WSU Center for Urban Studies 1
Utilization of Fiscal Intermediaries in Michigan’s Community Mental Health System
May 9, 2016 WSU Center for Urban Studies 2
Self-Determination
• The Michigan Department of Community Health (MDCH) self- determination policy and practice guideline is intended “to assure that arrangements that support self-determination are made available as a means for achieving personally-designed plans of specialty mental health services and supports”
• In Michigan, the public mental health system is implemented by 10 Prepaid Inpatient Health Plans (PIHPs) which oversee 46 Community Mental Health Services Programs (CMHs).
MDCH self-determination policy and practice guideline: http://www.michigan.gov/documents/SelfDeterminationPolicy_70262_7.pdf 3
Self-Determination Principles
• FREEDOM: plan a life of own choosing, with necessary supports
• AUTHORITY: control a certain sum of dollars in order to purchase these supports
• SUPPORT: to live a life in the community, rich in community associations and contributions
• RESPONSIBILITY: valued role in community and accountability
• CONFIRMATION: play important role in restructuring the system
First four principles included in MDCH self-determination policy and practice guideline http://www.michigan.gov/documents/SelfDeterminationPolicy_70262_7.pdf Fifth principle listed by Michigan Partners for Freedom in http://www.mifreedom.org/images/What_do_the_Principles_of_Self.pdf WSU Center for Urban Studies 4 Potential Evidence for Increasing Demand for Self-Determination
• One of the goals for the Michigan DD Council’s 2012-2016 State Plan centers around increasing “demand for self- determination”
• How can this be documented?
• Two possibilities:
• Findings from MDCH site reviews of PIHPs (not public)
• Data on fiscal intermediaries WSU Center for Urban Studies 5
Authority and Fiscal Intermediaries
• One principle of self-determination is AUTHORITY • Fiscal Intermediaries (FIs): • Separate from CMH • Handle an individual’s budget for supports/services • Documented in MDCH cost reports • Limitations • No data on how much money FI manages • FI not necessarily manager of costs for all services a person receives person’s FI might be managing just one of their services (such as respite only) • Considers only one aspect of self-determination WSU Center for Urban Studies 6
Data on Fiscal Intermediaries
• The Center for Urban Studies reviewed the MDCH data on cost reports from Michigan Community Mental Health Agencies: • http://www.michigan.gov/mdch/0,4612,7-132- 2941_4868_4902-256889--,00.html • Part 4 lists services and supports provided by CMHs for people with developmental disabilities • Fiscal Years 2010 - 2014 were available • Using these, Center staff prepared the following charts and maps to help visualize the data WSU Center for Urban Studies 7
Individuals with DD Receiving CMH Services with a Fiscal Intermediary, 2010-2014 60%
50%
40%
30%
OF OF CASES WITH FI
% % 20%
10%
0% 2010 2011 2012 2013 2014 YEAR Based on MDCH data available at http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4902-256889--,00.html WSU Center for Urban Studies 8 Percent of Individuals with DD Receiving CMH Services Who Had a Fiscal Intermediary (2010)
Key Percent of CMH cases that had a fiscal intermediary
No data available
Less than 1%
1% - 5%
5.01% - 10%
10.01% - 20%
20.01% - 40%
More than 40%
Based on MDCH data available at http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4902-256889--,00.html WSU Center for Urban Studies 9 Percent of Individuals with DD Receiving CMH Services Who Had a Fiscal Intermediary (2011)
Key Percent of CMH cases that had a fiscal intermediary
No data available
Less than 1%
1% - 5%
5.01% - 10%
10.01% - 20%
20.01% - 40%
More than 40%
Based on MDCH data available at http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4902-256889--,00.html WSU Center for Urban Studies 10 Percent of Individuals with DD Receiving CMH Services Who Had a Fiscal Intermediary (2012)
Key Percent of CMH cases that had a fiscal intermediary
No data available
Less than 1%
1% - 5%
5.01% - 10%
10.01% - 20%
20.01% - 40%
More than 40%
Based on MDCH data available at http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4902-256889--,00.html WSU Center for Urban Studies 11 Percent of Individuals with DD Receiving CMH Services Who Had a Fiscal Intermediary (2013)
Key Percent of CMH cases that had a fiscal intermediary
No data available
Less than 1%
1% - 5%
5.01% - 10%
10.01% - 20%
20.01% - 40%
More than 40%
Based on MDCH data available at http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4902-256889--,00.html WSU Center for Urban Studies 12 Percent of Individuals with DD Receiving CMH Services Who Had a Fiscal Intermediary (2014)
Key Percent of CMH cases that had a fiscal intermediary
No data available
Less than 1%
1% - 5%
5.01% - 10%
10.01% - 20%
20.01% - 40%
More than 40%
Based on MDCH data available at http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4902-256889--,00.html WSU Center for Urban Studies 13
Findings of Possible Interest
• Statewide, between 2010 and 2014, the number of individuals with DD who utilized FIs increased.
• About 16% of individuals with DD receiving CMH services had a fiscal intermediary in 2014. This rate increased from 2010, when it was about 13%:
2010 2011 2012 2013 2014 Total 40,275 43,158 43,711 43,579 46,981
With FI 5,155 5,697 7,053 7,577 7,611 % with 12.8% 13.2% 16.1% 17.4% 16.2% FI WSU Center for Urban Studies 14
Findings of Possible Interest (cont.)
• There were 2,456 more individuals using FIs in 2014 than in 2010. Much of the increase came from 5 CMHs:
Individuals using FIs Increase from 2010 2014 2010 to 2014 Oakland CMH 2,041 2,668 627 Macomb CMH 16 643 627 CMH for Central Michigan 113 471 358 Network180 (Kent) 93 348 255 Detroit-Wayne CMH 1,442 1,553 111 WSU Center for Urban Studies 15
Findings of Possible Interest (cont.)
• Only 3 CMHs had more than 20% of individuals with a fiscal intermediary for all five years:
• Oakland (PIHP Region 8)
• Oakland had the largest percentage of individuals with a fiscal intermediary for all four years (between 46.4% and 55.3%)
• Allegan and Ottawa (PIHP Region 3) WSU Center for Urban Studies 16
Findings of Possible Interest (cont.)
• At 12 CMHs, less than 5% of individuals served had a fiscal intermediary each year from 2010 to 2014.
• At two of these CMHs, less than 1% of the individuals served had FIs:
• Hiawatha (PIHP Region 1)
• Pines (PIHP Region 4) WSU Center for Urban Studies 17
PIHP Regions WSU Center for Urban Studies 18
PIHP Region Map (as of January 2014)
Map taken from Michigan Department of Community Health: https://www.michigan.gov/documents/mdch/BHDDA_Budget_FY2014_-_Senate_412754_7.pdf
WSU Center for Urban Studies 19 PIHP Region Listing
REGION 1 REGION 2 REGION 3 REGION 4 REGION 5 MID- NORTHCARE NORTHERN MI LAKESHORE SOUTHWEST MI STATE HEALTH NETWORK REGIONAL ENTITY REGIONAL ENTITY BEHAVIORAL NETWORK • Pathways CMH • AuSable CMH • Allegan CMH HEALTH • Bay-Arenac CMH (Bay, (Alger, Delta, Luce, (Oscoda, Ogemaw, • Muskegon CMH • Barry CMH Arenac) Marquette) Iosco) • Network 180 (Kent) • Berrien CMH • CMH for Central MI • Copper Country CMH • Manistee-Benzie CMH • Ottawa CMH • Kalamazoo CMH (Clare, Gladwin, (Baraga, Houghton, (Manistee, Benzie) • West MI CMH (Lake, • Pines CMH (Branch) Isabella, Mecosta, Keweenaw, • North Country CMH Mason, Oceana) • St. Joseph CMH Midland, Osceola) Ontonagon) (Antrim, Charlevoix, • Summit Pointe CMH • CEI CMH (Clinton, • Hiawatha CMH Cheboygan, Emmet, (Calhoun) Eaton, Ingham) • (Chippewa, Kalkaska, Otsego) • Van Buren CMH Gratiot CMH • Northern Lakes CMH • • Huron CMH Mackinac, Woodlands CMH (Crawford, Grand • Ionia CMH Schoolcraft) (Cass) Traverse, Leelanau, • Lifeways CMH • Northpointe CMH Missaukee, (Jackson, Hillsdale) (Menominee, Roscommon, • Montcalm CMH Dickinson, Iron) Wexford) • Newaygo CMH • Gogebic CMH • Northeast CMH • Saginaw CMH (Alcona, Alpena, • Shiawassee CMH Montmorency, • Tuscola CMH Presque Isle) REGION 6 CMH REGION 7 DETROIT REGION 8 OAKLAND REGION 9 MACOMB REGION 10 PIHP PARTNERSHIP OF WAYNE MENTAL CO CMH AUTHORITY CO CMH SERVICES • Genesee CMH SOUTHEAST MI HEALTH AUTHORITY • Oakland CMH • Macomb CMH • Lapeer CMH • Washtenaw CMH • Detroit-Wayne CMH • Sanilac CMH • Lenawee CMH (Wayne) • St. Clair CMH • Livingston CMH • Monroe CMH WSU Center for Urban Studies 20
Fiscal Intermediary Utilization in PIHP Regions WSU Center for Urban Studies 21 Region 1: North Care Network
35%
30%
25% Copper County 20% Gogebic Hiawatha 15% Northpointe Pathways 10%
5% % of individuals with DD utilizing fiscal intermediary
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 22 Region 2: Northern MI Regional Entity
20%
18%
16%
14%
Ausable Valley 12% Mainstee-Benzie 10% North County Northeast Michigan 8% Northern Lakes 6%
4%
% of individuals with DD utilizing fiscal intermediary 2%
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 23 Region 3: Lakeshore Regional Entity
35%
30%
25%
20% Allegan Muskegon
15% Network 180 Ottawa West Michigan 10%
% of individuals with DD utilizing fiscal intermediary 5%
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 24 Region 4: Southwest MI Behavioral Health
20%
18%
16%
14% Barry 12% Berrien Kalamazoo 10% Pines 8% St. Joseph Summit Pointe 6% Van Buren
4% Woodlands % of individuals with DD utilizing fiscal intermediary 2%
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 25 Region 5: Mid-State Health Network
35%
30%
Bay-Arenac 25% Clinton Eaton Ingham
CMH for Central Michigan
20% Gratiot Huron Ionia
15% Lifeways Intermediary Montcalm Newaygo 10% Saginaw
Shiawassee % of individuals of % individuals with DD utilizing Fiscal 5% Tuscola
0% 2010 2011 2012 2013 2014 Year WSU Center for Urban Studies 26 Region 6: CMH Partnership of Southeast MI
40%
35%
30%
25%
Lenawee 20% Livingston Monroe 15% Washtenaw
10% % of individuals with DD utilizing fiscal intermediary 5%
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 27 Region 7: Detroit Wayne Mental Health Authority
20%
18%
16%
14%
12% Detroit-Wayne 10%
8%
6%
4%
2% % of individuals with DD utilizing fiscal intermediary
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 28 Region 8: Oakland Co CMH Authority
60%
50%
40%
30% Oakland
20%
10% % of individuals with DD utilizing fiscal intermediary
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 29 Region 9: Macomb CO CMH Services
20%
18%
16%
14%
12%
10% Macomb 8%
6%
4% % of individuals with DD utilizing fiscal intermediary fiscal utilizing DD with individuals of%
2%
0% 2010 2011 2012 2013 2014 CMH WSU Center for Urban Studies 30 Region 10 PIHP
8%
7%
6%
5%
Genesee 4% Lapeer Sanilac 3% St. Clair
2%
1% % of individuals with DD utilizing fiscal intermediary
0% 2010 2011 2012 2013 2014 CMH