LANSING — Gov. Rick Snyder's plan to fill the gaps of Michigan's mental health care system might lie in his ability to convince lawmakers on both sides of the aisle to expand Medicaid to provide 500,000 Michigan residents with coverage under the federal Affordable Health Care Act.
Snyder, a Republican, told the Associated Press on Wednesday that it would "actually expand mental health coverage significantly" and that it is "one of the factors" he is "taking into account." Snyder said he will "make that call" during his budget presentation Feb. 7.
Last June's Supreme Court decision on the federal health care law gave states the power to choose whether to opt into the Medicaid expansion. But Republicans in Michigan, who control the legislature, remain hesitant to use that power.
Snyder's decision will come at the same time he is expected to propose new programs and call for increased funding for mental health care. Michigan Department of Community Health Director James Haveman said he expects Snyder to recommend about $5 million more toward mental health in the next month's budget proposal to create new programs aimed primarily at early intervention for youth.
Snyder asked the MDCH to review the mental health care system last month after he vetoed a bill that would allow residents to carry concealed weapons in public places like churches and schools, just days after the mass shooting in Newtown, Conn.
Snyder is likely to receive backlash from GOP lawmakers if he chooses to go through with the Medicaid expansion. Sen. Bruce Caswell, a Hillsdale Republican, introduced a bill last week that would prohibit Michigan from expanding Medicaid eligibility.
Republicans are hesitant to move forward before fully understanding the long-term effects of the decision, said Ari Adler, spokesman for House Majority leader Jase Bolger. "There is no guarantee that the federal government won't change its mind and provide less funding at some point," Adler said.
Under the federal health care law, a family of four with an income of $31,809 or less in 2012 would become eligible for Medicaid, according to the Kaiser Family Foundation. The federal government would provide Michigan with the full cost of coverage through 2016, eventually dropping down to a 90 percent share.
Snyder's decision to expand Medicaid would "be a wonderful first step in his commitment" toward improving mental health, said Malisa Pearson, executive director of the Association for Children's Mental Health.
With the closure of approximately 70 percent of state psychiatric hospitals since the mid-1980s, the bulk of services are now provided by the state's 46 Community Mental Health boards. But advocates say budget cuts have left the system underfunded. The state cut non-Medicaid mental health funding by about $44 million between fiscal years 2007 and 2012.
At the same time, funding for mental health services for those who do qualify for Medicaid has grown. Haveman said the state has increased Medicaid mental health funding to account for a growing number of Michigan residents who qualify for Medicaid. But historically about half the people who approach mental health services do not have continuous Medicaid eligibility, Reinstein said.
In the face of budget cuts, Community Mental Health centers have been forced to prioritize and can often serve only those with severe mental illnesses, said Michael Vizena, executive director of the Michigan Association of Community Mental Health Boards. People who have less severe forms of mental illness but who are not Medicaid eligible "very often have been turned away and put on waiting lists," he said.
Many of the people are low-income and would become eligible for Medicaid if Michigan chooses to opt into the expansion, he said.
Pearson, whose now 17-year-old son has been in and out of Michigan's mental health system since the age of 3, said many families who aren't eligible for Medicaid "simply can't afford the hundreds of dollars an hour to take their children to get services."
Advocates applaud Snyder's recent call to improve the mental health system as the first step in the right direction.
Haveman said the new programs Snyder is expected to introduce will include mental health first aid training in professions like teachers and physicians who often come in contact with children and young adults.
The training "will go through a whole series of how to understand the mentally ill person," Haveman said. Participants will also be educated about the services available in the community so if someone identifies a person in need of help they can "point them in the right direction," he said.
Associated Press reporter Jeff Karoub contributed to this story.