Hospitals say Medicaid rules slow behavioral‑health placements; MHA and Pine Rest urge fixes

Representatives of the Michigan Health & Hospital Association and Pine Rest Christian Mental Health Services told the Senate Committee on Health Policy that Medicaid‑linked pre‑admission screening procedures are causing long waits and placement delays for behavioral‑health patients in emergency departments across Michigan.

Lauren Lapine, senior director of legislative and public policy at the Michigan Health & Hospital Association, said the association’s data collection showed more than 1.2 million emergency‑room visits last year in which behavioral health was one reason for care, and that “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.”

Lapine described a two‑track process that treats commercially insured patients differently from Medicaid beneficiaries. She said a commercially insured patient assessed in an emergency department can be transferred directly if an inpatient bed is needed, but Medicaid patients require a pre‑admission screening assessment by the patient’s local community mental health agency (CMH). That CMH assessment — required by MDHHS contracts, Lapine said — often is not completed within the three‑hour target and can trigger conferences and disagreements between hospital clinicians and CMH social workers that stretch into days.

Kyle Hoffmaster, director of patient access at Pine Rest and a registered nurse, described operational consequences. Pine Rest staff routinely find available beds but said patients are sometimes delayed because the CMH requires a hospital ED assessment or sends a lower‑level clinician to complete the screening. “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, adding that the requirement sometimes forces unnecessary ED visits and stresses EMS and families.

Both presenters said pediatric and geriatric patients often board the longest and that Medicaid patients make up the largest share of those waiting. Pine Rest provided service statistics during testimony: about 7,000 hospital patients, 2,500 partial hospitalizations, 6,500 psychiatric urgent‑care visits and 50,000 outpatient visits in the prior year, and roughly 200 inpatient beds statewide in their system.

Committee members asked how weekends and staffing affect the three‑hour requirement; witnesses said some CMHs route calls to voicemail on weekends and consider the screening clock to start when their office reopens. Witnesses and senators described inconsistent processes across counties; Lapine said the three‑hour requirement stems from CMH contracts with the Michigan Department of Health and Human Services.

Both the MHA and Pine Rest urged legislative and administrative fixes to standardize the screening process and allow clinically qualified hospital personnel to perform pre‑admission screening when the CMH cannot meet time targets. Lapine said the change would streamline movement from emergency departments to the appropriate level of behavioral‑health care without altering CMH payment responsibilities.