Access Community and Team Wellness tell appropriations panel intake paperwork, workforce rules block timely SUD treatment

Mona Mackey, director of Access Community Health and Research Center, and Jessica Kowalski, deputy director of medical services at Access, told the House Appropriations Subcommittee on Human Services that state intake, authorization and credentialing processes are causing many people seeking substance use disorder care to drop out before treatment begins.

At the hearing, Mackey — representing the Arab Community Center for Economic and Social Services (ACCESS) — described the current client pathway: an intake call to the PIHP (Detroit Wayne Integrated Health Network, DWIN) that can take at least an hour and a half, then agency appointments for paperwork and subsequent ASAM (American Society for Addiction Medicine) assessments. Mackey said the journey to a meaningful treatment encounter can require as many as five separate appointments and that “4 out of 5 clients do not make it through the process to get the treatment portion of their care.”

Kowalski described operational workarounds Access uses to avoid losing clients, such as initiating medication-assisted treatment in a primary-care clinic as a walk-in without waiting for PIHP authorization. “We can initiate that and get to that later,” Kowalski said, meaning pharmacologic treatment can begin immediately in primary care while paperwork follows.

Both witnesses said a policy change effective Oct. 1 will transfer responsibility for the Certified Community Behavioral Health Clinic (CCBHC) intake process from PIHPs to CCBHCs, which will remove a middle layer of authorization. Mackey noted the change will not remove the many forms a client must still complete: “This is all needed before someone can even begin treatment,” she said, listing consent forms, orientation checklists, the ASAM assessment, an integrated biopsychosocial assessment and the treatment plan.

Kowalski told lawmakers that workforce requirements and licensing rules also limit access. She said Michigan requires nearly 2,000 hours of postgraduate counseling experience plus additional coursework and supervised hours; the state also does not accept addiction-credential transfers from other states, slowing workforce expansion. “The paperwork burden, it just remains overwhelming,” Kowalski said.

Kowalski and Mackey recommended policy changes including reduced credentialing barriers or reciprocity, financial incentives such as loan repayment, expanded walk-in and same-day medication-assisted treatment, telehealth and integrated wraparound services linking housing, employment and legal supports to clinical care.

Michael Hunter, president of Team Wellness Center, described operating an integrated community health organization that provides primary care, dental services, behavioral health, crisis stabilization and housing supports. He told the committee the no-show rate can be high — he cited figures near 50% — and that organizations must balance clinical staffing and security needs while competing with other programs for scarce behavioral health workers.

Mackey said Access has begun construction on a 51,000-square-foot Access to Recovery center intended to provide withdrawal management, crisis stabilization and short-term residential services and hoped to open in 2026. Committee members asked for the reports and documentation the witnesses referenced; the witnesses provided materials to the clerk and offered follow-up briefings.