Ottawa County CMH warns of rising costs and funding shortfalls; board approves consultant to review CCBHC and Medicaid finances

Ottawa County Community Mental Health officials told board members at a public meeting that rising provider costs, a shortfall in state Medicaid funding and uncertainty about the county’s participation in the federal CCBHC demonstration have pushed the agency toward a projected deficit, and the board voted to hire an outside fiscal consultant to review options.

The agency’s director, Michael Brashear, told the board that Ottawa CMH recorded 99 crisis contacts in April and that 73 percent of those contacts did not result in an inpatient hospitalization, while 27 resulted in inpatient stays — higher than the program’s 25 percent hospitalization benchmark. Brashear said the system’s crisis and residential capacity is limited: the Robert Brown Center has six crisis‑residential beds and the county’s crisis residential contracts total fewer than 30 beds.

Those operational pressures come as the agency continues to reconcile last fiscal year’s finances and work through a pending budget adjustment. Amy (fiscal manager) reported a year‑to‑date deficit position; a summary filed during the meeting showed a projected net deficit of approximately $1.99 million through May 15, 2025. Brashear said Ottawa CMH served about 4,500 individuals in 2024, with roughly 1,800 adults with mental illness and 917 children with serious emotional disturbance included in those totals.

Brashear stressed the interaction of several factors: growing residential and staff costs across the provider network, state rate‑setting that uses lagging data, withheld state Medicaid payments and new CCBHC fiscal rules that could expose the county to additional financial risk. He said the agency had proposed a fiscal strategy that depended in part on maximizing CCBHC reimbursement but that further technical review was needed before the board or county would accept the exposure.

“To be clear,” Brashear said, “we need to validate our assumptions with the state and a third party before moving forward. That’s why we brought in The Raymond Group.”

The board then voted to approve a consulting contract with The Raymond Group to evaluate the county’s CCBHC costing, Medicaid reporting and related financial assumptions. The motion’s exact contract amount and some implementation details were not specified in the meeting packet; the motion was moved and seconded and subsequently approved by roll call (motion carried).

Other operational updates discussed at length included: - Crisis services: Brashear said the agency is tracking step‑down placements (for example, inpatient → crisis residential → partial hospitalization) and emphasized partnerships with Holland Hospital for partial hospitalization. He said some populations — adults with developmental disabilities — are especially difficult to place in hospitals and that additional levels of care will be needed. - Eligibility and access: In April the agency completed 47 formal eligibility assessments, and 79 percent of those assessed were found eligible for CMH services. Brashear said the agency is still compiling whether the counts reported are unique individuals or contacts and will refine reporting once a new electronic medical record (EMR) goes live in June. - Programs that extend beyond Medicaid: Brashear reviewed Pathways (transportation, primary care linkage and social‑determinant interventions), the Community Navigator program (which conducts prescreens and in‑person navigation) and Clubhouse services (psychosocial rehabilitation). He reported program figures: Pathways reported 579 open interventions and 681 total referrals since 2018; Navigator interventions totaled 1,794 interventions with 569 crisis follow‑ups and 893 prescreens; Lakeshore Clubhouse reported 49 members and roughly 17,000 hours of skill‑building activities last year. - ACT and residential services: ACT (assertive community treatment) teams are limited to about 60 people by fidelity standards; Brashear said 10 ACT participants transitioned to a lower level of care in 2024 and that housing placements remain difficult to secure. He warned that several major residential providers had informed county leaders they could exhaust reserves in coming months without an immediate stabilization plan. - EMR migration: The agency plans to move to the PCE (state‑aligned) EMR in June to improve reporting and fiscal integration.

What the board decided and next steps The board approved the Raymond Group contract to provide targeted fiscal consultation and CCBHC costing review; the motion was moved and seconded and passed by roll call (mover and seconder not specified in the transcript). Brashear said the county will not proceed with any plan that increases the county’s financial exposure without explicit, county‑level agreement. He said he will meet with county administration, legal counsel, the Lakeshore Regional Entity (LRE) and MDHHS to clarify risk exposure and report back to the finance committee and the full board.

Brashear also indicated the agency will increase reporting detail to the Program Quality Improvement (PQI) and finance committees on: crisis disposition trends, eligibility funnel metrics (screening → assessment → authorization), service authorization types, contract vs. directly operated service splits, and a clearer linkage between millage, grants, CCBHC and Medicaid funding. He said the agency will propose a possible joint work session with the County Commission to review CCBHC exposure and fiscal options.

The board scheduled committee work; finance and PQI committees will meet ahead of future full board meetings so members can review detailed analyses before votes on budgets or major program changes.