Work group recommends five-year renewal of Genesee County health-services millage; commissioners debate levy, fund balance and program changes

Josh Freeman presented recommendations from a small work group that reviewed the Genesee County health services millage and advised placing a five-year renewal on the ballot while creating a work group with a deadline to return operational recommendations.

Freeman and Genesee Health Plan representatives emphasized three priorities: preserve access to care for current millage users, modernize how millage funds are used, and reduce duplication across providers. Freeman said the group found there is no "quick fix" to change health outcomes and recommended limiting a renewal to five years to allow the work group time to measure pilot results and align with the county's budget cycle.

Why it matters: Commissioners heard that the millage brings in roughly $13 million a year (staff cited an approximate figure), with sizable portions currently earmarked to the Genesee Health Plan and for jail health care and hospital uncompensated-care payments. Commissioners and presenters said the millage supports access for about 3,000 Genesee Health Plan enrollees and that changing Medicaid and SNAP rules at the state/federal level could alter demand.

Key data presented included an approximate annual revenue projection of $13,000,000, with about $7,000,000 identified for Genesee Health Plan and roughly $5.3 million budgeted for jail health care; a $2,000,000 figure for hospital uncompensated-care payments was listed in the packet as an illustrative budget line. Jim Milanowski (CEO, Genesee Health Plan) told commissioners that, in 2025, the plan had about 1,200 members diagnosed with hypertension and 431 with diabetes, figures commissioners cited when urging more upstream, chronic-disease management.

Commissioners debated policy options: several advocated using existing fund balance to temporarily reduce the levy (examples discussed included a potential renewal at ~0.8 mill), while others warned that drawing down reserves or using one-time savings should be done carefully so the millage can remain responsive to need. The equalization director explained constraints and ballot/levy mechanics, noting that a renewal must be proposed at an amount equal to or lower than prior-year levy totals or else be treated as a new millage under rollback rules.

Several commissioners suggested a more targeted approach and asked staff to examine whether hospital uncompensated-care payments could be reduced by enrolling eligible patients in Genesee Health Plan at discharge, and whether the county could pursue Medicaid-waiver strategies to shift costs. Commissioners also discussed program-level reforms, a request-for-proposals approach to drive innovation, and measures to address major drivers of chronic disease (hypertension, diabetes and dental care).

There was no final vote on the millage at this meeting. After lengthy discussion, commissioners agreed to modify the resolution language and bring a revised proposal back for a full-board meeting; the board voted to postpone formal action to the next full commission meeting (the chair asked staff to return with a modified resolution and budget options). Freeman noted that to place a renewal on the November ballot staff would need to act by an August filing deadline, giving the board limited time for decisions and public outreach.

Next steps: Staff will draft modified renewal language and return with levy, fund-balance and program options to a future meeting; commissioners signaled interest in a shorter renewal period (five years), a formal work group with deadlines, and evaluation metrics tied to long-term outcomes.