Program: Community mental health non-Medicaid services

Appropriation:

Special Revenue Funds:

$1,582,400

 

GF/GP:

$275,347,800

 

Total:

$276,930,200[21]

Program Description:

This appropriation funds Department of Community Health expenditures that are not covered by Medicaid, but mimic the services provided by the Medicaid program on mental health issues for people whose income and assets make them ineligible for Medicaid.

The term “Medicaid” is used generally to describe 56 entitlement programs jointly administered by federal and state governments (states must participate in at least 14 of them to get federal matching funds).  The programs are designed to help the poor by providing them with short- and long-term healthcare services.  The original Medicaid program was passed in 1965 as part of Lyndon Johnson’s “Great Society” initiative, in which he declared “unconditional war on poverty.”  Michigan spends $2 billion from its GF/GP account annually covering the costs of the program, and costs are expected to increase dramatically.

The services clients may receive under this program include, but are not limited to, help with substance abuse problems, general counseling, outpatient services, “inpatient care in a structured, secure environment,”[22] psychiatric evaluations, hospital care, Intelligence Quotient and other “projective” psychological testing, health services (minor first-aid treatment, in-home nursing visits, and dietary services); “occupational therapy” (for problems that involve work performance); and “specialty services” such as music, recreational, art, and massage therapies.[23]

Program Recommendation:

This program should be eliminated.  The federal government has established guidelines for the provision of Medicaid services based on a variety of factors, including assets and income.  It is laudable to assist people who fall outside of the established government categories, but where do expansions of the state end, and personal and civic responsibility begin?  If government refrained from crowding out private solutions to social ills with high taxes and regulation, private individuals and institutions could do more to address the needs of Michigan citizens.   Savings:  $276,930,200.

Program: Multicultural services

Appropriation:

All from GF/GP:

$3,163,800

 

Total:

$3,163,800[24]

Program Description:

This appropriation funds Community Mental Health Service Programs (CMHSP) for contracts for mental-health services to specified ethnic groups.

Recommended Action:

The funding for this program could be eliminated.  Mental health services should not be either withheld or dispensed on the basis of ethnicity.  Savings: $3,163,800.

Program: Medicaid substance abuse services

Appropriation:

Federal Funds:

$14,479,800

 

GF/GP:

$11,647,700

 

Total:

$26,127,500[25]

Program Description:

This appropriation funds Medicaid substance abuse services.  These services are managed by CMHSPs. Spending on substance abuse treatment is increasing, and more of the funding burden is being shouldered by taxpayers.  Payments for substance abuse treatment increased 5.4 percent per year from 1987-1997, even as inpatient treatment was increasingly replaced by less costly outpatient treatment. While this is a slower rate than the growth in overall national health expenditures (8.2 percent per year), there is cause for concern.  In 1997, $11.9 billion was spent nationally on treating substance abuse. In that year, 62 percent of all substance abuse treatment funding came from the public sector, while only 55 percent of all mental health spending came from government. Taxpayers were increasingly called upon to fund substance abuse treatment; 61.8 of substance abuse treatment was funded through public sources in 1997, compared with only 50.3 percent to years earlier. By contrast, private insurance-funded spending grew only 1.9 percent a year.[26] This discrepancy suggests a shift to public sources and/or a relative lack of cost control in public-sector programs.

Recommended Action:

All state substance abuse programs could be eliminated in favor of private assistance.  Substance abuse is a serious problem that leads to a loss in productivity, the breakdown of families, and a number of other adverse consequences.  However, this program is an other example of a system that takes resources from families and communities through taxation, funnels it through expensive state and federal bureaucracies, and returns a portion of the amount taken to certain selected individuals and organizations.  These resources should be left with individual families and local communities who are close to the problems, and who can provide assistance that is more accountable and effective than that from distant bureaucracies in Lansing and Washington. Savings:  $26,127,500.

Program: Respite services

Appropriation:

Special Revenue Funds:

$3,000,000

 

GF/GP:

$318,600

 

Total:

$3,318,600[27]

Program Description:

This appropriation funds respite care for families who have children with emotional disturbances.

Recommended Action:

The state should remove itself from respite-care services.  As with other forms of respite care, one should commend the hard work of family members who attend to their ill relatives.  But every dollar that government takes from needy families, businesses, and individuals is a dollar that they cannot use to solve their own respite problems, or those of their neighbors.  Savings: $3,318,600.

Program: State disability assistance program substance abuse services

Appropriation:

All from GF/GP:

$5,453,600

 

Total:

$5,453,600[28]

Program Description:

This appropriation funds per-diem room and board payments for financially needy adults or emancipated minors who reside in substance abuse residential facilities.

Recommended Action:

This line item could be eliminated for the same reasons addressed by “Medicaid Substance Abuse Services” program, above.  Savings: $5,453,600.         

Program: Community substance abuse prevention, education, and treatment programs

Appropriation:

Federal Funds:

$57,744,900

 

Special Revenue Funds:

$1,460,000

 

GF/GP:

$17,130,500

 

Total:

$76,335,400[29]

Program description:

This appropriation funds programs that distribute grants for substance abuse prevention, education, and treatment to 18 agencies and treatment centers. The treatment centers are outpatient and residential; there is no hospitalization. 

Recommended Action:

Eliminate this line item for the same reasons addressed under the “Medicaid Substance Abuse Services” program.  Savings: $76,335,400.