Hospitals report long emergency-department waits for behavioral-health patients; MHA and Pine Rest urge screening changes

Lansing — Hospital and behavioral-health providers told the Michigan Senate Committee on Health Policy on March 19, 2025, that Medicaid beneficiaries seeking behavioral-health care spend longer periods boarding in emergency departments and that procedural rules for pre-admission screening contribute to delays.

Lauren Lapine, senior director of legislative and public policy at the Michigan Health and Hospital Association, said MHA data collected from about 70 hospitals showed "On any given day there are over 155 patients that are waiting in emergency departments across the state for access to critical behavioral health services." She told the committee that pediatric and geriatric patients board the longest and that patients with Medicaid wait longer than those with commercial insurance.

Lapine reported that over a one-year period the association's data showed more than 8,000 Medicaid patients boarded in emergency departments compared with about 5,000 commercially insured patients. She also explained the state's pre-admission screening process for Medicaid patients: a community mental health agency (CMH) must complete a pre-admission screening assessment within three hours for a Medicaid beneficiary who presents in crisis, and hospitals routinely report that CMHs do not always meet that timeframe.

"If I'm a Medicaid beneficiary, the hospital psychiatrist can't independently determine I need inpatient care without the approval of a community mental health clinician simply because the CMH ... must decide whether or not they are willing to pay for my services," Lapine said, describing how payment and authorization rules can delay patient transfers to inpatient psychiatric care.

Kyle Hoffmaster, a registered nurse and director of patient access at Pine Rest Christian Mental Health Services, told the committee that available inpatient beds at providers such as Pine Rest are sometimes unusable because the CMH pre-admission assessment or authorization is delayed or requires the patient to be taken to an emergency department before the assessment will be completed. "Because of the structure of the public behavioral health system in Michigan, we are forced to send patients to emergency department for an assessment that is often completed by a bachelor's level social worker from the CMH," Hoffmaster said.

Hoffmaster described examples where Pine Rest had capacity but could not accept patients because CMH requirements directed the patient to an ED for assessment; after the ED and CMH completed their reviews the patient was then referred to Pine Rest. He and Lapine urged a change to allow clinically qualified hospital personnel to complete the pre-admission screening when CMHs are unable to meet the three-hour standard.

Committee members asked about weekend coverage, variability between CMHs, and the qualifications of CMH screeners. Lapine and Hoffmaster said practices vary by county and agency, that some CMHs provide 24/7 services while others do not, and that hospitals report CMH screeners are often bachelor's-level social workers though qualifications vary.

Senators who spoke during the presentation praised crisis centers such as Common Ground and urged better statewide standardization of behavioral-health infrastructure and access. No legislative action was taken during the presentation; the committee adjourned after the briefing.

The presenters said they are willing to work with the Legislature on statutory or contractual changes to streamline pre-admission screening and reduce time patients spend boarding in emergency departments.