The Michigan legislature and Governor Rick Snyder are one step closer to finalizing the state's Fiscal Year 2018-2019 budget, with Senate passage of the chamber's proposed $56.6 billion ($41.9 billion General Fund) spending bill on May 3. The Senate proposal comes in at 3% less than the current budget and 8% less than the Governor’s 2019 spending plan.
Following the revenue estimating conference on May 16, a conference committee will be appointed to negotiate differences between the three proposals. As has been customary under Governor Snyder’s leadership, the state is once again targeting passage of the budget in June.
Below is a comparison of the Executive, Senate, and House budget proposals regarding areas of interest to Family Physicians, and which impact the delivery of and access to healthcare in Michigan.
The House removed funding that covered the cost of gift cards for beneficiaries who completed a Health Risk Assessment. The Governor and Senate included $1.7 million Gross ($117,000 General Fund) for these cards to incentivize beneficiaries to complete the HRA.
The Senate changed boilerplate language to prohibit Healthy Michigan coverage for beneficiaries who have been enrolled for 48 cumulative months and with income above 100% of the Federal Poverty Level, The Senate boilerplate change also includes language prohibiting a person from receiving coverage through Healthy Michigan if he/she received traditional Medicaid in the previous fiscal year and is still eligible for coverage through traditional Medicaid
Early Primary Care Pilot Program
The Governor and Senate removed funding for an early primary care pilot program aimed at placing physicians in medically underserved areas. The House retained $1 million in funding for this pilot and included boilerplate language that outlines participation criteria and requires a report by April 1 on the status of the pilot.
Primary Care Loan Repayment Program
The House included $5 million in one-time funding for a primary care loan repayment program to incentivize residents in six specified specialties, including Family Medicine, to practice for two years in a medically underserved community following completion of residency in return for $50,000 in loan repayment. The Governor and Senate did not include funding for this program in their budgets.
Combating Emerging Public Health Threats
The Governor's budget included $6.7 million Gross ($4.75 million General Fund) to support local health departments as they address emerging public health threats such as PFAS and drinking water contamination. The House concurred, and the Senate shifted the $4.75 million GF to the Essential Local Public Health Services Line.
MiDocs Graduate Medical Education Consortium
The House and Senate included $5 million General Fund for this consortium, plus $5 million in private funding and any associated federal match, to the MiDocs consortium, which is intended to increase the availability of primary care residencies in underserved areas. The Governor did not included funding for MiDocs in his budget.
Direct Primary Care Pilot
The Governor's budget removed $5.7 million Gross ($2.016 million General Fund) in one-time funding of the Direct Primary Care Pilot from his budget proposal. The House and Senate updated boilerplate language requiring Michigan Department of Health and Human Services to continue implementation of the pilot and provide a quarterly report on the status of the implementation on 12 metrics.
Medicaid Work Requirements
Confident in passage of Medicaid work requirement legislation that is currently under consideration in the House, Senate boilerplate language requires a report by September 30 or 6 months after implementation of Medicaid work requirements, whichever is sooner, on the number of Medicaid recipients who are noncompliant with work requirements. The boilerplate also includes a provision that would withhold pay for top MDHHS officials unless they seek and win approval of a federal waiver to implement the requirement.
Click here to read a complete budget comparison prepared by the Senate Fiscal Agency.