Newsletter June 2025
Behavioral Health
Todd Lewicki, PhD, LMSW, MBA
Chief Behavioral Health Officer
How Medicaid Supports Michigan's Citizens
Medicaid plays a critical role in supporting Michigan’s citizens in a multitude of ways. Coverage is especially critical
for individuals with low incomes, disabilities, and/or complex health needs. Nationally, Medicaid is the United
States' largest provider of health insurance and, in Michigan, covers more than 2.6 million residents (Michigan
Department of Health and Human Services, 2025). The state of Michigan’s Pre-Paid Inpatient Health Plans
(PIHPs) and Community Mental Health Service Programs (CMHSPs) serve and support well over 290,000
Medicaid beneficiaries in ways that help adults and children with mental illness, individuals with intellectual and/or
developmental disabilities, persons with a substance use disorder, and anyone experiencing a behavioral health
crisis. Services and supports promote community integration, improve quality of life, safeguard individual rights,
and are person-centered. Medicaid services save lives and offer dignity and hope to the vulnerable, enabling many
to live as independently and fully as possible within their communities.
Through the primary support of Medicaid, the Community Mental Health (CMH) system serves as the front line of
behavioral health care for some of the most vulnerable persons in Michigan. Examples of services include case
management, psychiatric care, community living supports, peer services, vocational services, residential services,
respite, applied behavior analysis (autism), and crisis intervention. The PIHP and CMH systems are committed to
ensuring that all individuals have access to quality behavioral health care, especially those individuals that would
fall through the cracks of the healthcare system. Without Medicaid to help Michigan’s most vulnerable, the
consequences of falling through the cracks would be dire, severe, and far-reaching.
Individuals with serious mental illness, intellectual and/or developmental disabilities, and substance use disorders
would lose access to critical services. In well over 50 years of behavioral health policy evolution, refinement, and
innovation, individuals would be left without the necessary services and supports they have relied upon to live
safely and independently in their respective communities. Many individuals with untreated mental health or
substance use disorders would be in danger of losing stable housing and could end up in trouble with the law,
being jailed or imprisoned. It is also likely that loss of Medicaid coverage would increase the worsening symptoms
of an individual’s behavioral health disorder, increasing costly visits (and wait times) to emergency rooms, more
frequent psychiatric hospitalizations, and higher healthcare costs overall. Stigma, or negative or improper beliefs
about a person or their condition, would certainly rise as well, further contributing to the CMH beneficiary’s sense of
alienation and loneliness, two enemies of well-being and good mental health.
The effect of Medicaid beneficiaries losing their coverage goes well beyond the individual and the legal and
healthcare systems, as if those effects were not broad and deep already. The strain on families and caregivers
would be untenable, leading to caregiver burnout, financial hardship, loss of productivity, and family
breakdown. This “local effect” will drag quality and contentment of life down, leading to greater crises in the
community, from abuse to self-harm. The broader community, i.e., towns/cities, counties, states, nationally, would
likely see increases in spending on emergency services, law enforcement, and institutional care. You will especially
recall that emergency care and law enforcement are already overburdened and spread thin, and we have already
found newer ways to involve these two important systems in improving outcomes for persons with severe mental
illness, intellectual and/or developmental disabilities, and substance use disorders. Lastly, through the Home and
Community-Based Services Rule, institutional care in Michigan has been all but eliminated. Any return to this mode
of care would be unjust, illegal, and unethical.
The PIHP and CMHSP systems in Michigan have made significant strides in improvements and outcomes in
behavioral and substance use disorder treatment. Improvements include better home-based services, job growth,
improved evidence-based practice delivery, greater economic stability, and positive outcomes for Medicaid
beneficiaries. These benefits should not be ignored. Even more critically, not heeding the consequences of cutting
Medicaid coverage for beneficiaries should be deliberately avoided (Whitmer, 2025). Medicaid does more than
directly support beneficiaries; through this support, healthcare systems, families, community organizations,
communities, the state, and the nation are all supported. There is not one part of life that Medicaid support does
not improve.
For further information or questions, please contact Todd at Todd Lewicki@midstatehealthnetwork.org