthy Moms, Health Babies initiative. The legislature will now be tasked with combining their individual proposals into a cohesive final state budget. The MHA will continue advocating for increased Medicaid reimbursement as the budgets are consolidated, while supporting members in achieving success with individual priorities.
Questions on the budget can be directed to Adam Carlson at the MHA.
The MHA Board of Trustees met April 12 at the MHA Capitol Advocacy Center in downtown Lansing, joined by Michigan Senate Health Policy Chair Kevin Hertel (D-St. Clair Shores). Hertel acknowledged the state’s significant challenges in meeting behavioral healthcare and workforce needs and identified these areas as priorities for the Senate Health Policy Committee. Board members stressed the need for lawmakers to support policies that allow flexibility and foster innovation, such as continuing to expand telehealth options started during the pandemic and looking beyond staffing ratios toward more effective ways to meet patient care needs within a finite labor supply.
The board also heard from colleagues about a recent learning and technology exchange between Michigan health system leaders and their Israeli counterparts and had the opportunity to listen to the reflections of Shreya Desai, a neurobehavioral researcher and current government relations and health policy fellow with the MHA. Desai shared her experiences working with the MHA Advocacy Division and how it will influence her future medical career.
The board spent time providing input and direction on the key pillars of the association’s action plan, which is focused on supporting financial viability, promoting workforce sustainability, fostering health equity and addressing behavioral health needs. This strategic conversation included a review of recent state budget initiatives, including the MHA’s successful advocacy to secure $75 million for healthcare worker recruitment, retention and training for Michigan hospitals, which is the latest victory in a series of state budget appropriations that has resulted in $1.45 billion in new hospital funding since January 2020.
In addition, the board expressed support for ongoing efforts to work with the state to maximize the federal Medicaid match to increase overall Medicaid reimbursement rates and funding for targeted services such as obstetrics, outpatient, psychiatric and trauma care. In furtherance of workforce sustainability, the board supported the association’s social media campaign to promote and increase awareness of a broad range of healthcare careers. The board also engaged in a discussion of health equity and the association’s continued work to assist members in eliminating disparities in healthcare through the leadership of the MHA Health Equity Taskforce. Improving access and funding for behavioral health continues to be a key priority for the association and board members provided input to the MHA on data collection efforts to advance advocacy strategies to reduce emergency department wait times for patients seeking inpatient psychiatric care. Finally, the board approved Type 2B association membership for Southwest Michigan Behavioral Health.
For more information about the actions of the MHA Board of Trustees, contact Amy Barkholz at the MHA.
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 fiscal year (FY) 2023 state budget bills were approved by the Michigan Legislature July 1. House Bill (HB) 5783 and Senate Bill (SB) 845, which provide for the FY 2023 budget, now go to the governor’s desk for final review and signature into law.
In a statement released July 1, MHA CEO Brian Peters said, “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 that treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates, all of which support access to healthcare services in rural areas. Each of these areas are instrumental in keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.
The budget also supports MHA and hospital priorities with new funding to improve and enhance state behavioral health facility capacity and 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 toward replenishing Michigan’s healthcare talent pipeline.
In other action, the House of Representatives supported legislation to create an opt-out grant program for hospitals to establish medication-assisted treatment (MAT) for substance use disorders in their emergency departments. SB 579, introduced by Sen. Curt VanderWall (R-Ludington), now returns to the Senate for a final concurrence vote before it is sent for the governor’s signature. Hospitals provided MAT programs prior to introduction of the bill, and the MHA has already partnered with the Michigan Department of Health and Human Services (MDHHS) to implement the first round of grants provided under this legislation. No hospitals would be required to participate in the program.
The full Senate advanced to the House of Representatives a bill to register certain medical laboratories in Michigan. SB 812, also introduced by VanderWall, would create a registry for interventional pain management, kidney access and vascular laboratories. As currently written, SB 812 would not provide any form of oversight or clinical requirements for the registered labs, and the MDHHS would not have authority to deny or remove registered labs from the list. The MHA has not taken a position on the bill but is closely monitoring any changes.
Finally, a bill related to telemedicine was introduced in the Senate. SB 1135, introduced by Sen. Mike MacDonald (R-Macomb Township), would amend the state’s Social Welfare Act to ensure that recent expansions in telehealth visit coverage also apply to the Medicaid Medical Assistance Program and Healthy Michigan Program. The bill would specify that recipients are covered equally for telehealth visits, expand the “distant site” definition, and ensure that providers are reimbursed at an equal rate to in-person services. The MHA is reviewing the legislation and has not yet taken a position on the bill. The association will keep members apprised of future action.
Members with questions on state legislation related to healthcare should contact Adam Carlson at the MHA.
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 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 MHA responded to several media requests the week of Feb. 7 on topics including passage Feb. 9 of House Bill 5523 that provides $300 million in healthcare workforce funding, Gov. Gretchen Whitmer’s Feb. 10 executive state budget recommendation and COVID-19 hospitalizations.