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 Granholm
Creates Mental Health Commission
Gongwer News Service, December 12, 2003
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Saying the state
must move to a more "user-friendly mental health system that
ensures timely access to care, fosters quality and excellence in
service delivery," Governor Jennifer Granholm has issued an
executive order creating a state mental health commission within
the Department of Community Health.
The commission will consist of 29 members named by the governor
and serving at her discretion, according to Executive Order
2003-24. In addition, the directors of the departments of
Community Health, Corrections and the Department of Human Services
will serve as ex-officio members of the commission.
Community Health Director Janet Olszewski also has made
reorganizing the state's mental health services a top priority
(see related story). The commission was created partly in
reaction to the changes and cuts made to the mental health
system under former Governor John Engler.
The order is necessary, it states, because "the
publicly-supported mental health system is currently at a
crossroads, requiring the input of interested parties working
together to address the challenges confronting the system."
Designated as an advisory commission, the executive order
directs the body to "identify and prioritize pressing issues and
significant challenges that must be addressed to preserve and
improve services for adults and children with serious mental
illness or emotional disturbances."
The commission is also to make recommendations to improve the
organization, quality and effectiveness of services and develop
a "Michigan-specific plan to determine the most appropriate
strategy for achieving mental health parity in this state."
It is directed to issue a final report and recommendations by
September 30, 2004.
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Olszewski Planning Revamp of Mental Health, Add Prevention
Gongwer News Service, December 12, 2003
There will not be much money to add services, in the current or
the coming fiscal year, but Community Health Director Janet
Olszewski said she is still hoping to restructure how the state
handles mental health and long-term care in the state. And she
is looking for savings through moving more spending to
prevention services for both mental and physical health.
Mental health care could see some revolutionary changes as the
department tries to answer concerns raised much of the past
decade that state and county programs are not providing
sufficient support for those afflicted and their families. And
long-term care could follow the deinstitutionalization path as
the department works to provide more services to seniors in
their own homes.
Concerns about the "destruction" of the state's mental health
system were a hallmark of opponents to the administration of
former Governor John Engler. As he first eliminated the
Department of Mental Health, combining it with Public Health,
and then began closing state mental health institutions,
opponents charged the state was abandoning mental health
services.
Most of those in the state institutions were moved to the care
of community mental health boards, but opponents charged those
boards were not given sufficient resources, monetary or
otherwise, to meet all of the needs of those with mental
illness.
Ms. Olszewski said many of those concerns of insufficient
resources and care are still being raised. The solutions will
hopefully come out as the Governor's Mental Health Commission
(Executive Order 2003-24) completes its work next year (see
related story).
The goal of the commission is to give those critics of the
system as well as service providers and others an opportunity to
help shape the changes, she said. "We hear from families that we
left them unsupported; we hear from providers that there are too
many layers; we hear from sheriffs that they end up with all our
problems," she said.
The commission has much to look at. "We've been through several
years of deinstitutionalization; we have medications available
that weren't before; we know for children we do not have enough
providers," she said.
What it will not be looking at is new state mental health
facilities. "I don't think back to large state facilities is
where anyone wants to go," she said. "We want to provide
services in the least restrictive setting."
And she said the cost of building a new facility would be
prohibitive in the current budget climate.
But the commission will have to address broader access for those
who do need an institutional setting. "We do not have good
geographic access," she said.
Of the seven remaining facilities, all are in the lower half of
the Lower Peninsula. And she said people living near a state
facility are still often moved across the state because the
facility nearest them is full.
The department is also looking at concerns raised for many years
that many elderly people are ending up in nursing homes because
that is the only place Medicaid will cover the services they
need and Medicaid is the only way they can afford those
services.
"We want to spend some energy looking at long-term care," Ms.
Olszewski said. "We want to improve our ability to provide care
for people in their own homes and communities."
The department has also moved the long-term care ombudsman into
the Office of Services to the Aging from the private contractor
that once handled the service. Ms. Olszewski said the hope is
bringing the service in house will improve response times, bring
more accurate responses and allow the issues raised to that
office be better used in setting policy.
But with the state budget still sliding, Ms. Olszewski said she
is looking for ways to also cut some costs in providing health
care. And she hopes the state's efforts can also translate to
savings for private insurers and employers as well.
"Costs to private employers continue to rise," she said. "About
70 percent of health care costs are tied to chronic disease."
And she said in most cases those diseases can be prevented or at
least better managed if they are caught earlier. "We're trying
to move upstream," she said.
The department is working in a number of areas to better track
down those with undiagnosed chronic disease and to move those
with poor health habits to change them.
One of the key initiatives will be by Surgeon General
Kimberlydawn Wisdom to get people to move, period, Ms. Olszewski
said.
Ms. Olszewski praised the governor and the Legislature for their
budget work around Medicaid. "I don't know any other state going
through this level of cuts that's held Medicaid essentially
harmless," she said.
The state actually has expanded Medicaid some through the
Freedom to Work Act (PA 33, 2003), which, starting January 1,
allows those with disabilities to increase their earnings
without losing Medicaid coverage. "People were not doing as much
as they could because they could not afford to lose health
care," Ms. Olszewski said.
What will not likely be expanding, though, is the reimbursement
levels to hospitals and physicians caring for Medicaid patients.
And Ms. Olszewski said that has already left some areas of the
state with insufficient health care.
"I firmly believe we have a very fragile provider network for
Medicaid," she said, adding there are serious concerns that
physicians in some areas may further limit the number of
Medicaid patients they will accept because the system is not
covering their costs.
She noted that Michigan already has lower reimbursement rates
than other states and falls short of Medicare reimbursement
rates, the yardstick for health care rates. "Statewide we're
about $900 million short," she said.
But she said the only way to increase reimbursements at this
point would be to make more people ineligible for Medicaid.
"Essentially if you make people ineligible you just put them
into the uninsured pool," she said.
One remaining unknown is the new federal Medicare prescription
program. Though the program does not begin until 2005, Ms.
Olszewski said the state has to begin working now to be prepared
to implement the measure.
Of particular concern is how the new Medicare program will
affect those eligible for both Medicare, a solely federal
program, and Medicaid, a joint state/federal program. The state
will need to determine how benefits will be balanced between
those two programs for about 140,000 people in the state.
The new Medicare program could also affect the state's Elderly
Prescription Insurance Coverage program. "We need to take a look
at that and how much of that is taken over by Medicare," she
said.
The creation of the new Department of Labor and Economic Growth
will also lead to some better coordination among state health
care programs, Ms. Olszewski said. "This is more than just a
reorganization," she said. "They'll become part of our teams in
a much easier way."
Under the executive order (2003-18), Community Health brought in
the Bureau of Health Professionals, which licenses physicians
and nurses, and brought back the Bureau of Health Systems, which
licenses hospitals and nursing homes. The change, Ms. Olszewski
said, brings all of the decision making about health care under
one roof, at least organizationally.
"We can look at how we regulate long-term care facilities and
how that fits into the administration's policy on long-term
care," she said. "We can look at serviced shortages and whether
licensing is feeding into workforce shortages."
Ms. Olszewski said a restructuring of Community Health in July
was done with bringing in the new bureaus in mind, so she said
there will not likely have to be any further structural changes
to the department because of the additions, nor will there
likely be any changes to those bureaus as they move to their new
home.
"People in the field should not see any shakeups," she said.
She said the bureaus the way they are structured already lend
themselves to meeting the goal of the July restructuring, which
was to ensure those in the public health community had clear
sources for answering questions and concerns. "It really
solidified responsibility and accountability," she said, adding
that the prior structure left local community health officials
with one of three different bureaus to search through when
problems or concerns arose.
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A Conversation with Governor Granholm on Charter Schools and
Tax Support for Education
Gongwer News Service, December 12, 2003
State officials came closer in 2003 than they have in a decade
to making significant changes to the state's charter school
limits before a proposal imploded in autumn, but any further
attempts to change the charter school laws will not be a
priority in 2004, Governor Jennifer Granholm said in an
interview with Gongwer News Service.
Still somewhat tender after the controversy that surrounded the
issue this fall, Ms. Granholm was quite specific is saying
several times that charter schools are "not something I want to
make a priority for 2004."
"This charter school issue is something so hot both sides either
run from it or shoot at it," Ms. Granholm said when asked what
she had learned from the fallout of the issue.
But in 2004 Ms. Granholm said the state will be "grappling" with
discussions on possible changes to the state's tax structure so
that it provides both a stable source of revenues for schools
and services as well as helps make the state more competitive.
"We need to look at the tax architecture of the state. It is
still based primarily on a 20th century economy, a manufacturing
economy. And in the 21st century what is it we are going to need
to do from the tax perspective to ensure a stable quality of
life and a competitive low-tax environment?" Ms. Granholm said.
Sales taxes have been the primary source of state funding for
schools since 1994, but sales taxes have not always been the
most stable source of revenues, she said. There is no reason
that sales taxes cannot remain a main source of education
funding, but there may be other dedicated revenues the state can
turn toward schools.
In the wide-ranging interview, an often animated Ms. Granholm
said that even with budget difficulties being the primary focus
of the year, the administration has taken action on 30 of 33
priorities that she listed in the State of the State address.
She cited action on early childhood education, reconstituting
major sections of state government, enacting a new emphasis on
manufacturing and on promoting "cool cities," as well as
bringing to fruition a major series of proposals on land use
that are now being implemented both through legislation and
administrative actions.
"It's been a great year," Ms. Granholm said.
Asked what her worst day as governor has been, Ms. Granholm
cupped her head in her hands and said that the "terrible days"
are when she has to call the parents of Michigan armed services
members killed in action. As a parent herself, she said she
could only imagine the pain those people are feeling must be
"terribly wrenching."
And she was unfazed by repeated Republican criticism that her
main accomplishment is in holding press conferences and public
forums. While Republicans have said that Ms. Granholm listens,
but cannot lead, she shrugged, "Consider the source. That is
something I have not heard from the citizens. I have heard it
from Republicans."
There is a "certain arrogance" in the idea that as governor she
should not consult "my employers" while making decisions, she
said. And, she acknowledged, it would be much easier to simply
make decisions without bringing people to the table for
discussions, but it is important that the public feels it has a
stake in those decisions.
"You have to have an inclusive government," she said.
CHARTER SCHOOLS: Many people came to the table earlier this year
in trying to resolve the controversy over charter schools, and
Ms. Granholm said, "Everyone of the people around the table had
some responsibility for seeing that thing fall apart."
The charter school bill collapse-though, ironically, legislation
to allow for charter high schools in Detroit did become law
because even without Ms. Granholm's signature because a bill the
Legislature had returned did not come back with the consent of
both houses before it was constitutionally required to do
so-stands as possibly the biggest collapse of the young Granholm
administration.
The charter school issue this year had revolved around a
proposal by Belleville industrialist and philanthropist Bob
Thompson to donate $200 million to build charter high schools in
Detroit. After meeting with Mr. Thompson, Ms. Granholm tried to
search out a way to both accommodate his proposal and put some
greater controls on charter schools.
The Legislature sent her a bill authorizing the Thompson
schools, which she threatened to veto (though she did not want
to do so) because it did not include a complete solution to the
issue.
Ms. Granholm met with Senate Majority Leader Ken Sikkema
(R-Wyoming), House Speaker Rick Johnson (R-LeRoy) and Detroit
Mayor Kwame Kilpatrick, and they struck a deal. It would have
authorized the Thompson schools, allowed for more
university-chartered schools (universities can now charter 150
schools), created more oversight over the charter schools and
sought to resolve controversy over Detroit Public Schools
governance. But it was never publicly announced by Ms. Granholm.
Almost immediately, the agreement began to unravel as Mr.
Kilpatrick insisted he had not agreed to the proposal, which was
wildly unpopular at least among activist groups in Detroit.
Thousands of Detroit school teachers protested at the Capitol,
and then Ms. Granholm announced that the deal was off because
Republicans were allegedly trying to slip new issues into the
legislation. Republicans said they had merely sent the governor
a working draft of a proposal.
Legislators then called on Attorney General Mike Cox to
determine if the Thompson charter bill was in fact law because
it had been recalled improperly from Ms. Granholm's desk. Mr.
Cox said it was, and directed it receive a public act number.
But then stunningly Mr. Thompson announced that because of the
controversy, he would not go forward with his proposal.
Asked what lessons she had learned from the experience, Ms.
Granholm said she had tried to bring two different parties to
the table on the issue and "the moment it got too hot to handle,
both sides ran in the other direction. Can't blame a girl for
trying."
Asked what effect the charter school issue had on her
relationship with Mr. Kilpatrick, Ms. Granholm said, "It was a
good learning experience for both of us." Asked what she learned
specifically, she repeated that she learned charter schools
would not be a priority for the upcoming year.
It also showed, along with "so many goofs" that she does not
have all the answers, Ms. Granholm said. But, "show me somebody
who's never made a mistake, I'll show you someone who has never
led. I'm not afraid of that."
One thing Ms. Granholm had hoped to lead the state on was a
return to greater civility to government, and she admitted it
wasn't always easy to keep her temper. When shots are fired at
her, she wants to fire back, she said, but-theatrically biting
on a finger-she said she didn't think the people wanted division
and discord in government.
THE STATE'S TAX STRUCTURE: Leading the effort to review the
state's tax structure over the next year will be Treasurer Jay
Rising, who will be assisted by a number of top business
leaders, including Dick Blouse, president of the Detroit
Regional Chamber of Commerce, Ms. Granholm said. Mr. Blouse has
also pulled together a number of business groups, including
members of regional chambers to discuss the tax issue.
The group will look at the state's entire tax structure, she
said. Part of the impetus for the review is the 2010 phaseout of
the single business tax, but the review has to be of the state's
whole tax structure given the state's changing economy.
Actual changes to the tax structure are not imminent, "and you
want to make sure it's done right and it's done thoughtfully,"
but she was hoping that proposals for changes would be made in
2004.
She said she did not want to return to property taxes as the
major funding source for schools since that led to the
discrepancy between school districts with which the state still
wrestles. But the state has to look for a stable source of
school funding because "the sales tax, as we have learned, is
not necessarily the stablest form of revenue."
It's not that the state shouldn't have the sales tax as the
source of 48 percent of the school aid fund's money, Ms.
Granholm said, but there may be other dedicated sources of
revenues as well that could go to schools.
"It is important to capture revenue from areas of growth in the
economy," she said, but the state must also be competitive as
well. There may a more fair way to distribute the tax burden,
she said, "some restructuring may be necessary."
The only idea in the tax review that will be off the table are
tax increases, she said. "I don't think anyone wants to see tax
increases."
The House is now facing a decision on approving a six-month
pause in the rollback of the income tax from 4 percent to 3.9
percent, and Ms. Granholm sharply criticized House Republicans
for considering more budget cuts instead of a pause (see
Thursday's report).
Asked if there were any conditions under which she may have to
ask the rollback delayed further-if for example, the state
continued to lose revenue because the economy did not pick
up-Ms. Granholm dropped her head to the table in sign of
distress, but said such a possibility could not be ruled out. It
would depend on what was happening in the state at the time, she
said. If, for example, the state were attacked by terrorists,
then more revenue may be needed.
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