Includes Funding for New Notable Primary Care Programs
On April 11, the Michigan House Appropriations Subcommittee on Health and Human Services released its Fiscal Year 2018-2019 appropriations recommendation, which includes over $25.14 billion in gross funding (approximately $4.5 billion in state general fund dollars).
MAFP’s main budget priorities—including the Michigan State Loan Repayment Program, Healthy Michigan, and the Medicaid Primary Care Fee Uplift—saw level funding under the proposed measure.
The proposed budget includes adjustments to traditional Medicaid funding required in light of a lower federal match rate due to Michigan’s improving economy, as well as increased state funding for Healthy Michigan of $24 million in response to the incremental federal funding reduction set forth under the Affordable Care Act.
Notable changes from FY 2017-2018 includes $5 million in state funding for a five-year work project program to provide medical education loan repayment for primary care physicians who commit to practicing for two years in a medically underserved area following completion of residency. The program appears to mirror the Michigan State Loan Repayment Program but focus exclusively on physicians in the specialties of Family Medicine, General Pediatrics, General Surgery, General Internal Medicine, and Psychiatry.
The measure also includes $5 million in funding for MiDocs, a program aimed at increasing primary care physician residency training programs in rural and underserved areas. MiDocs is being spearheaded by a consortium of four medical schools—Wayne State University School of Medicine, Central Michigan University College of Medicine, Michigan State University College of Human Medicine, and Western Michigan University Homer Stryker M.D. School of Medicine—in collaboration with Michigan Area Health Education Center (MI-AHEC). The program would also include a loan repayment component for participants. MAFP has been part of a broader stakeholder group providing input on the MiDocs initiative and helping to identify geographic areas of the state in most need of primary care physicians.
The House recommendation puts forth other notable provisions including:
- Increased Medicaid rate for neonatology services (from 64% to 75% of Medicare rates)
- Removal of $1.7 million gross ($117,800 in state funds) to discontinue the current practice of providing $50 gift cards to certain eligible Healthy Michigan recipients who complete health risk assessments
- Removal of $666,100 gross ($236,800 in state funds) from six Graduate Medical Education hospitals not providing data required by the legislature
- Reduction of $11.6 million in special Medicaid reimbursements by the federal government including Specialty Network Access Fee (SNAF), physician adjustor payments, GME innovations pool and university disproportionate share hospital payments (DSH)
- Elimination of $5.7 million gross one-time funding ($2 million in state funds) for a Direct Primary Care pilot program and instead revises the directive to require Michigan Department of Health and Human Services to continue the program though available work project authorization, which includes quarterly reports
- Retains language to continue ongoing behavioral health integration pilots, also known as the 298 initiative
- $4.8 million to local health departments experiencing potential PFAS contamination
- $1.5 million in state funds to continue support for primary care clinics and free clinics; the clinics are currently supported by federal bonus funding that is no longer available
- $1 million in state funds to enhance state laboratory and county medical examiner testing of opioids to enable accurate identification of prescription and non-prescription substances in cases of drug overdose or drug poisoning death
The subcommittee approved the package, which will next be considered by the full House Appropriations Committee. The legislature and Governor Snyder have set what has become a traditional June deadline for completion of the budget process.