Executive Summary: The Michigan Budget Process

The purpose of the bill is to reduce state Medicaid disproportionate share hospital (DSH) allotments annually from fiscal year (FY) 2014 through FY 2020. The reduction will occur “at the same time as the Marketplace and Medicaid provide increased coverage options that will reduce uncompensated care levels for hospitals. State Medicaid programs make DSH payments to qualifying hospitals that serve a large number of low-income individuals.”

The budget process is a powerful planning tool for government to make important resource decisions. According the Carney and Schoenfeld‘s article on How to read a Budget, an operating budget is a reflection of government’s financial plans. When a budget is

The budget process for each year begins by examining how much was spent each month. For each month, a budget is created for the following year. Staff members at the unit level impact the budget with supply usage.

The Commissioners Court is required to adopt a final budget by no later than the close of the calendar year. This annual budget serves as the foundation for the County’s financial planning and control. The budget includes appropriations for the general fund, certain special revenue funds, debt service funds, and proprietary funds. The budget is prepared by fund, function, department, and object codes. Transfer of appropriations between departments requires the approval of Commissioners Court.

Medicaid coverage and financing augmented access to a variety of behavioral health services, including psychiatric care, counseling, prescription medications, inpatient treatment, case management and supportive housing. Medicaid expansion states have seen higher rates of healthcare utilization in terms of medication and services for the treatment of behavioral and mental health conditions, highlighted by studies that have shown that Medicaid expansion is associated with increases in Medicaid-covered prescriptions for and Medicaid spending on medications to treat opioid use disorder and opioid overdose (1). States that have expanded Medicaid through Section 1115 Waivers experienced coverage gains similar to the states that implemented traditional Medicaid expansions (1). In fact, Indiana made large gains in Medicaid enrollment and the uninsured rate reductions between 2013 and 2015 were higher than the average decrease among the expansion states (1).

Overall, the primary issue is clear. Detroit cannot meet the demand for care (especially primary care). They are overwhelmed by the influx of uninsured and poor in all hospital systems and departments (ER in particular [mental patients overwhelmingly]). The Health Authority and VODI work, which consolidates the safety net financing and health care delivery for the poor, is a great start in dealing with the presented problems. The recommendation for stakeholders needing to attract primary care physicians to the area is an obvious must, but we need incentives. Formulating group partnerships and teaming with other states could infuse money into the Detroit health care system. The assessment could have provided a better case with key documented interviews; such as the testimonies of doctors and volunteers that work at the “free” clinics, and how “overwhelmed” they are by the huge increase in the uninsured. Also, there should be more evidence, backed with statistics that demonstrate primary care physicians are scarce.

The ability to revise a budget can be done with the legislature and governor. Budget

The Michigan legislature has been considering an iGaming bill that may result in Michigan being the next US state to implement iGaming. While iGaming would be a new step for Michigan, the state already has some experience with forms of gaming on the internet. Michigan was one of the first states to implement an iLottery, and it proved to be a popular venture. Over 276,000 residents of Michigan have opened iLottery accounts and hundreds of thousands of tickets are sold per day through the iLottery. So might Michigan be fertile ground for full iGaming? And might it be another step toward the US industry getting to the critical mass it needs in order to keep growing?

I chose to compare and contrast Ohio and Michigan State Medicaid. Medicaid is a state and federally funded entitlement program that pays for medical services to qualified low-income Michigan residents. It is one of the largest programs at the state level, providing services to over one million Michigan residents annually. All of the health care programs in Michigan have an income test and some of the programs also have an asset test. These income and asset tests may vary with each program. For some of the programs, the applicant may have income that is over the income limit and still be able to obtain health care benefits when their medical expenses equal or exceed their deductible (formerly known as spend-down) amount. Below are two examples of Michigan Medicaid plans that are available.

Based off of this proposal it is determined that there would be an increase of about 31% compared to the previous year’s annual health budget of $2.6 billion. The money earned would be used for early intervention, “wraparound” services for families, “innovation” programs, Mental health workforce: Education and Training, and for capital facilities and training. To ensure the funding is being used efficiently and properly “Under the terms of the proposition, each county would draft and submit for state review and approval a three-year plan for the delivery of mental health services within its jurisdiction. Counties would also be required to prepare annual updates and expenditure plans for the provision of mental health services” (lao.ca.gov). This review is to make sure that the tax money is only being used towards mental illness issues and nothing else.

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

The years 1996 to 1997 brought about another wave of health care reform for Massachusetts. The expansions in 1996 and 1997 resulted in an increase in the number of people enrolled in MassHealth (Massachusetts Medicaid program). As well, one of the key elements of Massachusetts’s safety net is

Medicaid financing has become an increasing issue for most states throughout the years. The Government Accountability Office (2010) reported that forty-seven of the states as well as the District of Columbia had concerns regarding the sustainability of their program. Around 16% of the state budgets go towards Medicaid each year, totaling around $183 billion (Center on Budget and Policy Priorities, 2015). A significant share of vulnerable populations relies on Medicaid for medical coverage. Rocco, Gellad, & Donohue (2015) estimated that of the

Michigan expansion. The “Healthy Michigan Plan” is the Section 1115 waiver that was approved by CMS in December 2013 for Michigan to implement the ACA’s Medicaid expansion. This plan uses Medicaid funds to provide coverage for all newly eligible adults with income up to 138% of the FPL (Norris, 2017).