Michigan Senate Passes DCH Budget; Medcaid Expansion Question Lingers

LANSING – The Michigan Senate on Thursday passed its Department of Community Health budget with some minor changes after much discussion about how the chamber would handle whether or not to expand Medicaid in its proposal to force the subject to be discussed in conference committee.

The bill (SB 198 ) was discharged from the Senate Appropriations Committee despite opposition from Senate Democrats. The chamber adopted a substitute that included three amendments: adjusting restricted funding sources to not reflect savings due to Medicaid expansion in the budget; a placeholder for potential human trafficking intervention services; and an amendment to create a workgroup that will help with community mental health services in Benzie and Manistee counties.

Sen. Vincent Gregory (D-Southfield) was the one to take to the podium for an amendment that would instead include Medicaid expansion; it was rejected predominately along party lines, save Sen. Roger Kahn (R-Saginaw Township) who agreed with Democrats to do so.

While the House and Senate have “points of difference,” as one senator has said, in various budgets, not including Medicaid expansion did indeed prove to be the one major topic both chambers agreed on despite the state’s top Republican, Governor Rick Snyder, advocating for the expansion while creating a fund to help sustain it once the federal government commitment dwindles.

The House has been taking testimony on HB 4714 , which requests a waiver from the federal government in place of the traditional expansion and calls for various reforms to the program instead.

“(The House is) taking in information and what they do with that information moving forward will become more definitive in terms of their actual plan,” said Sen. John Moolenaar (R-Midland), chair of the Senate Appropriations DCH Subcommittee, when asked about how receptive his colleagues are to the House proposal.

“At this time we don’t have legislation in the Senate on this and we’re following the discussion in the House,” he said. “Ultimately it’s going to come down to what does the department seek in terms of a waiver and what will (Center for Medicaid and Medicare Services) grant in terms of flexibility.”

Angela Minicuci, spokesperson for the department, said that even though the Senate reported its budget without any kind of expansion, it was “too early in the budget process” to rule out the possibility of whether an expansion could or could not occur in Michigan.

As for the House plan, “…There are definitely some areas of concerns but there are also some really good things in the plan,” she said. “We remain committed to seeing some form of coverage for the uninsured in Michigan.”

And Kahn, chair of the Senate Appropriations Committee, said that while the Medicaid issue is “complex,” he believes “there would be a desire for changes.”

But whether or not those desires result in changes or, as he said, a political decision will remain “the ping pong match” of Legislature and the administration.

“We make sausage here, not filet mignon,” he said. “We’ve got to find a way to get votes that will move something forward that will help the people of the state of Michigan.”

Senate Democrats presented several other amendments to the chamber, including one that saw a tied vote on expanding the Healthy Kids Dental plan to the state’s most populous counties of Wayne, Oakland, Macomb and Kent.

“We continue to store money in the rainy day fund but there are children in our state that are in great need of this care,” said Sen. Virgil Smith (D-Detroit), sponsor of the amendment.

Without Lt. Governor Brian Calley serving as the President of the Senate, no tie-breaker vote could be issued and so the amendment was defeated for lack of a majority.

Currently the Senate subcommittee bill does include funds for an expansion of the program but does not specify which counties it will be divvied up by – one of several other changes, including restoring graduate medical education funding, made by the subcommittee.

But, Moolenaar having previously stated his support for the program, he said both on the floor and in a later interview that as much as he would like to support that amendment, he could not without having “a final target number to work with.”

“I think it’s a very strongly supported program and everywhere we’ve been able to expand it’s been well-received. The desire is in the next couple years to cover the entire state,” he said, adding that if it can be expanded sooner, he would be open to doing so. “It’s just a matter of whether the funds are there.”

He said some ideas have been floated about trying to expand the program into the state’s larger counties by zip code but he and others were in the process of trying to see if that would be something that could be implemented.

“It’s helpful to expand it in a way that the entire county is covered rather than a portion of it,” he said.