Hospitals say Medicaid process delays behavioral‑health placements; MHA, Pine Rest urge changes

Representatives of Michigan hospitals and a large behavioral‑health provider told the Senate Committee on Health Policy that Medicaid beneficiaries with behavioral‑health crises face longer waits for inpatient placement than commercially insured patients because of how community mental health (CMH) pre‑admission screening is implemented.

Lauren Lapine, senior director of legislative and public policy at the Michigan Health & Hospital Association, presented 18 months of hospital data and said hospitals reported ‘‘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 also told the committee "last year alone, there were over 1,200,000 emergency room visits where behavioral health was one of the reasons for the individual's care." Lapine said the numbers came from about 70 hospitals that submitted weekly data to MHA and that pediatric and geriatric patients board longest.

Lapine described the state's process as different for commercially insured and Medicaid patients. For Medicaid beneficiaries, a community mental health agency must complete a pre‑admission screening assessment, and by contract that assessment must be completed within three hours. "The MHA routinely hears from hospitals statewide ... that this assessment is not happening within that 3 hour time frame," Lapine said, and when CMH and hospital clinicians disagree about inpatient need the conferenced decision can take days.

Kyle Hoffmaster, director of patient access at Pine Rest Christian Mental Health Services, described clinical and operational impacts. He said Pine Rest frequently has available beds but cannot receive Medicaid patients until a CMH pre‑admission screen or a psychiatrist conference permits transfer. "We are adding additional stress and cost to families to go to emergency department," Hoffmaster said. He described instances in which Pine Rest clinicians assessed a patient and recommended hospitalization but were told by CMH to send the patient to an emergency department for the CMH screening; after the ED screening, authorization for hospitalization followed and the patient was later referred back to Pine Rest.

Presenters and several senators discussed the lack of standardization across CMHs, weekend coverage gaps and the qualification level of CMH staff performing screenings. Lapine and Hoffmaster urged that clinically qualified hospital staff be allowed to perform the pre‑admission screening when a local CMH cannot meet the three‑hour standard.

Committee members also pointed to existing community crisis facilities. Senator Runstead described Common Ground in Oakland County — a 24‑hour crisis center — as an example of a model that keeps people out of emergency departments and jail. Several senators said county‑to‑county variation in services is a problem that money alone has not fixed and said legislative action should aim for more standardized, navigable processes.

The presenters did not propose a specific statutory drafting in the hearing but asked the committee to consider operational fixes to reduce emergency‑department boarding for Medicaid patients with behavioral‑health needs.