Michigan Community Health Center Representatives Testify on State Budget

On April 19, the House Appropriations Subcommittee on Community Health heard testimony on the Medicaid program.  Doug Paterson, Director of State Policy at Michigan Primary Care Association, and Anthony King, Chief Executive Officer of The Wellness Plan Health Centers, presented testimony on behalf of Michigan Community Health Centers. 

Collectively Michigan Community Health Centers operate 160 community health clinics (also called Federally Qualified Health Centers) across Michigan and provide primary medical, dental, and behavioral health care to nearly 600,000 residents of our state.  Michigan Community Health Centers are, comprehensive health care facilities that provide services to medically underserved areas and populations of our state, serving as the safety net for individuals who are low-income, uninsured, and/or would not receive medical or dental care if Community Health Centers were not there to serve them. 

A unique characteristic of Community Health Centers is that they are 501 (c) (3) non-profit organizations, and each is governed by a board of directors comprised of at least 51% users of the Health Center.  These organizations are truly community owned and governed by the people who use them. – Doug Paterson, Director of State Policy, Michigan Primary Care Association

In 2009, The Wellness Plan Health Centers provided medical care to 24,000 people in Detroit, providing 60,000 encounters; 78% of these people are on Medicaid and another 17% are totally uninsured. 

Community Health Centers are unique in that we are truly “safety net” providers.  Thirty-two percent of the people we collectively serve in Michigan have no health care insurance and 40% are covered by Medicaid or MIChild.  No other provider network in this state has that type of payer mix.  The MISSION of our network and its members 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 we serve, our members strive to make that a reality.  But we cannot do it without help from State Government.  As you can see from our statistics, our members are extremely dependent upon Medicaid revenues.  It comprises a majority of our revenue and any cuts to either populations, benefits or services simply means we struggle more to help Michigan meet its commitment to helping all people get the health care they need. 

Today, we would like to make three requests. 

The first is that you do everything possible to maintain the integrity of Medicaid.  We ask that you protect Medicaid services and eligibility, and ensure 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 2090 to cut Medicaid provider rates by 8% to assure that benefits and eligibility could be maintained.

It is our argument that the federal government increases the Federal Matching Rate (called FMAP) to help states with the ever increasing demands for Medicaid and to assure that the program’s integrity could be 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.  We ask this committee to use the federal increase in FMAP for its intended purpose to assure that the Medicaid program is held harmless.

Secondly, we request 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

Good oral health care is extremely important in preventing, diagnosing and treating both oral and primary health care needs of patients.  Solid evidence exists demonstrating 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 a heart attack or stroke) increases
  • Heart disease rates increase
  •  Incidence of low birth weight 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 12% and the charges for those visits went up 42%.  This is truly and penny wise, pound foolish decision and we would beg that you reinstate this benefit.  The $5.2 million needed to restore this benefit will more that pay for itself over the long run.  The Senate realized the wisdom in our argument, and their version of the Michigan Department of Community Health budget does in fact restore this benefit.  We ask for your support as well.

Finally, we implore you to take on the difficult task of addressing the need to fix the tax structure in Michigan that currently guarantees continuing budget deficits and forces all of us providing essential services to Michigan residents to sit here and cannibalize each other, fighting over the leftovers.  While in this very testimony, we argue 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 lobby primarily for health services and see them as very important 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 things are essential to a decent quality of life in our state, and you all have been elected to be the stewards of this state’s needs. We ask you 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 next year.  Even with these revenue options, another $600 million in cuts will still be necessary to balance next year’s budgets.  Whether you agree with these as the appropriate revenue strategies or not, we beg of you to do what is right and consider some mix of revenue options.  Please invest not disinvest in our future.  No entity has ever cuts its way to prosperity.  After 9 years of cuts, you cannot argue that our state is more prosperous.  Let’s change direction.  We ask you to protect the future of our state by addressing the need for increasing revenue along with cuts and reforms.

Finally, we also implore you to look carefully at tax expenditures as another revenue option.  It is ridiculous that we argue over an 8 billion dollar budget while we give away $38 billion in tax expenditures each year.  It is time that these are reviewed with the same scrutiny. 

Please join with those of us who are voices for people who are often ignored and who need representation in today’s political arena.  THEY NEED YOUR VOICE! – Anthony King, Chief Executive Officer, The Wellness Plan Health Centers


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