A unique characteristic of Michigan’s 31 Community Health Center organizations – which provide high quality primary and preventive health care to nearly 600,000 residents at over 160 delivery sites across the state – is that they are 501(c)(3) non-profit organizations. Each Health Center is governed by a board of directors, of which at least 51% are patients of that center. These organizations are truly community owned and governed by the people that use them.
Community Health Centers are also unique in that they are truly “safety net” providers. Thirty-two percent of the people Michigan Health Centers serve have no health insurance and 40% are covered by Medicaid or MIChild. No other provider network in the state of Michigan has that type of payor mix.
The mission of Michigan Community Health Centers and the membership organization that represents them, the Michigan Primary Care Association, is to promote, support, and develop comprehensive, accessible, and affordable quality community-based primary care services to everyone in Michigan. In each of the communities that Health Centers serve, MPCA members strive to make that a reality. But we cannot do it without help from State Government.
Michigan Community Health Centers are extremely dependent upon Medicaid revenue. In fact, reimbursement from Medicaid comprises a majority of Health Centers’ revenue. Cuts to either Medicaid populations or services simply means Health Centers struggle more to help Michigan meet its commitment to helping all people get the health care they need.
On behalf of the state’s Community Health Centers, Michigan Primary Care Association requests three things of state legislators:
One, that they do everything possible to maintain the integrity of Medicaid. We ask for protection of Medicaid services and eligibility, and the assurance that reimbursement rates are adequate to maintain a sufficient number of providers willing to provide Medicaid services.
Michigan is now in its ninth consecutive year of significant state budget deficits. Through much of this period, our state has been able to provide innovative approaches to reduce the pain of budget cutting. Unfortunately, creativity can take us only so far and we have basically depleted most available one-time funding ideas. It finally became necessary in fiscal year 2009 to cut Medicaid provider rates by 8% to assure that benefits and eligibility could be maintained.
MPCA maintains that the federal government increased the Federal Matching Rate (FMAP) to help states with the ever increasing demand for Medicaid and to ensure that the program’s integrity is maintained. Yet in Michigan, the administration and legislature appear to have viewed this increase as simply a way to supplant state funds to avoid cuts to other budget areas. MPCA asks the Michigan legislature to use the federal increase in FMAP for its intended purpose: to assure that the Medicaid program is held harmless.
Second, MPCA requests that the adult dental benefit under Medicaid be restored. While eliminating oral health benefits for Medicaid adults was estimated to save $5 million in up-front general fund savings, we believe the actual cost to be much higher for the following reasons:
- Michigan will lose $16 million in federal matching dollars to pay dental providers to provide care in the appropriate setting
- People with untreated dental disease end up in hospital emergency rooms, which is far more costly than seeing a dentist
- Providing preventive care makes wise use of Michigan’s limited resources, as preventive care costs much less than restorative care
- In the first six months following elimination of the Medicaid adult dental benefit in 2003, Medicaid emergency room visits related to oral health increased 11% compared to the same six-month period the previous year
Oral health is extremely important in preventing, diagnosing and treating both oral and primary health care needs of patients. Solid evidence demonstrates that in people without access to dental care:
- Pre-term births (before 35 weeks) increase
- Diabetes is more difficult to control
- Incidence of arteriosclerosis (narrowing of blood vessels that can lead to heart attack or stroke) increases
- Heart disease rates increase
- Incidence of low birthweight infants increases
- Morbidity and death from oral cancer increases
- Incidence and suffering from dental disease increases
- Employability declines
We should also learn from the past. When the Medicaid adult dental benefit was eliminated in October 2003, over 600,000 disabled, elderly, and pregnant adults found themselves without needed dental care. During the first six months following the benefit elimination, Medicaid dental emergency room visits increased and the charges for those visits went up 42%. This is truly a “penny wise pound foolish” decision and begs that the Michigan legislature reinstate this benefit. The $5.2 million needed to restore this benefit will more that pay for itself over the long run.
Finally, MPCA implores Michigan legislators to take on the difficult task of addressing the need to fix the state’s tax structure. The current structure guarantees continued budget deficits and forces all who are providing essential services to Michigan residents to cannibalize each other, fighting over the leftovers.
While MPCA argues that Medicaid should be held harmless, we acknowledge that to do this will mean that cuts to other services will be the result. While we advocate primarily for health services and see them as essential to a healthy future population, we cannot argue that we alone deserve the funding priority. Health services should not be pitted against education, public safety, protection of children who are being abused, or public infrastructure that has been ignored for years and in bad need of attention. All of these services are essential for quality of life in our state, and legislators have been elected to be the stewards of this state’s needs. We ask them to do just that.
The Governor has proposed an increase in the service tax and a tax on physicians as part of the budget solution for Fiscal Year 2011. Even with these revenue options, another $600 million in cuts will still be necessary to balance next year’s budget. Whether or not state legislators agree that these are appropriate revenue strategies, MPCA encourages them to do what is right and consider some mix of revenue options. Our message is clear, “Please invest not disinvest in our future.” No entity has ever cut its way to prosperity. After nine years of cuts, no one can argue that our state is more prosperous. Let’s change direction. We ask our elected officials to protect the future of our state by addressing the need for increasing revenue along with implementing cuts and reforms.
Finally, MPCA also implores Michigan legislators to look carefully at tax expenditures as another revenue option. It is ridiculous that we argue over an $8 billion budget while we give away $38 billion in tax expenditures each year. It is time that these are reviewed with the same scrutiny.
In summary, MPCA asks Michigan’s elected officials to please join with those of us who are voices for people often ignored and who need representation in today’s political arena. THEY NEED YOUR VOICE!