Washtenaw County: Notes on the WCCMH Board Meeting for 5/17/19

I apologize for the use of so many acronyms, but I have tried to make sure to explain what they stand for at least one time for each. This is typical of administrative meetings where the acronyms fly fast and furiously. Their use is an understandable convenience for the people involved, but when they go unexplained, they add to the confusion of innocent bystanders.

Washtenaw County Community Mental Health (WCCMH) Board meetings are usually held on the third Friday of the month from 9:30 to 11:30 a.m. at the Learning Resource Center (LRC), 4135 Washtenaw Ave, Ann Arbor, MI 48108. Board materials for the 5/17/19 meeting are posted on line.

The current financial status report included a discussion of the continuing problem with the mysterious “migration” of consumers [clients of WCCMH] from regular Medicaid that covers DABS - people who are Disabled, Aged, and Blind - to the Healthy Michigan Plan (HMP). HMP is Michigan’s version of Medicaid expansion under Obamacare. Medicaid reimbursement rates to CMH for services are much lower for the HMP than for regular Medicaid. Later in the meeting, this came up again - when someone who has “migrated” to the HMP is re-identified as a DAB, there is no retroactive compensation to CMH for lost funding. Also, when someone is part of the HMP, they are limited to 3 years on that plan and a work requirement has been added for many of its beneficiaries. 

During the Executive Director’s report, an observation was made that 20 years ago CMH decided to “philosophically” oppose group homes in favor of supported living in one’s own or family’s home with an emphasis on “self-determination”. There are still group homes - my sons live in one of them. In my opinion, having decisions based on a philosophical argument from a public agency rather than on individual need is a mistake that is detrimental to people with DD and their families. “Self-determination” as a method of delivering services, can be helpful to people with DD, even for people with severe intellectual disabilities who are under guardianship, but often it is not. It sometimes amounts to a shift in responsibility, from the public agency to the family, for finding and supervising services. Adding these administrative burdens to the already relentless task of caring for someone with a severe disability can be crushing. “Self-determination”, in the usual meaning of having control of one’s life, is not always achievable, especially for someone with severe intellectual or behavioral disabilities.

The Community Mental Health Partnership of Southeast Michigan (CMHPSM) is the regional administrative agency that passes Medicaid funds from the state and federal government to a four-county area in Southeast Michigan. The CMHPSM is improving its administrative functions and is seeking a permanent Executive Director. It is also dealing better with personnel issues than had been previously reported. 

A presentation was given on the Direct Care Worker crisis by CMH staff and Scott Brown from Renaissance Community Homes. A Power Point presentation  accompanied a report called “Deconstructing the Direct Care Service Crisis” concerning a proposal to implement recommendations made three years ago by a legislative workgroup to improve wages and working conditions for direct care workers that was largely ignored by the state. The presentation emphasized how the crisis undermines care and support to CMH consumers and is imposing extraordinary costs on provider agencies causing many of them to go out of business.

I will be discussing these proposals in a future blog post.

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At the June meeting of the WCCMH, there will be a discussion of services for people with developmental disabilities: 

June 21, 2019 
4135 Washtenaw Ave, LRC Room Michigan 9:30-11:30am
Ann Arbor  

Abelone Kelley May 29, 2019 0

Washtenaw County: Disability Town Hall on Impact of the Direct Care Worker Shortage on PWD

Saturday, June 15th, 2019, 10:30 a.m. - 12:30 p.m.

Washtenaw Community College

Morris Lawrence Building, Room 101

4800 E. Huron River Drive, Ann Arbor, MI

"Inadequate wages, tied to Medicaid funding, have created a Direct Care Worker shortage. Provider agencies cannot compete with other businesses that offer higher wages. People with disabilities rely on direct care workers for essential support services to access their communities. This is ours to fix."

Next steps? Actions to take?

Panelists: [State] Senator Jeff Irwin; [State] Representative Yousef Rabhi; Robert Stein - MALA; Laura De Palma - Caring Majority

RSVP appreciated: kgrant@communityalliance.com

Abelone Kelley May 27, 2019 0

Michigan Court of Appeals Upholds Guardian's Right to an Injunction to Prevent the Transfer of her Ward

A recently published decision by the State of Michigan Court of Appeals upholds the right of a guardian to seek injunctive relief from the Probate Court to prevent the transfer of her ward from one facility to another, based on showing that such a transfer would be detrimental to the wellbeing of the person under guardianship.

In re Guardianship of Lisa Brosamer v. Lenawee County Community Mental Health Authority (CMH) Is a case involving Lisa Brosamer who is severely developmentally disabled. Patricia Brosamer became Lisa’s guardian in 2009. Lisa’s mother cared for Lisa in her home from 1961 to 2006, when, due to the mother’s declining health, Lisa was moved into a residential treatment facility. Lisa is severely intellectually disabled and is unable to care for herself.

On Sept. 26, 2018, the guardian filed a petition with the Probate Court to stop a planned transfer of Lisa from one group home to another. Patricia Brosamer contended that the Lenawee CMH proposed transfer would be detrimental to Lisa. Lenawee CMH argued that the agency met the requirements of the law by determining that the transfer from one facility to another would not be detrimental and that the legislature did not intend for a guardian to be able to veto a decision by CMH. 

Lenawee CMH based its case on this excerpt from the Michigan Mental Health Code:

330.1536 Transfer of resident; notice; appeal.

Sec. 536.

1. A resident in a facility may be transferred to any other facility, or to a hospital operated by the department, if the transfer would not be detrimental to the resident and the responsible community mental health services program approves the transfer. [emphasis added]
2. The resident and his or her nearest relative or guardian shall be notified at least 7 days before any transfer, except that a transfer may be effected earlier if necessitated by an emergency. In addition, the resident may designate 2 other persons to receive the notice. If the resident, his or her nearest relative, or guardian objects to the transfer, the department shall provide an opportunity to appeal the transfer.
3. If a transfer is effected due to an emergency, the required notices shall be given as soon as possible, but not later than 24 hours after the transfer.

Probate Court findings

The guardian presented four witnesses, each of whom had a history with Lisa or daily interactions with her and “…might reasonably be capable of opining as to how the proposed transfer might affect Lisa’s wellbeing.” All four concluded that transferring Lisa from her current group home placement would be detrimental.

Lenawee CMH provided affidavits from three people, none of whom had a history with Lisa comparable to that of the guardian's four witnesses. According to the Lenawee Director of CMH, the decision that there would be no detriment was based on unnamed “expert” staff.

The Probate Court granted the injunction against moving Lisa out of her current placement. Lenawee CMH appealed the decision.

Court of Appeals

The Court of Appeals stated that “Although respondent [CMH] frames its argument on appeal as one regarding statutory interpretation, respondent’s [the guardian’s] argument actually concerns the probate court’s factual findings” of detriment to Lisa.

On the CMH agency's responsibility to other clients, the Court stated:

"Being sensitive to the fact that respondent must walk the tightrope of balancing the needs of consumers—sometimes against one another—with the limited resources that it has, MCL 330.1536 is clear that respondent cannot transfer a consumer if the transfer would be detrimental to that consumer. Thus, the relative hardship on respondent that the injunction imposes is no greater than the hardship imposed by MCL 330.1536 itself. Contrarily, the hardship Lisa may endure if she were to be transferred to the detriment of her wellbeing is significant. [emphasis added] Additionally, although third parties and the public have an interest in respondent’s ability to transfer consumers and balance its resources for the benefit of the community, Lisa has the right to be free of detrimental transfers, and with respect to MCL 330.1536, the interests of third parties in transfers that might be detrimental to Lisa are not relevant to whether the transfer is permissible; and, we note that nothing bars respondent [CMH] from seeking to have the injunction lifted if a transfer that would not be detrimental to Lisa’s wellbeing arises. Finally, the injunction will not be impractical to enforce.

“Based upon the above factors, and considering there was no adequate remedy at law to ensure that respondent would not be transferred, the probate court’s injunction was not outside the range of reasonable and principled outcomes.”

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This summary leaves out a number of interesting details in this case. 

For instance, at about the same time that Lisa's case manager of ten years retired in June 2018, a new case manager was brought in. This coincided with when Lenawee CMH determined that another consumer needed a bed at Lisa's current group home and concluded that moving Lisa to another group home would not be a detriment to Lisa. The guardian asked for a new case manager, “because [she] could not understand how the case manager could conclude that a transfer was appropriate while being so new and unfamiliar with Lisa.” The Court found evidence that this was true by comparing the testimony of the guardian's witnesses to the affidavits presented by Lenawee CMH.

The guardian's witnesses included:

• Lisa's doctor of 14 years who testified that, considering Lisa's age and disabilities, she lacked the "coping mechanism" to adjust to an unfamiliar setting. 
• A witness who had known Lisa for 20 years and had worked at the home where CMH wanted to transfer Lisa, said the proposed placement was not as suitable and feared that Lisa might have altercations with another resident with aggressive behaviors. 
• The guardian testified that Lisa had thrived at her current placement and had strong bonds with the staff and other residents. 
• Lisa's court-appointed attorney, who had been involved in the case since 2011, indicated that, because of the guardian's "extensive involvement with [Lisa] over the years," she was in "a superior position to any of the other witnesses or affiants know what [would] be detrimental to Lisa."

Abelone Kelley May 22, 2019 0

Washtenaw County: Notes on the WCCMH Board Meeting for 4/19/19

Washtenaw Community Mental Health Board meetings are usually held on the third Friday of the month from 9:30 to 11:30 a.m. The timing alone may explain why there are so few members of the public who attend the meetings or take the opportunity to speak to the Board during the time set aside for public participation. Most of the attendees are Board members, WCCMH staff, or people who have been invited to talk to the Board on specific topics. 

At the WCCMH Board meeting on April 19, 2019, there were at least half a dozen members of the public who made comments during public participation, many of whom had participated in state House budget hearings on 4/11/19 in Lansing. Those hearings can be viewed on Michigan House TV. 

The April 11th Agenda for the House Appropriations Subcommittee on Health and Human Services included an Overview of the FY 2019 - 20 Executive Recommendation for Behavioral Health and State Hospitals by the DHHS (Department of Health and Human Services) and Public Testimony on the DHHS Budget Recommendation. Public comments begin at around 1 hour and 10 minutes into the video. There were a number of commenters from Washtenaw County, most speaking about the benefits of services for people with severe mental illness and a few representing people with developmental disabilities. A provider of services who is also a parent, said that Monroe CMH is far behind in reimbursing providers like himself for services and that this has a domino effect on families, clients, and employees. Some spoke against the privatization of mental health services and others bravely spoke of their experiences with severe mental illness and surviving seemingly hopeless situations, including childhood sexual abuse.

The agenda and other materials for the 4/19/19 Board meeting are available on the Washtenaw County website. The public part of the meeting was cut short for a closed session to discuss pending litigation that challenges the State’s underfunding of Community Mental Health agencies. As I understand it, these agencies are put in the position of having to either cut services that they are mandated to provide or to violate mandates against budget deficits that they are unable to cover with funding reserves because they have been depleted by underfunding. In current state budgets, there has been a slight increase in general appropriations that can include spending on services to people who are not eligilble for Medicaid.

A notable development is that Jane Terwilliger has resigned as the Executive Director of the 4-county Community Mental Health Partnership of Southeast Michigan (CMHPSM). This followed the results of a survey that was highly critical of her performance. The COO (Chief Operating Officer) is now heading the organization and there will be a search for a new Executive Director.

Another part of the meeting focused on Board Committee structure and planning for services funded by the 2017 Washtenaw County millage to improve mental health services and safety. As I have said before, my interest is usually in subjects connected with services to people with intellectual and developmental disabilities. If you are interested in how the WCCMH is funded and spends available resources, the Agenda package includes detailed financial information on this subject.

Abelone Kelley May 07, 2019 0

Legislative Forum on the Direct Care Worker Crisis in Michigan

This announcement is from the CMHAM (Community Mental Health Association of Michigan) Weekly Update for March 29, 2019:

"Coalition Announces Legislative Forum on Michigan’s Direct Care Worker Crisis A group of statewide advocacy organizations, including the CMH Association of Michigan, is holding a legislative forum to highlight the state’s direct care worker crisis. The details of the event are provided below."

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LEGISLATIVE FORUM ABOUT THE DIRECT CARE WORKER CRISIS IN MICHIGAN!

WHEN: FRIDAY, APRIL 12, 2019, 8:30-10:00 AM

WHERE: IN THE GRAND ROOM OF THE KENT ISD EDUCATIONAL SERVICE CENTER

2930 Knapp St NE, Grand Rapids, MI 49525 PARKING IN LOT #11

WHY: 50,000 DIRECT CARE WORKERS ARE NEEDED TO PROVIDE CRUCIAL SUPPORTS AND SERVICES TO INDIVIDUALS WHO HAVE A MENTAL ILLNESS AND/OR DEVELOPMENTAL DISABILITY. THE COMMUNITY MENTAL HEALTH SYSTEM ALONE PROVIDES SERVICES TO APPROXIMATELY 300,000 MICHIGAN CONSTITUENTS. THIS SYSTEM DIRECTLY OR INDIRECTLY IMPACTS MORE THAN TWO MILLION MICHIGAN CITIZENS.

Inadequate wages, which are tied to Medicaid funding, have created a Direct Care Worker shortage. Turnover rates average 37%, and providers cannot compete with other businesses that offer higher wages, often with fewer work demands. People with disabilities who rely on direct care workers for essential supports are unable to access their communities, attend college, work and live full lives.

To RSVP and/or request more information or a reasonable accommodation, please contact Salli Christenson at 800 292-7851, ext. 130 or salli.c@arcmi.org

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Here are more CMHAM weekly updates

From the CMHAM Website: 

"The Community Mental Health Association of Michigan (CMHAM) is the state association representing the state’s public Community Mental Health (CMH) centers, the public Prepaid Inpatient Health Plans (PIHP) public health plans formed and governed by the CMH centers) and the providers within the CMH and PIHP provider networks..."

Abelone Kelley April 10, 2019 0

Michigan minimum wage increase and new paid sick leave requirements go into effect

These should help improve working conditions for Direct Support Professionals who work with people with disabilities, but they don’t go nearly far enough to stabilize the workforce. For people making more than minimum wage, the increase theoretically puts upward pressure on all low wage jobs.

The Michigan minimum wage has increased from $9.25/hour to $9.45/hour. An article form the Detroit Free Press, “Michigan paid sick leave changes: What to know about new law” by Micah Walker, 3/29/19, explains the new sick leave law.

These policies would have been more generous had the voters been allowed to vote on a proposed minimum wage increase and if a paid sick leave policy that was approved by voters had not been not been almost gutted during the lame duck legislature in December 2018.

“The paid sick leave law comes after activists gathered enough signatures to get the issue on the Nov. 6 ballot. However, instead of allowing it to go on the ballot, Republicans in the Legislature adopted the proposals in September and two days after the November election introduced bills to gut the laws they had passed just a few months earlier. If the proposals had gone to the ballot and passed by voters, it would have taken a three-fourths majority to amend the laws.”

The sick-leave law applies to workplaces with 50 or more employees, which includes full-time and some part-time employees with a lot of exemptions allowed.

Employees can take paid leave for:

• A physical or mental illness, injury, or health condition affecting themselves or a family member.
• Medical diagnosis, care, or treatment of themselves or a family member
• Preventive care for themselves or a family member
• If the employee or a family member is the victim of sexual assault or domestic violence
• For the closure of the employee's place of business by order of a public official
• To care for a child whose school or daycare has closed by a public official
• The employee's or a family member's exposure to a contagious disease
• To relocate
• To obtain legal services

The Act requires an employer to pay employees at a rate equal to or greater than the normal hourly wage, base wage, or minimum wage. The employer does not have to include overtime, vacation, bonuses, commissions, supplemental pay, price-rate pay or gratuities when calculating the pay rate. 

Read the article for more details.

Abelone Kelley March 30, 2019 0

Notes on the Washtenaw County CMH Board Meeting of 3/25/19

When I report on meetings, it is usually from the perspective of people with developmental disabilities and their families, so I may leave out details that would stand out more to people with other disabilities or mental illness. The CMH packet of materials that is available with the agenda before each Board meeting has much more information than what I cover and is a good resource for keeping up with current issues in the CMH system. 

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The Washtenaw County Community Mental Health (WCCMH) Board of Directors met at the administration building at 555 Towner St. in Ypsilanti, MI, rather than its usual meeting place at the Learning Resource Center at 4135 Washtenaw Ave, Ann Arbor, MI.

Minutes for the last meeting of the board can be found with the agenda and packet of meeting materials.

A detailed financial report, Attachment #2, is available. There was a discussion of methodology to determine the state Medicaid rate reimbursement for services provided by CMH. The problem with the formula used is that it apparently does not take into account all the variables that cause expenses to be higher in some places than others. Washtenaw County, for example, has a higher cost of living than other areas, but that is not accounted for in the rate of reimbursement. Also, the caseload of people served by WCCMH continues to rise while it has been falling in the state overall. 

There is continuing concern about the inability of PIHPs (regional administrative agencies that pass on Medicaid funds to local CMH agencies) to save a sufficient amount of funding in reserve to provide financial stability to the CMH system.

Trish Cortes, the Executive Director of the WCCMH, said in her report to the Board, that local agencies have been getting some traction with the Michigan Department of Health and Human Services and that the state is acknowledging the problem of insufficient revenues. A midyear adjustment is being considered.

Department of Health and Human Services (DHHS) budget hearings on Behavioral Health [Community Mental Health services including services for DD] were scheduled for March 21, 2019 before the Senate Committee on Health/Human Services. Jeff Irwin is a state Senator from Ann Arbor who is on this committee.

House Health and Human Services Committee budget hearings will be held April 11, 2019 at 1:30pm or after session, in the House Approps Rm, 3rd floor Capitol.

It is important for legislators to hear from provider agencies, consumers, and families about the impact of insufficient mental health funding. If there is no relief, it is possible that WCCMH and other CMH agencies will be in the position of being unable to provide mandated services to consumers. 

This is from an email from Alan Bolter, Associate Director of the Community Mental Health Association of Michigan (CMHAM) on DHHS Budget Hearings: 
 
“Over the past few weeks, Bob [Sheehan] and I have had several encouraging meetings with the administration and legislators and believe there may be an opportunity to make some progress on our funding challenges. We believe the DHHS budget hearings would be a perfect opportunity for our members to back up the message lawmakers are hearing from CMHAM. With that said, we strongly encourage you to participate in either or both of the upcoming hearings, especially if you have a member from your community on the committees.”

The following is the message from CMHAM to legislators on budget issues:

1. Medicaid rates set to match demand and costs: Set the Medicaid rates to the state’s public mental health system (the process that provides over 90% of the funding for this system) to reflect the actual and projected growth in demand for and the real costs of providing the services associated with Michigan’s Medicaid mental health benefit.

2. Medicaid rates to include contribution to risk reserve: Include, in the Medicaid rates to the state’s public mental health system the federally required contribution to risk reserves at a level sufficient to allow for the fiscal soundness of the public mental health system,

3. Allow the public mental health system to hold sufficient risk reserves: Allow the state’s public Medicaid mental health/specialty health plans (the Prepaid Inpatient Health Plans; PIHPs) to hold risk reserves of the size that would be held by any risk-bearing organization. With the earmarking of the risk reserve contribution in the rates (see 2 above), allow the CMHs to retain and reinvest any Medicaid savings that they generate through efficiencies and effective clinical practices.

4. Free up local dollars to meet unmet non-Medicaid needs, by halting the inappropriate drain of local dollars to fulfill state Medicaid obligations: eliminate the Local Match Draw Down requirement (section 928); assume the appropriate state role in ensuring the soundness of the state’s Medicaid mental health system by halting the demand that counties close the Medicaid gap caused by the systemic underfunding of Michigan’s public mental health system. 

5. Restore General Fund dollars to the public mental health system: Restore the lion’s share of the State General Fund dollars cut from the CMH budget to ensure that persons, not covered by Medicaid, have access to needed mental health services.

If you as a family member are testifying before a legislative committee or sending in written comments, you may have other concerns or want to express some of the same concerns in your own words. Advice from CMHAM: If you plan on attending, you should plan on bringing around 20 copies of your testimony and arrive at least 10 minutes early to fill out a card...

These are members of the house and senate committees considering appropriations for the Health and Human service budget: 

State House Health & Human Services Committee -- Whiteford (C), Green (MVC), Inman, Allor, Yaroch, Glenn, Huizenga, VanWoerkom, Hammoud (MVC), Hoadley, Love, Brixie, Cherry. 

State Senate Committee on Community Health/Human Services -- Sen. MacGregor (Chair), Sen. Bizon (Vice Chair), Sen. Schmidt, Sen. LaSata, Sen. MacDonald, Sen. Barrett, Sen. Hertel (Minority Vice Chair), Sen. Irwin, Sen. Santana

Community Mental Health Partnership of Southeastern Michigan (CMHPSM) Regional Update

[The WCCMH belongs to the Community Mental Health Partnership of Southeast Michigan (CMHPSM) along with CMH agencies from Livingston, Lenawee, and Monroe Counties. The CMHPSM is one of ten PIHPs (Prepaid Inpatient Health Plans) in Michigan. PIHPs are regional administrative agencies that pass Medicaid funds from the state to local CMH agencies.]

The CMHPS recently commissioned an evaluation of their Chief Executive Officer Jane Terwilliger. The results were not good. She has been CEO of the PIHP for four years and before that was the Executive Director of the Monroe County Community Mental Health Authority. There were many complaints about her job performance. The agency staff were especially upset that she has discontinued holding staff meetings. Directors on the Board from the four counties were the most critical of her performance.

Jane Terwilliger’s contract was extended for six months, but the CMHSP board has put conditions on her employment for immediate improvement with time requirements for changes. If these do not occur, her contract may be terminated. 

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Well, folks, that’s about all the excitement I can take from one more WCCMH Board meeting. The next meeting is April 19, 2019 4135 Washtenaw Ave, Ann Arbor LRC Room Michigan 9:30-11:30am .

Abelone Kelley March 29, 2019 0