The Mental Health Association in Michigan

is the only statewide, non-governmental agency concerned with the broad spectrum of mental illness across all age groups.

November 24, 2018

Letter from Lansing – November

a monthly public policy newsletter from the Mental Health Association in Michigan (MHAM)

Vol. 1, No. 11                                                                                 Nov. 2018

Governor’s Proposed Supplemental Omits Wage Increase for Direct Care Staff

It is expected that the Leigslature, during its lame-duck period to close the 2017-18 legislative session, will adopt a major supplemental appropriations bill for state government. The Governor’s office has released its proposal for that. Regrettably, despite the best efforts of a new statewide coalition, the proposal does not include funding for an increase in wages to public mental health system direct care support staff.

Direct care workers provide important personal care services and community supports to persons with disabilities in residential settings. These workers are the front-line of the behavioral health system, and often spend more time with consumers than any other care staff. If we don’t have a quality workforce, consumers are put at risk.

The average starting wage for direct care workers is $10.46 per hour – less than what’s typically offered to retail and fast-food employees. Wages at that level (and the fact there are few or no benefits with these positions) limit who will apply, how long they’ll stay in their positions, and job performance motivation levels. Our constituents and their families constantly face staff shortages, disruptions to continuity of care, and service limitations inconsistent with care plans.

We were appreciative a few years ago that the state raised direct care wages by 50 cents per hour. But we also recognize that the initial plan of the executive and legislative branches called for a second year of such increase. Unfortunately, that second increase did not happen.

A DHHS workgroup wrote in 2016 (Budget Section 1009 Report) that the state needs to make additional investments into Medicaid-covered services and supports; that direct care workers should earn a starting wage at least $2 per hour higher than minimum wage; and that this rate should increase as the state’s minimum wage does.

We have a crisis in behavioral health care in Michigan. One of the contributing factors is the low pay rate for direct care workers. Some of the state’s most vulnerable citizens are at extreme risk and can’t live as they wish. We respectfully urge the executive and legislative branches to do all they can to improve the situation as soon as possible. And we ask that you convey this message as well to your legislators and Governor Snyder.

Feds Provide Expanded Opportunity for Severe Mental Illness Treatment

The federal government is giving states an opportunity to increase the time period that Medicaid will cover mental health treatment for an individual in an “Institution for Mental Disease” (IMD).

For years, the mental health community has had to deal with an exclusion on Medicaid coverage of treatment for persons age 21-64 in facilities with more than 16 beds (the federal definition of an IMD). This came to be known as the “IMD exclusion.” It was apparently born out of fear that states would put too many consumers under inpatient care if Medicaid were going to pay for it. But as U.S. HHS Secretary Alex Azar recently said, the IMD exclusion resulted in “the worst of both worlds: limited access to inpatient care and limted access to other options.”

A few years ago, restrictions were relaxed so that a managed care Medicaid beneficiary could receive up to 15 days in an IMD.

Now, the federal government will allow states to submit waiver demonstration proposals that, if approved, would allow an IMD stay for up to 30 days for any Medicaid beneficiary. (The administration had already begun doing the same for substance use disorder.) This is an extremely positive and important step, as our constituents have historically been discriminated against by the IMD exclusion. Also, in a state like ours, this can alleviate another barrier to inpatient care for those who clinically require it. As we’ve written before, Michigan has a crisis in the  lack of available and accessible psychiatric hospital beds.



Recent Detroit News Editorial on Mental Healrth

Recent Dome Magazine Opinion Piece



Still Time to Register for Partners In Crisis (PIC) Winter Conference Dec. 14

Location: Michigan Community Mental Health Association, 426 S. Walnut, Lansing 48933
Time: Registration at 8:45. Program from 9:15 – Noon
Cost: FREE

Topics: Mental health parity activity across the country; work of the Legislative Corrections  Ombudsman Office; PIC initiatives and progress in 2018

To Register: E-mail Greg Boyd at

Letter from Lansing is published monthly by MHAM. The primary mode of distributing the newsletter is electronic mail, but we will postal-mail copies to persons lacking Internet access. If you’ve come across this issue through a friend or colleague and wish to subscribe (there is no charge), kindly let us know.  If at any point you wish to unsubscribe, simply contact our office.

Mental Health Association in Michigan
Mark Reinstein, Ph.D., President & CEO
Oliver Cameron, M.D., Ph.D., Board Chair
2157 University Park Dr., Ste. 1 | Okemos MI,  48864
P: 517-898-3907 | F: 517-913-5941 |
(membership available on-line)
A United Way-Supported Agency, affiliated with Mental Health America

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