Community Mental Health Authority Information

Under an Authority model, consumers will receive services from current CMH professionals using the same eligibility and service criteria to provide the behavioral health services in the same locations, using the same amount of dollars.  The continuation of quality mental health services to consumers is one of the Board of Commissioners’ primary objectives as they consider this transition. Changing to an Authority model will in no way diminish current service levels for consumers, nor will it change the flow of “regular” funding—State CMH/County on General Fund; United States/Michigan to PIHP to the CMHSP on Medicaid; United States/Michigan to CMHSP on CCBHC; and County to CMHSP on millage. The difference is in Medicaid, where there is a deficit.  In that instance, the “bill” is returned to the PIHP which either pays or forwards it to the State. To the extent that the bill is due to greater Medicaid need, not mismanagement, the bill will be paid by the PIHP and if necessary, the State.

The Authority will be obligated to provide the same level of Medicaid service entitlements and GF CMH services. The Mental Health Board will make the decision on whether additional services can be added if there is an Authority. This will likely depend on the result of the millage, which is independent of the authority/department issue. 

Yes, they can use the buildings. Currently, CMH occupies almost 25,000 square feet in 4 buildings and paid $450,000 in Fiscal Year 2025. Three of the four buildings are shared with other departments. No change is included during the transition agreement. Beyond that, under an Authority model CMH can continue to occupy this space and enter into a long-term lease agreement with the County.

No. Becoming an Authority is not related to how Medicaid structures the system or what is in the Medicaid benefit package.  

The short answer is no, becoming a CMH Authority will in no way change or “take away” who is in control of consumer treatment, how they are treated, or what services they receive. Under an Authority model, the same professionals will use the same eligibility and service criteria to provide the same behavioral health services in the same locations, using the same amount of dollars.

The continuation of quality mental health services to our community is one of the Board of Commissioners’ primary objectives as they consider approving this transition. Changing to an Authority model will in no way diminish current service levels.

We are not aware of any evidence one way or the other. Effectiveness or “being received well” are not concepts affected by Authority status, one way or another. The analogy might be this: Are partnerships more efficient or better received than corporations?

Currently, program accountability is exclusively with the Mental Health Board. That would not change. The only accountability the Board of Commissioners has over CMH is regarding millage funds. That would not change. The Board of Commissioners would continue to appoint the Mental Health Board and could remove such Board members if necessary. That would not change.

Currently, the only “leverage” the County has over the Mental Health Board and Director is in the millage-funded programs. This would not change. The mental health code dictates the County’s contribution to CMH Authorities. It can never be used as leverage. 

The County Board of Commissioners will have the same limited control that they have now. They appoint Mental Health Board Members and control the millage.

No. The County Board of Commissioners would have to change the Enabling Resolution. 

The State of Michigan has no choice but to approve the authority. It has up to a year to approve the termination of the County department.

The County Board ultimately approves any millage request for placement on the ballot as a question to voters. The County Board would then decide each year how much of the authorized millage to levy.  The County Board would then be obligated to appropriate the millage revenue to the Authority.

The Ottawa County, Michigan Insurance Authority will continue to insure the CMH buildings and any liability associated therein. The CMH Authority will pursue additional liability insurance as it deems appropriate.

Out of the 79 counties (out of Michigan’s 83 counties) that have created CMH authorities, only one has returned to a department—Washtenaw. It returned to a department after the multi-county authority that it was in dissolved. It did not otherwise decide to return to a department, but the decision was forced upon it.

No. The Board of Commissioners controls this issue. 

The State has to approve the General Fund plan 90/10 state/county split. Medicaid funding is determined by the PIHP. The Authority can apply for CCBHC funds from the United States/State of Michigan directly.

 MCL 330.1205 covers the process. Federal law covers the State’s liability.

The authority is created upon adoption of the resolution. MCL 330.1220 provides one year to the DHS to approve the termination of the CMH department, unless it approves the change earlier.     

Three years from the date that the State approves the termination of the department, which it must do within the next year. So somewhere between three and four years.

79 counties have completed this process without unintended consequences to employees or residents. Ottawa is actually choosing a slower process in transitioning than many of those counties used. 

2016 examined the loss of revenue to the County and the potential for higher costs to the proposed Authority. Fiscal risk was not anticipated in 2016 because it had never happened in Ottawa. That changed in 2019 when Ottawa had a $2 million deficit and the LRE ran out of money. Moreover, by extending the County cost allocation services for at least three years at the same charges, there is no significant financial impact during the transition. In short, risk circumstances and a better transition plan are what have changed.

In 2019, Ottawa County was obligated to cover the $2 million shortfall in CMH Medicaid funding.

As noted above, in 2019, PIHPS across the State ran out of money. Not a single county that had an authority had to step up to cover the risk because MCL 330.1205(6) covered them from the risk. Muskegon and Washtenaw had to use $10 million each in general funds. Ottawa used other County funds to cover its $2 million deficit. Things cannot be clearer than that.

Actually, the move is being considered because at present the CMH department is in a stable financial situation since its deficit is due to Medicaid entitlements and those will be covered by the LRE. Since it takes a year to fully establish the Authority, the decision must be made during a period like the present, where there is no uncovered deficit.

Deficits in Medicaid and CCBHC entitlements are presently at the risk of the County with its $127 million general budget, while an Authority’s same risk is covered by the State of Michigan’s $82 billion budget. 

Unless the State shifts the risk to the County, it is obligated to fund the shortfall under the Michigan Medicaid Plan and 42 USC 1398a. MCL 330.1205(6) blocks the State from risk shifting to Ottawa County. So, the LRE or its successor PIHP would have to initially cover non–mismanagement Medicaid deficits. If that is insufficient, as it was in 2019, the State is obligated by federal law to pick up the entitlements. 

Yes. In 2019, many of the regional PIHPs, including the LRE (“Lakeshore Regional Entity”) our PIHP, were unable to the fund the deficits of CMH departments and CMH authorities. The counties that funded those authorities were not asked to fund those deficits because of MCL 330.1205(6). Instead, the Authorities presented their deficits to the State and it increased funding to cover those deficits. The county departments, including Ottawa, Muskegon, and Washtenaw, were left to cover the deficits with their own resources. Ottawa was able to recover the $2 million it had in 2019 deficits with the funding increases in 2020.

The General Fund and millage-funded programs in CMH are not running deficits. The deficits are in the Medicaid side of CMH, which has entitlements determined by the federal government and State and Ottawa County CMH receives its Medicaid allocation on the revenue side from the State on behalf of the United States/State of Michigan partnership. The LRE has reported that, at present, it has the funding to cover last year’s deficit. If Ottawa CMH becomes an Authority, the State will be responsible for squaring revenues with entitlements, which will stabilize CMH.

No, not in the Authority model. By MCL 330.1205(6) the County is not liable.

This is not true. In 2019, Muskegon County and Washtenaw County spent $10 million each from their general funds to cover their CMH departments’ Medicaid shortfalls. None of the counties with authorities had that experience. That is proof of taxpayer protection.  

The State Legislature, not DHHS, has incentivized the counties to create CMH authorities. The State Legislature is the entity trying to protect the counties and the public CMH system through authorities and PIHPs. 

In the first three years of the transition, little is likely to change because the County will still be providing services. Over time, as responsibilities shift and the workload stabilizes, the need for additional positions in administrative support areas may level off. In the long run, some of these expenses could be reduced due to lower workload and operational need. For example, the County may purchase fewer software licenses for contract software or determine that a supporting department position does not need to be added as previously anticipated.

The County is not generating profit from CMH administrative reimbursement; it is recovering costs for services the County currently provides (such as HR, finance, IT, legal support, procurement, and other shared services). During the initial transition, the County would continue providing many of these administrative services, so cost reimbursement would continue for a period of time. Longer term, the County could still provide administrative support to a CMH authority through a service contract if both parties choose to do so. If the authority ultimately chose to obtain those services elsewhere, the County would no longer receive reimbursement—but the County would also no longer be performing that work. Any mismatch in timing would be managed through normal budgeting and staffing adjustments, and should balance over time as workload and costs decline.

No. The County is willing to provide the services under a contract.

Unfortunately, there are too many variables to show a side-by-side comparison over the years. The key is that if or when there is a Medicaid deficit, the State is financially responsible.

The Board of Commissioners and CMH authority board have no ability to influence Medicaid-driven cost and reimbursement trends as is evidenced by the $2 million 2019 deficit and the $5 million 2025 deficit. Both deficits were due to Medicaid deficiencies over which the County has no control.

The Washtenaw federal case involved two particular recipients’ Medicaid entitlements for developmental disability care.  It does underscore; however, that entitlements cannot be cut regardless of whether funding exists at the CMH department level. 

The layoffs occurred there due to the over-expenditure of General Fund CMH. Medicaid entitlements were covered by its PIHP. Neither Michigan nor the PIHP are obligated to pick up General Fund mismanagement of authorities or departments.

Medicaid mismanagement or General Fund mismanagement are not covered by anyone. Medicaid entitlement deficits are covered by the PIHP or State of Michigan. In the examples given, there was mismanagement.

Washtenaw had no choice. The multi-county authority in which it was a part went out of business. Ottawa is proposing a single county authority with the same funding as now, so whatever dislocation occurred in Washtenaw should not occur her

In the short term, the State Legislature protects such wages and benefits. Long term, wages will be determined by the Mental Health Board.  

The claim is that over time, the experience of authorities is that their employees receive wages comparable to those of other authorities and the private medical care field, not the counties. While that is expected to mean higher wages, perhaps it is best to say the wages will be more market-driven, and therefore more equitable, than at present.

Yes. The union will continue.

The employees have a union and the statute for protection. In the long term, the revenues from this medical enterprise funded by the United States and State of Michigan and the same funding that the County has always given will provide the same resources for the Authority to operate as it does now. There is no change in funding.

CMH employees may apply for County openings if they are interested and qualified. All candidates, whether current County employees or external applicants, are considered through the same competitive hiring process, and positions are filled based on qualifications and fit for the role. CMH employees would not get “priority” in this process.

The County would provide administrative support to an authority for a fee, as it does now. No change is necessary. In the long run, an authority could seek alternative options for these administrative services or they could be provided by new authority staff. Any new staffing, if it occurs, should be minor, as the labor remains the same. 

If the Board of Commissioners approves the transition to an Authority, that position would be promptly filled.   

After the transition period, an authority would contract with County departments to maintain interdepartmental relationships.

No.

Should not change.

Community Mental Health serves over 4,000 out of 306,000 residents.

CMH has locations throughout the County, including Holland, Grand Haven, and Hudsonville. The majority of CMH services are provided in the community throughout the County. Holland is the largest municipality in Ottawa County. As an Authority, the Mental Health Board would be responsible for locating service centers.

Until a few weeks ago, the intent of the State of Michigan was to consolidate the 10 regional entities, including the LRE, into 3 new PHIPs in which Ottawa County would not participate. The State has stepped back and is considering whether to keep or make another change, but has affirmed its intent to make a change.

Only the first session in Georgetown was recorded on video. Questions and Comments from the community were documented and are being answered here.