I wrote this up about my journey through mental health with my son, Chad, from blessed memory. It doesn’t matter how long it’s been, because the story never leaves me.

My husband and I adopted Chad in 1972, when he was 3 months old. I never used any form of birth control, just never got pregnant. I felt the Lord led us to Chad. He was a wonderful baby and toddler. He never cried. Checking in on him while he slept was the only way I knew he had woken up from his nap.

Chad was so smart and deep thinking, even as a little tot. What a joy he was, and my heart was full to bursting. Then, one day, everything came crashing down. I began getting weird phone calls from women or would answer a phone call which went to a deadline when I picked up the call. Making matters worse, there was a big empty field behind my house, and sometimes, I would see headlights heading for my door, and then the car would turn quickly avoiding a collision with my home. It was a very frightening time. My husband worked second or third shift at Buick Motors. I was alone with my child all night most of the time. I have to say I was married at 18 – very young and very naive. I trusted people too easily, too much. When my trust with my husband was broken, it was very difficult.

Ten years after adopting Chad, I learned I was pregnant. I was ecstatic! I could hardly contain myself. I didn’t want to tell anyone until my husband came home so I could tell him first. When he finally arrived home, I opened up my front door and yelled outside that I was pregnant. His reaction totally burst my bubble of happiness. He actually told me it wasn’t a good time to have a baby, and I should get an abortion. It was totally not the reaction I expected. That is when I realized I had to face that something was wrong.

Chad was 11 years old at this time, and even though I still had my head buried in the sand Chad would tell me something was wrong. One day he was riding his three-wheeler in the field with his dad when a girl appeared. His dad told him she was a neighbor, and he should give her a ride. Somehow Chad realized she was the one his dad was being unfaithful with, and when he told me, he felt so disloyal to me. It took me a long time to get Chad to understand it wasn’t his fault that his dad was unfaithful to me, and Chad was not the cause of my pain. That was all on his dad. But that was just the beginning of all of our problems.

I kept the pregnancy and stayed in the marriage. I went through nine months with absolutely no emotional support from my husband, falling into a deep depression. I could not handle such betrayal and thought about ending my life. At that time my baby moved in the womb shocking me out of such thoughts. Throughout my pregnancy Chad and his best friend were my support. They walked two miles with me every day and kept me company when I needed it the most. When Brett was born, Chad and I were so excited! My neighbor would come over in the morning to get Chad off to school and give me a few hours of sleep.

When I accepted the cheating was ongoing, I could not live that way anymore. The situation escalated and my husband became physically abusive to the point where I thought I was going to die. I believe God intervened at that time. The abuse stopped and I called my sister. She and her eldest son arrived to pick me and my children up.  This began our journey through mental health.

Chad began acting out and developed a love/hate relationship with his dad. I didn’t know how to cope with him. This was 1982/83. When Brett was about 2 years old, I met my current husband, Alex. He was so understanding and considerate. We became friends before we ever dated. He was just there for me and my kids. When we finally married, we had to deal with the effects all this had on Chad.  First, I tried a counselor or two, but they were no help. Chad was too intelligent for them. After Alex and I married, many incidents occurred with Chad. Finally, I had him at the FOX Center at the St. Joseph Hospital campus in Bloomfield Hills. It was a great program that seemed to be helping. Alex. Brett and I met several times for family therapy.

Unfortunately, Chad’s biological dad was supposed to have therapy with Chad, but on two occasions he did not show up. His not showing up was a huge setback for Chad. He was diagnosed with juvenile diabetes and when the allowed number of visits were up at the FOX Center, he was released. He was not ready to be released, but insurance companies don’t really care.

Years passed with many scary episodes occurring. One day Chad threatened to take his life. He was yelling and really going over the edge. His younger brother Brett came out of his room and smashed his beloved guitar while yelling at Chad. I went into the bathroom and called 911. Chad was taken to Gerber Hospital where he was met by a social worker. Unfortunately, the social worker was not very effective at calming Chad down. Upon his release Chad went to his home in Flint. By this time, he was maybe in his 30s and had his own home in Flint. At 3 AM, he called me and didn’t know what to do. I told him to go to CMH in Genesee County. He said he did not want to go alone, but I had other obligations and couldn’t just leave my younger son and drive to Flint. I told him to call his Grandma. I figured she would feel honored to go with him. That didn’t work, but his Dad’s girlfriend accompanied him. It was not all smooth sailing after that, although Chad did like his case worker. In the interim, due to infection, he developed nephropathy, kidney disease, requiring experimental treatment. Chad had two stents in his arteries and ended up going to dialysis three days a week for the next three years.

Alex and I would visit once a month. We’d take Chad shopping, and sometimes buy something special like salmon or crab legs and go back to his home and we’d cook dinner together. He was very interested in food/cooking, so we’d experiment with different herbs and spices or techniques. Other times we would go out for dinner.  Everything was actually going quite well. There were times that the bipolar or anxiety would flare up, but we could always shut it down. Throughout all Chad’s struggles, he managed to graduate from Baker College with a degree in the Health Sciences.  Chad wanted to help others. He never gave into his challenges, always trying to move forward.

Then, one day, I received a call and learned that Chad was in the hospital, on full life support. It seemed he stopped breathing at dialysis, and they called an ambulance. He remained on life support for 48 days. I resigned myself to the fact that I had lost him already, without even a chance to say goodbye. It was a tough time for me.  Eventually I began to accept that this was the end. Then a doctor came in and said we’d have to make a decision soon because Chad was not responding to any treatment.

I was totally floored. I went to the chapel and talked to the Lord for a couple of hours.  A mother can’t be expected to say, “Let my son go. Turn off the machines.” That was just not right. I needed to say goodbye and know that we were in a good place. It was so hard to just let go like that. When I went back up to his room the nurses were getting him set up on partial life support. So, I thanked the Lord and felt so blessed.  He still had a respirator so he couldn’t really talk, but we could communicate anyway.

It was so wonderful to be able to talk and care for my son. We were not exactly out of trouble. Everyday something else went wrong. When they tried to do portable dialysis, his blood pressure would drop dangerously low. He had a bad bed sore at the base of his spine. He could not get up and walk to the restroom without his prosthetic leg. His leg had been amputated years before because of an accident while he was working at a roofing job. As he waited for the nurses to answer his call button, he would have accidents which aggravated the bed sore. The bed sore was stage 4 by then. They performed surgery to reroute his colon and create a colostomy. The surgeon said the infection had spread throughout his system. His big toe on his healthy leg turned black and would have to be amputated. His feeding tube wasn’t working and he lost whatever the nurses put into the tube for nutrition. Then the day came when he looked at me and mouthed, “Mom, please call Hospice.”

I could not argue with him. I know he fought as long as he could for me. He told me so. I told him, “Chad, I loved you from first moment I saw you. I’ve loved you all your life, and when God calls me home my soul will find yours and I will love you through eternity.”

Chad got a big smile on his face, and that is how I always remember him, with that particular smile.

Click here to view all Connection publications.

Hello fellow social workers! As you may already know as part of our Licensure Modernization efforts, we are looking at supervision standards and as our first step we are asking social workers who currently or in the past have provided licensure supervision to take our survey and share their experiences. Your input is valuable in understanding the current state of supervision and identifying areas for support and improvement within our profession. Thank you so much for taking the time – it is officially open now! 

Click here to answer a few questions about your experience with providing supervision. Help us understand how supervision is currently happening as we ultimately look at and update standards for supervision in Michigan. 

Be sure to ‘opt-in’ at the end with your name and email address for a chance to win $100 gift card! 

If you have a particular interest in Supervision I encouraged you to join us monthly.

If you have any questions about the survey, our efforts around supervision, the Working Conditions & Workforce Committee or anything else work-force related please don’t hesitate to reach out to me, Jordan Freeman, directly at jfreeman.naswmi@socialworkers.org as I am always excited to chat directly with you all!

Social Work Supervisor Survey – JotForm

This survey is designed for social work supervisors in Michigan. The intention of this survey is to ultimately look at and update standards for supervision in Michigan.

form.jotform.com

The Mental Health Code states that Community Mental Health Service Providers are required to distribute Recipient Rights Booklets to each recipient receiving services. Click here to place your order.

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

On Tuesday, Politico reported on a “closed-door meeting” among Republican U.S. House members about the future of Medicaid, as the federal government seeks new savings and tax cuts.

A new plan discussed, according to the report, was placing “per capita caps” on states that have expanded their Medicaid programs, which Michigan did during Republican Gov. Rick SNYDER‘s administration. In exchange for widening the eligibility scope, from 35 percent of the federal poverty level (FPL) to 133 percent, the federal government offered 100 percent coverage from 2014 to 2016.

Beginning in 2020 and for years afterward, the federal government is scheduled to cover 90 percent.

On top of new caps on states with expanded programs, as Medicaid features both state and federal dollars, the federal proposal also featured a new “rainy day fund” for states to individually store new savings they discover from their Medicaid systems.

When it comes to her own vision for researching how Medicaid is being used in Michigan, Santana said “this is the beginning of the conversation. It is not the end of it.”

“As we see things coming down from the feds we will be assessing what’s necessary through those reporting mechanisms,” Santana said. “From the Senate standpoint, we always want to be on time with our budget because we don’t want to put people in jeopardy in the state. However, I think that as we move through this process, if we do see some action by the federal government, we do want to make sure that we can react to that action as swiftly as possible.”

But despite uncertainty, SB 180 increases the amount of assets that can be disregarded when determining Medicaid eligibility, using more than $14.18 million – $41.3 million overall – to raise up to 40 percent FPL that can be disregarded to 60 percent.

Additionally, SB 180 dedicates $144.35 million from the state’s General Fund for multiple one-time projects. For example, for state-owned psychiatric hospitals that did not qualify for certain federal Medicaid payments, the proposed budget provides $78.7 million. The issue originates from 2018 court decisions involving the now-defunct psychiatric hospital previously inside the Women’s Huron Valley Correctional Facility, as well as the current Center for Forensic Psychiatry in Saline.

Another $18 million would support “an “alternative payment methodology” for Federally Qualified Health Centers (FQHCs) in Michigan, which offer dental, mental health and substance abuse treatment care to communities flagged as underserved.

“We have over 15,000 across the state of Michigan. Having that new system, an alternative payment system, is really important to their infrastructure to be able to get those payments for the Medicaid services that they’re providing,” Santana said.

However, the $18 million FQHC proposal is to ensure those centers are paid swiftly instead of waiting for the federal government.

“Through that infrastructure process, we want to make sure that those payments from the federal government do happen,” she said.

Specific Behavioral Health Budget Items:

• $3 million – Oakland County Health Network (OCHN) for a behavioral health urgent care center
• Shift of $25 million CCBHC costs to PIHP/CMHSP autism costs and language to carve-out autism benefit (Sec. 1007)
  • 1007. From the funds appropriated in part 1 for autism services, the department shall make payments to PIHP and CMHSP for autism services separate from other per-capita payments. Funds appropriated for autism services must not be used to fund non-autism costs for PIHP and CMHSP.
• Senate budget reduces the executive budget recommendation for community reentry of incarcerated individuals (from $20 million general fund to $2.5 million) to provide coverage starting 90 days before an individual’s scheduled release.
• Senate budget reduces the executive budget recommendation for Medicaid spend down with a new income disregard that will allow more people to gain access to coverage. Executive budget proposed $96.4 million which would shift income disregard to 100% FPL, Senate budget reduces to 60% FPL and includes $41.3 million.

Opioid Healing and Recovery Fund Senate Subcommittee:

Proposal Sober Living – competitive grants $10,000,000

Families Against Narcotics $6,000,000

SUD Tribal entities – competitive grants $5,000,000

SUD Short-term recovery house – comp. grants $5,000,000

Peer recovery services statewide $4,000,000

Hype athletics – SUD crisis and mobiliz. center $3,500,000

LAHC SUD project $3,500,000

Neighborhood service org. – statewide $3,000,000

Detroit recovery project – expansion $3,000,000

Detroit recovery project – Young adult facility $2,000,000

Why Support CMH PAC? 

In the Michigan Legislature there are:

• More new legislators due to term limits.
• Fewer legislators with in-depth knowledge about behavioral health issues.
• More legislative proposals that directly and indirectly impact Michigan’s publicly funded mental health system.
• More aggressive interest groups competing for limited resources.
• Very few legislative champions for persons with mental health, developmental/intellectual disabilities and substance use disorders.

CMH PAC helps overcome some of these obstacles by raising awareness for issues that are important to behavioral health care. The CMH PAC supports legislators/candidates who support and advocate on behalf of Michigan’s publicly funded mental health system.

Hello fellow social workers! As you may already know as part of our Licensure Modernization efforts, we are looking at supervision standards and as our first step we are asking social workers who currently or in the past have provided licensure supervision to take our survey and share their experiences. Your input is valuable in understanding the current state of supervision and identifying areas for support and improvement within our profession. Thank you so much for taking the time – it is officially open now! 

Click here to answer a few questions about your experience with providing supervision. Help us understand how supervision is currently happening as we ultimately look at and update standards for supervision in Michigan. 

Be sure to ‘opt-in’ at the end with your name and email address for a chance to win $100 gift card! 

If you have a particular interest in Supervision I encouraged you to join us monthly.

If you have any questions about the survey, our efforts around supervision, the Working Conditions & Workforce Committee or anything else work-force related please don’t hesitate to reach out to me, Jordan Freeman, directly at jfreeman.naswmi@socialworkers.org as I am always excited to chat directly with you all!

Social Work Supervisor Survey – JotForm

This survey is designed for social work supervisors in Michigan. The intention of this survey is to ultimately look at and update standards for supervision in Michigan.

form.jotform.com

Click here to view all Connection publications.

The purpose of this toolkit is to provide concepts, tools, and resources representing a variety of approaches, in support of the work of CMHA’s member organizations and CMHA as they facilitate and encourage respect, growth, and empowerment.

The contents of this toolkit are intentionally varying, designed to reflect the range of needs, communities, and organizational cultures in which CMHA and our members operate.

This tool kit is just that – a tool kit containing a set of practices and policies that foster respect, growth, and empowerment. The use of any of the components in this toolkit is at the discretion of CMHA’s member organizations. This tool kit is not a set of actions or beliefs recommended by CMHA; nor is it an exhaustive collection of all resources around respect, growth, and empowerment.

The toolkit is a living document, meant to be revised periodically as the needs and views of CMHA members change and new tools and resources are identified.

• Healthcare Integration and Coordination – 2024/2025 Update: Survey of Initiatives of Michigan’s Public Mental Health System
• 2025 Michigan Behavioral Healthcare Workforce Shortage Survey.

The former is the most recent edition of the annual study of the healthcare integration efforts in which Michigan’s public mental health system is involved. The latter is a first of its kind study of the breadth and depth of the workforce shortage faced by Michigan’s public mental health system and its private provider partners.

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

The Health Plan Services line item fell short by $55 million from the General Fund and about $250 million in total last fiscal year. House Republicans say that’s a problem. House Democrats say the solution is not to cut funding and make access to health care more difficult.

The House Appropriations Committee Track held an informational hearing on Wednesday regarding health plans with testimony from the Michigan Association of Health Plans, Blue Cross Blue Shield of Michigan and the Department of Health and Human Services.

Bollin said that although the state may be obligated for services rendered, the goal was to provide the committee with information to prevent the same budgeting mistake from occurring during the next fiscal year.

Democrats on the committee, however, said they feared that the end goal would be to reduce funding for critical health care plans, such as Medicaid.

“It’s really concerning to me that we’re sitting here talking about efficiencies, and we have one of the most efficient models for Medicaid in the nation, as we’re saying we want to cut people’s coverage, and that’s a ridiculous proposition. That’s something I will never accept,” House Appropriations Committee Minority Vice Chair Rep. Alabas Farhat (D-Dearborn) said.

Michigan’s Medicaid program is efficient compared to neighboring states, Todd Anderson of Blue Cross Blue Shield of Michigan said.

“Since Governor John Engler established Medicaid managed care in the 90s, there are still very strong results for the state of Michigan,” he said. “We’re at just under $6,000 per member in cost, while Ohio is at over $8,000 close to $9,000 and Indiana is over $8,000 as well.”

One of the challenges with estimating how much health plan services will cost during a fiscal year is that health care prices are not set until after the state has to pass a budget, said Dominick Pallone, executive director for the Michigan Association of Health Plans.

“In a perfect world from appropriators, you all would probably much rather know the rates and then pay the budget or set the budget based on those rates, but the reality of the process we have here is, in order to get more accurate rates, the rates are set after the budget it set,” Pallone said.

“We saw this redetermination where people fell off Medicaid at large amounts very quickly. The people falling off are generally our healthier people, or generally people that were not using services,” Pallone said. “The people that remained are much sicker.”

Rep. Cam Cavitt (R-Cheboygan) expressed concern that the estimates completed by actuaries were consistently off year-over-year. “Every year, it seems like the actuaries are off, and by a significant amount,” he said.

If the actuaries are consistently underestimating the cost of health care plans by 6 to 8 percent, that is a conversation to be had, Farhat said, but it’s nuanced.

“When you’re talking about cutting the overall cost of the program, the only way you do that is by cutting people’s access to health care,” he said. “Make it clear to the people in Michigan that you’re not going to cut these earned benefits that they count on every single day. Why should parents have to wonder if they can take their kids to the doctor’s office? That’s ridiculous.”

Meghan Groen, Medicaid director for DHHS, said one of the department’s primary objectives was to monitor how programs were making people healthier.

Rep. Julie Rogers (D-Kalamazoo) said that it was important for the state to continue its efforts to provide people with preventive care. “If you’re going after fraud, waste and abuse in a cost containment thing, cutting Medicaid is the wrong way to go about it,” she said. “What it’s going to do is drive up costs because you’re going to cut off primary care … so instead of seeing someone for a couple of $100 is a primary care office, you’re going to have tens of thousands of dollars in surgeries in the hospital. I understand the thought of cost containment, I really do, but in this area, you have to be very intentional on how you go about it.”

Glanville said that the state budget should reflect the state’s values, even as the state faces the need for cuts. “We need to ask ourselves, what is it that the people of Michigan want and expect and to move in that direction,” she said. “I would hazard a guess they would like to have as much support with health care as possible.”

Rep. Natalie Price (D-Berkley) said that if Medicaid doesn’t cover the cost for people’s health care, they will be passed along to other patients.

“If somebody comes into the emergency room in an emergency, they have to be treated,” she said. “If those costs are not covered by Medicaid, they have to get passed on to the rest of us.”

• CCBHCs (SAMHSA Grants)
• LGBTQ+ specialized 988 services (SAMHSA)
• Tribal Behavioral Health Grants (SAMHSA)
• Behavioral health workforce development programs (HRSA/SAMHSA)
• Mental and Behavioral Health Education and Training
• Behavioral Health Workforce Education and Training
• Minority Fellowship Program
• State Offices of Rural Health (CDC)
• Rural Community Development (USDA)
• State Councils on Developmental Disabilities (ACL)
• Adverse Childhood Experiences (CDC)

Reconciliation Calendar: The second stage of reconciliation where individual committees develop and report legislation that would change laws within their jurisdiction related to spending, revenue, or the debt limit is starting to shape up.  Here is the calendar of Committees with their instructions thus far:

Create the Michigan Intensive Child and Adolescent Services (MICAS) array. The array would include:

• Intensive crisis stabilization services
• Intensive home-based services
• Intensive care coordination with wraparound
• Respite care
• Parent support partner services
• Youth peer support services
• Demonstrate the capacity of the state to provide these services to Medicaid-eligible children and youth under 21
• Provide information to the public to explain the availability of MICAS services and share who is eligible to receive these services
• Implement a statewide behavioral health tool to help determine who is eligible for MICAS services and the appropriate level of care needed
• Develop a process for eligible individuals to appeal a service denial and file complaints

Please note: The proposed settlement agreement does not provide direct payments to Medicaid-eligible children and youth under age 21, but MDHHS has agreed to pay attorney fees and litigation costs.

If the Court grants final approval after the Fairness Hearing on 8/27/25, the relief contained in the terms of the proposed settlement agreement would be available to all affected individuals.

The Class Action Notice, which outlines a summary of the settlement’s terms, as well as the full Agreement, can be found in the attached document. You can also view the Class Action Notice and an outline of next steps by visiting our website here.

Questions can be sent to: KBSettlement@drmich.org

For any other questions or more information, email MDHHS-BCCHPS-Questions@michigan.gov.

• 1 million children;
• 300,000 people living with disabilities; and
• 168,000 seniors.

Additionally, 45% of births in Michigan are covered by Medicaid.

Healthcare coverage provides real returns. The Congressional Budget Office estimates that long-term fiscal effects of Medicaid spending on children could offset half or more of the program’s initial outlays. And Medicaid enrollment for children has been shown to increase not only positive health outcomes but also educational attainment, wages in adulthood, and future tax revenue from increased earnings for those who are covered.

Medicaid is not only critical for the health of individuals – its coverage is also essential for assuring the sustainability of hospitals, community health centers, physician practices, and nursing homes across the state. I led bipartisan efforts to expand access to Medicaid, which took effect in 2014. Since Michigan expanded Medicaid, hospital uncompensated care has fallen by more than 50%. Hospitals in Michigan receive nearly $7 billion in Medicaid funding annually, accounting for almost one-fifth of the state’s hospitals’ net patient revenue.

More than 70% of Michigan’s Medicaid budget comes from federal funding. Cuts to federal funding will jeopardize coverage for more than 2.6 million Michiganders and threaten Michigan’s hospitals, community health centers, and nursing homes with closure. These threats are especially acute in small towns and rural communities, where coverage rates are higher than in other parts of the state. 37.3% of small town and rural Michiganders are covered by Medicaid.

In addition, local hospitals are often the largest employer in many of Michigan’s rural communities. According to the Michigan Health and Hospital Association, Michigan’s health care industry has a total economic impact of $77 billion per year: greater than any other industry in the state. Medicaid expansion alone sparked the creation of more than 30,000 new jobs: one-third in healthcare and 85% in the private sector. These jobs boost the personal spending power for Michigan residents by about $2.3 billion each year and result in approximately additional $150 million in tax revenue annually. Having Medicaid also reduces medical debt for Michiganders and ensures our healthcare professionals are compensated for their work.

States that did not expand Medicaid offer a case study of what will happen to our healthcare infrastructure if federal officials choose to undermine this important program. Hospitals are six times more likely to close in non-expansion states, and rural communities suffered the most. In Michigan, rural hospitals will struggle to keep critical functions like labor and delivery units open if Medicaid payments are reduced.  

House Republicans have proposed cutting up to $880 billion from Medicaid, which could mean that Michigan loses as much as $2 billion each year. That is a 42% reduction in the share of state Medicaid spending per resident. This executive directive will enable us to better understand the impact of those cuts on Michigan.

Section 1 of article 5 of the Michigan Constitution of 1963 vests the executive power of the State of Michigan in the governor.

Section 8 of article 5 of the Michigan Constitution of 1963 places each principal department under the supervision of the governor.

Acting under the Michigan Constitution of 1963 and Michigan law, I direct the following:

Impact of Federal Medicaid Cuts

1. Within thirty days of this order, the Michigan Department of Health and Human Services (MDHHS) must review federal budget proposals and prepare a report illustrating potential scenarios related to the impact of Congress’ proposal. The report, drawing from available analyses and based upon reasonable assumptions, should delineate the specific impact of proposed cuts to Medicaid, including:

– The number of Michiganders who could lose health care if the proposed cuts go into effect.
– The effect of the proposed cuts on hospitals and other relevant service providers, especially in rural and other underserved communities, including reductions in services and closures of facilities.
– The impact on timely access to care for Michiganders, such as the creation or expansion of healthcare deserts in areas of the state.
– The ways in which reductions in federal money could impact the state’s budget, including the need for cuts to other vital services.

2. The Department of Insurance and Financial Services and the State Budget Office must provide support to MDHHS in assessing the scope and impact of the proposed cuts.

3. All state departments and agencies must coordinate and cooperate with MDHHS in executing the duties outlined by this directive.

This directive is effective immediately.

Thank you for your cooperation in its implementation.

Click to view the full PDF of the executive directive.

Why Support CMH PAC? 

In the Michigan Legislature there are:

• More new legislators due to term limits.
• Fewer legislators with in-depth knowledge about behavioral health issues.
• More legislative proposals that directly and indirectly impact Michigan’s publicly funded mental health system.
• More aggressive interest groups competing for limited resources.
• Very few legislative champions for persons with mental health, developmental/intellectual disabilities and substance use disorders.

CMH PAC helps overcome some of these obstacles by raising awareness for issues that are important to behavioral health care. The CMH PAC supports legislators/candidates who support and advocate on behalf of Michigan’s publicly funded mental health system.

Concerns raised over MDHHS plan for competitive PIHP contracts

On Feb. 28, 2025, the Michigan Department of Health and Human Services (MDHHS) requested public input through an online survey as the state transitions to a competitive procurement process for its Prepaid Inpatient Health Plan (PIHP) contracts. The public input survey period ended on March 31, 2025. According to MDHHS, the feedback gathered through this process will help inform the state’s direction and priorities as it considers changes to the way behavioral health services are funded and administered.

MAC has concerns regarding this move, as such a process could pave the way for the privatization of Michigan’s public mental health system. Privatization poses a significant risk to local control. Unlike the current publicly managed system — which ensures that local communities have a voice in decision-making — privatization shifts power to out-of-state corporations and governing boards, often with little or no connection to the communities they serve. This change threatens to erode community input, transparency, and accountability in the delivery of essential mental health services.

MAC plans to keep a close eye on how this process unfolds and will continue pushing for local communities to stay in charge when it comes to managing PIHP contracts. It’s important that any future system ensures the voices of local residents are heard and that there’s strong public oversight.

For more information on this issue, contact Jimmy Johnson at johnson@micounties.org.

This story, along with the growing list of solutions journalism stories centered around the work of Michigan’s public mental health system, can be found at: https://cmham.org/newsroom/

This partnership, with the Issue Media Group (IMG), is built around the concept of “solutions journalism” – providing news about innovative and concrete ways that communities, across Michigan, are addressing the needs of their residents along a number of dimensions – healthcare, economic development, education, the arts, to name a few. Solutions journalism investigates and explains, in a critical and clear-eyed way, how people try to solve widely shared problems. While news sources and many of us typically define news as “what’s gone wrong,” solutions journalism runs counter to that definition by covering the innovative responses to identified needs and problems.

This partnership ensures that the work of Michigan’s public mental health system is highlighted in IMG’s large suite of solutions journalism-focused publications.

You can subscribe, at no cost, to these publications, on the websites of each of these publications. The list of partner publications and their websites are provided below:

Second Wave – Michigan

Capital Gains – Lansing

Catalyst Midland

Concentrate – Ann Arbor/Ypsi

Epicenter – Mount Pleasant

Flintside

Metromode – Metro Detroit

Model D

Route Bay City

Rural Innovation Exchange

Second Wave -Southwest Michigan

The Keel – Port Huron

The Lakeshore

Upword – UP

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

“Between (the) public safety trust fund, revenue sharing trust fund, income tax (cut), the shutdown prevention (funding) and this road plan, I don’t know how much money we will have left at the end of the day,” Anthony said. “At some point, many of these concepts are going to have to transition from the press conference room into the balance sheet.” 

This afternoon, the Senate Appropriations Committee spent nearly two hours discussing House Republicans’ road funding proposal, as well as possible shortfalls in Michigan’s present system for financing road and bridge projects. 

Reps. Pat OUTMAN (R-Six Lakes), Tom KUNSE (R-Clare) and Steve FRISBIE (R-Battle Creek) testified on behalf of HB 4180 , HB 4181 , HB 4182 , HB 4183 , HB 4184 , HB 4185 , HB 4186 , HB 4187 and HB 4230.

One part of the road funding plan is to completely direct any state taxes paid at the gas pump to roads, exempting fuel for cars from Michigan’s sales tax and instead establishing a 51-cents-per-gallon gas tax. 

Right now, 45 percent of the School Aid Fund (SAF) for public education spending depends on Michigan’s sales tax in Fiscal Year (FY) 2023. Also, constitutionally, the state is obligated to distribute the first 4 percent it receives from sales tax revenue to cities, villages and townships.

If sales taxes aren’t paid at the fuel pump, House Republicans plan to backfill whatever schools and local governments might lose from other areas of the budget, particularly sections related to grant programs and tax credits to large-scale corporations. 

Anthony said she’s excited to really dig into the numbers behind “these very costly plans.” She referenced how House Republicans also want to dedicate in statute 1.5 percent of sales tax revenue to law enforcement agencies through a Public Safety and Violence Prevention Fund, as well as to set Michigan’s income tax rate from 4.25 percent to 4.05 percent.

When it comes to the road funding debate, Anthony said to the press she wants to ensure no critical services are being robbed, particularly as Congress still contemplates downsizing the federal government’s future contributions to Medicaid. 

“We see what’s happening at the federal level, the threats to things like Medicaid . . .there’s a lot of uncertainty, and much of that uncertainty falls on states to try to figure out how we continue to protect vital services,” Anthony said. “In order for us to contemplate a roads plan, it has to make sure we’re not trading critical investments for people.” 

She added that a negotiated plan needs to be sustainable, long-term and not composed of “one-time gimmicks.” She described today’s plan as one “in isolation,” resulting in “very significant and devastating reductions” in government programs if implemented as is. 

In FY ’24, the state’s General Fund revenue – for both general government and school spending – was less than $15.92 billion. The road funding plan would be worth more than 20 percent of that. 

“That’s about a 20 percent cut to the rest of the General Fund budget, more than the entire General Fund budget for the Department of Corrections,” said Sen. John CHERRY (D-Flint) during today’s meeting.

Cherry additionally asked how House Republicans’ plan would hold state constitutional revenue sharing harmless when it comes to local governments. According to the House Fiscal Agency (HFA) in August 2024, the state is estimated to have made more than $1.07 billion in revenue-sharing payments to 280 cities, 253 villages and 1,240 townships. 

Outman explained the House is working on a revenue-sharing trust fund for local governments that will ensure some stability on the subject. However, Anthony remained skeptical over how those two proposals – road funding and a reassuring fund for local government payments – could sustainably coexist. 

Meanwhile, Macomb County senators, Sens. Veronica KLINEFELT (D-Eastpointe) and Kevin HERTEL (D-St. Clair Shores), remained concerned over how the House’s plan maintains the funding formula established by Public Act 51 of 1951, where 47.9 percent of distributions to county road agencies are based on resident vehicle registrations and 16.41 percent based on the share of county local road mileage. 

Although Macomb County technically receives more money than rural counties, with more than $137 million in FY ’23, the value is less on a per-resident basis. For example, Antrim County, according to a Citizens Research Council (CRC) of Michigan report, received $310 per resident in FY ’23, while Macomb County’s allocation was worth $156 per resident. 

“I think the challenge is . . . in order to do the right thing, it’s going to take some political will for people to look at this issue for what it actually is, (and) realize that it’s unfair at its most basic level,” Hertel said. “Public Act 51 was created . . . when we were funding infrastructure in upstate areas, and communities like mine were willing to do that at the time to help development in other areas of the state.” 

He said Michigan is now at a place where roads in his district have taken some of the worst toll over the years, making “it really hard to support anything that doesn’t fix that effort.” 

Outman made the case that Hertel’s hometown, St. Clair Shores could see a $10.5 million increase under House Republicans’ plan, explaining it’s time to inject billions of dollars into the overall system and satisfy everyone. Hertel responded that his district has been getting the short end of the stick, with a lot of residents’ taxes leaving the county to back Northern Michigan infrastructure. 

He made the case that the problem of road funding should actually be fixed, instead of telling counties that having more money is simply the best deal they can get and should take. 

Overall, Klinefelt said House Republicans are not sitting in a position where they’re going to get votes right now. 

“I want to point something out to you – I can’t even get my colleagues to agree to what I want to do with roads. How the heck are we going to get our colleagues to agree with what you want to do with roads with respect to the rest of the budget?” Klinefelt said. “It’s a plan with a lot of this outstanding money that nobody knows where it’s going to come from.” 

Klinefelt added that some of the very organizations supporting the $3.1 billion plan “are going to be the first ones knocking on your door when something in their budget is being cut to pay for this.” 

Why Support CMH PAC? 

In the Michigan Legislature there are:

• More new legislators due to term limits.
• Fewer legislators with in-depth knowledge about behavioral health issues.
• More legislative proposals that directly and indirectly impact Michigan’s publicly funded mental health system.
• More aggressive interest groups competing for limited resources.
• Very few legislative champions for persons with mental health, developmental/intellectual disabilities and substance use disorders.

CMH PAC helps overcome some of these obstacles by raising awareness for issues that are important to behavioral health care. The CMH PAC supports legislators/candidates who support and advocate on behalf of Michigan’s publicly funded mental health system.

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

Sen. Sarah ANTHONY (D-Lansing), chair of the Senate Appropriations Committee

Sen. Anthony said she’s thought about this issue for a while since the lion’s share of state employees live in her mid-Michigan/Lansing-based district. She said she’s seen what’s taken place with the federal employees and how “an unelected billionaire is literally using a chainsaw” to find efficiencies. 

“As the person who helps negotiate the state budget, I know everything requires a scalpel. We don’t have room for negative consequences to find efficiencies,” she said. “That’s not to say there aren’t areas where we can’t tighten our belts. We can always find ways to be more efficient. We do that on an annual basis. We do have areas of duplication. Now, for anyone who is serious about helping us in those areas, I welcome that. It’s part of good government. But to create chaos among state employees in a way that creates dysfunction and wreaks havoc, I don’t support. The biggest losers end up being the public. 

“From what I’ve seen, these “efficiencies” at the federal level haven’t been realized. I have dug into some of these reports and what we’re finding is that all of this alleged waste and all of these people who apparently aren’t doing anything is fake math. It’s contracts that have already expired, and it’s picking on some employees who the Supreme Court said the way in which they’re being fired is illegal.  

“What we’re going to find is that DOGE is not working, and I’d hate to embrace the same concepts and approaches at the state level.” 

Rep. Ann BOLLIN (R-Brighton), chair of the House Appropriations Committee

“Yes. It’s called BOGE – Budget (Bollin) Overhaul of Government Expenditures.”

Sen. Joseph BELLINO JR. (R-Monroe)

“We 100 percent need one.”

He noted that he’s 64 ½ and is on Medicare. He said he notified the human resources folks that he’d be willing to keep his Medicare as long as the state picks up the costs of his supplemental. Bellino said he was told the state keeps all of its older workers on the state insurance policy.

“My insurance is $2,000 a month for my family because the state doesn’t let its older employees take Medicare. That’s a waste of millions of dollars a year, and that’s one little thing,” he said. “It’s a bureaucracy that costs the state a lot of money. I would go on Medicare tomorrow to save the state money, but they won’t do it.”

Bellino also noted that in his first term, then-House Appropriations Chair Shane HERNANDEZ went back and forth with the Department of Transportation (MDOT) about funding 260 unfilled positions that the department hadn’t used in three years.

“He eventually conked them on the head and got those positions cut, but it wasn’t easy,” he said. “We’re also renting a state plan to Tom IZZO and Michigan State to make recruiting trips. MDOT is saying the state is making money on this deal, but, to me, this looks like we’re taking money out of one pocket and putting it in another.”

Sen. Jeff IRWIN (D-Ann Arbor)

The term-limited Democrat said he teamed up with former Rep. Mark MEADOWS back in the day to introduce legislation to create a performance monitoring and “continuous improvement” effort within state government. The focus, he said, was monitoring and measuring key indicators of success to gear state government toward efficiency and effectiveness.

“I thought at the time that former Gov. SNYDER might pick up on it because it was in line with some of his statements,” Irwin said. “If you recall, his ‘dashboard’ was an attempt to formalize and focus that idea.”

As for a state-level DOGE, Irwin said, “If it’s done well, it would be good,” but it would need to be non-partisan, serious and consistent.

House Minority Floor Leader Bryan POSTHUMUS (R-Rockford)

“No question we need MIDOGE. Extreme excess and abuse of taxpayer dollars isn’t restricted to just the federal government. Until we take control of the governor’s office, the changes the House GOP has made to appropriations, oversight and rules is a step toward that.”

House Minority Floor Leader John FITZGERALD (D-Wyoming)

“If a department like DOGE were to exist in Michigan, its top priority should be to improve efficiency while committing to a high standard of service that prioritizes the health, safety, wellbeing and prosperity of Michiganders. In other words, nothing like the current federal DOGE.”

Rep. Matt MADDOCK (R-Milford), Majority Vice Chair of the House Appropriations Committee

“If you don’t think there’s waste, fraud and abuse in our $84 billion state budget, then you’re either in on the scam or blind.”

Rep. Phil SKAGGS (D-Grand Rapids)

“Though Americans have quickly soured on Elon Musk and his infamous chainsaw, here in Michigan, Republicans remain infatuated with the erratic and corrupt multi-billionaire with a propensity to make Nazi salutes.

“While we must continually look for ways to make state government more efficient and transparent, there is no way we should import Musk’s policies of firing veterans, gutting everything from airline traffic control to life-saving medical research, and endangering Social Security we have all worked hard to earn.

“The last thing Michigan needs is an unaccountable Grand Poobah mindlessly hacking key healthcare and educational services people need – all to pay for tax cuts for billionaires.”

Sen. Jim RUNESTAD (R-White Lake), chair of the Michigan Republican Party

“Michigan’s budget has ballooned by over 40% since Whitmer took office, yet many families still don’t feel the government is working for them. Every budget is riddled with special projects, and nearly every department has offices and programs that waste taxpayer money. Corporate handouts consistently fail, with $670m being spent by the SOAR fund over the last three years, all with zero jobs created.

“Last year, the legislature voted to approve over $4 billion in business subsidies, all while people and businesses leave the state. Earlier this year, a battery maker fled the state after taking nearly $1 million from taxpayers. Creating a Michigan DOGE would allow every dollar to go further, and guarantee taxpayers receive the services they need.”

Rep. Tyrone CARTER (D-Detroit)

“No. What we see at the federal level, I don’t know if it transcends to the state level, and we haven’t really seen any results. I mean, you can say that you found all this fraud, waste and abuse, but I don’t see any documentation.

“And, we still, I hope, unlike the federal level, have co-equal branches of government.”

Sen. Thomas ALBERT (R-Lowell), former chair of the House Appropriations Committee

“Yes, and the first thing it should do is put up a ‘for sale’ sign next to every vacant government building.”

Rep. Julie BRIXIE (D-Okemos)

“We already have one. It’s called the Legislature, and it’s our statutory duty to present a balanced budget to the governor by July 1. I hope no one is suggesting we spend money to pretend to save money.

“It reminds me of when Matt Maddock was looking for waste and fraud but he, his two staffers and an intern couldn’t find any.”

Rep. Phil GREEN (R-Millington)

“Any organization of any size needs individuals who will be focused on eliminating waste and ensuring efficiency. When the organization is a government that is directly accountable to its citizens, transparency and accountability are of the utmost importance.

“A government entity with an $80 billion budget has a monumental task of eliminating waste and ensuring that they are not taken advantage of by unscrupulous scammers. Citizens work hard to fund their government, and they have needs that only the government can provide. Thus, we need to ensure that we, as a government, provide a quality, strong safety net. And the services that we provide actually help the people.

“The concept of DOGE is a common-sense approach to ensuring the maximum amount of dollars gets spent helping the people that need it most. We, as a government, should always be seeking ways to keep our residents and their needs first. Eliminating sloppiness and waste is a good step in ensuring our residents get served!”

Rep. Emily DIEVENDORF (D-Lansing)

“Elon’s DOGE is doing a fine job of dismantling democracy, removing checks and balances, raising the cost of living, leaving millions of Americans without a social safety net, tanking the economy, destroying scientific progress, erasing history, endangering national security, and violating our civil liberties . . . all by itself. Let’s learn from the stupidity and not do the same.”

Rep. Mark TISDEL (R-Rochester)

“I was hoping the Auditor General’s office was already doing that. Large organizations often endure ad hoc growth. Every organization benefits from a periodic, top to bottom, dose of re-engineering.”

Rep. Noah ARBIT (D-West Bloomfield)

“Is that a joke? Besides, we already have an incompetent unelected billionaire who fancies herself a policy maven pulling the strings of Michigan government officials; her name is Betsy DeVOS and Michiganders don’t really seem too fond of her, either.

“In all seriousness, I’m all about looking at the efficiency of government; doing a bonfire of silly regulations that stymie development and growth, silly departmental rules that inhibit servicing our constituents . . . and building a state government that is lean, mean, efficient, and solves problems.

“That is not what Musk is doing. This requires real oversight and good-faith efforts of those working within the executive branch to help the Legislature understand what’s wrong and how we can fix it.

“Cutting for cutting’s sake is wrong; but we also know there is a limit to what you can achieve by merely throwing money around. Reforms need to be made – procedural, cultural, technological. So, we need to work in a serious, bipartisan basis to explore what can be done.”

Why Support CMH PAC? 

In the Michigan Legislature there are:

• More new legislators due to term limits.
• Fewer legislators with in-depth knowledge about behavioral health issues.
• More legislative proposals that directly and indirectly impact Michigan’s publicly funded mental health system.
• More aggressive interest groups competing for limited resources.
• Very few legislative champions for persons with mental health, developmental/intellectual disabilities and substance use disorders.

CMH PAC helps overcome some of these obstacles by raising awareness for issues that are important to behavioral health care. The CMH PAC supports legislators/candidates who support and advocate on behalf of Michigan’s publicly funded mental health system.

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

Why Support CMH PAC? 

In the Michigan Legislature there are:

• More new legislators due to term limits.
• Fewer legislators with in-depth knowledge about behavioral health issues.
• More legislative proposals that directly and indirectly impact Michigan’s publicly funded mental health system.
• More aggressive interest groups competing for limited resources.
• Very few legislative champions for persons with mental health, developmental/intellectual disabilities and substance use disorders.

CMH PAC helps overcome some of these obstacles by raising awareness for issues that are important to behavioral health care. The CMH PAC supports legislators/candidates who support and advocate on behalf of Michigan’s publicly funded mental health system.

This story, along with the growing list of solutions journalism stories centered around the work of Michigan’s public mental health system, can be found at: https://cmham.org/newsroom/

This partnership, with the Issue Media Group (IMG), is built around the concept of “solutions journalism” – providing news about innovative and concrete ways that communities, across Michigan, are addressing the needs of their residents along a number of dimensions – healthcare, economic development, education, the arts, to name a few. Solutions journalism investigates and explains, in a critical and clear-eyed way, how people try to solve widely shared problems. While news sources and many of us typically define news as “what’s gone wrong,” solutions journalism runs counter to that definition by covering the innovative responses to identified needs and problems.

This partnership ensures that the work of Michigan’s public mental health system is highlighted in IMG’s large suite of solutions journalism-focused publications.

You can subscribe, at no cost, to these publications, on the websites of each of these publications. The list of partner publications and their websites are provided below:

Second Wave – Michigan

Capital Gains – Lansing

Catalyst Midland

Concentrate – Ann Arbor/Ypsi

Epicenter – Mount Pleasant

Flintside

Metromode – Metro Detroit

Model D

Route Bay City

Rural Innovation Exchange

Second Wave -Southwest Michigan

The Keel – Port Huron

The Lakeshore

Upword – UP

Connections purpose is to be an avenue for the exchange of information that includes people’s dreams, stories, concerns and successes. Its intent is to connect us all – the individuals who sit around the board room table, our customers, our administrators, caregivers, and our partners in the communities in which we live.

The Mental Health Code states that Community Mental Health Service Providers are required to distribute Recipient Rights Booklets to each recipient receiving services. To place an order with CMHA please visit our websites bookstore page.

The CMHA BoardWorks program was developed to assist Board members in fulfilling their obligations as CMH leaders, directors of policy, and advocates for those they serve.

Members of the Senate Appropriations Health and Human Service Subcommittee heard concerns expressed by health care officials over future funding if President Donald Trump’s administration and Congress slash Medicaid funding as part of government spending cuts.

Meghan Groen, state Medicaid director with the Department of Health and Human Services, said the department has heard one of multiple items that might be considered to reach budget reconciliation numbers in the federal budget is a reduction in the federal Medicaid expansion match from the current 90 percent.

Groen said if the 90 percent federal match for the Healthy Michigan Program were reduced to the roughly 65 percent federal match for traditional Medicaid, that would result in a funding loss of about $1.1 billion per year to the state.

“Absent an investment to cover that, 30 percent of Michigan’s Medicaid population would lose their health insurance coverage,” Groen said.

Nearly 750,000 people in the state could lose coverage if large-scale Medicaid cuts were to be enacted, she said.

Sen. Rick Outman (R-Six Lakes) asked Groen whether savings could be achieved within the budget, to which she said she is supportive of finding savings. There are programs in place to protect against waste, fraud and abuse including eligibility determination processes and a fraud and control unit within DHHS, she said.

“There’s always more work to be done … and that’s why we have all these robust measures,” Groen said.

Sen. Veronica Klinefelt (D-Eastpointe) asked if DHHS could handle all of those cuts “through rooting out waste, fraud and abuse.” Groen said no.

Julie Tatko, president and CEO of Family Health Care, said a loss of Medicaid funding could lead to critical funding losses, as well as having to reduce staff. People who lose coverage may not pursue needed care and may have to travel further to obtain care and may wait until their health has deteriorated before seeking care, she said

Lisa Rutledge with Western Wayne Family Health Care said any kind of changes or cuts would mean the elimination of jobs.

Philip Bergquist, CEO of the Michigan Primary Care Association, questioned calls for implementing work requirements for Medicaid eligibility.

“Most people enrolled in Medicaid already work and they’re going to continue working,” Bergquist said. “Adding some mechanism really serves as a mechanism of creating a pretty confusing and complex new barrier for people to navigate.”

Of states that have enacted Medicaid work requirements, 13 applied for waivers to enact such policies during Trump’s first term in office. Arkansas implemented a Medicaid work requirement in 2018, but it was halted by a federal judge in 2019. While the requirement was active, more than 18,000 people lost coverage.

Bergquist said the group estimates about 103,000 of its patients would lose care if work requirements were enacted. This would also lead to an estimated $75.6 million reduction in reimbursements to Michigan’s community health centers.

“We’ll do everything that we can do to serve people with the resource that we’ve got, but, I just want to say plainly, there is no way for us to continue everything that we’re doing right now with that loss of resources and the health of communities will be negatively impacted,” Berquist said.

Dr. Farhan Bhatti, a family physician and CEO of Care Free Medical, said if his facility were to close due to deep cuts to federal funding it would lead to 2,100 patients who rely on Medicaid and 1,700 more patients would lose their access to health care.

“They would have nowhere else to go, and I would venture to guess that at least half of my patients voted for President Trump and believed him when he said that cuts to Medicaid would be off the table,” Bhatti said.

Adam Carlson with the Michigan Health and Hospital Association, objected to arguments relating to waste, fraud and abuse.

“There’s been a lot of talk about waste, fraud and abuse. For the most part, based on the proposals we’ve seen, those are just intended to mask real cuts that could be imposed on the program,” Carlson said.

He pointed to the Federal Medical Assistance Percentage, or FMAP, which is used in determining the amount of federal matching funds for state expenditures are provided to states. A reduction of even 1 percentage point, Carlson said, would reduce funding to the state by about $150 million.

Why Support CMH PAC? 

In the Michigan Legislature there are:

• More new legislators due to term limits.
• Fewer legislators with in-depth knowledge about behavioral health issues.
• More legislative proposals that directly and indirectly impact Michigan’s publicly funded mental health system.
• More aggressive interest groups competing for limited resources.
• Very few legislative champions for persons with mental health, developmental/intellectual disabilities and substance use disorders.

CMH PAC helps overcome some of these obstacles by raising awareness for issues that are important to behavioral health care. The CMH PAC supports legislators/candidates who support and advocate on behalf of Michigan’s publicly funded mental health system.