LANSING (AP) - Gov. Rick Snyder may have to convince lawmakers across the political spectrum that expanding Medicaid eligibility under the Affordable Health Care Act will allow Michigan to also plug a gap in its increasingly underfunded mental health care system.
Last June, the Supreme Court empowered states to choose whether to opt into the Medicaid expansion. If Michigan does, some 500,000 additional residents would be covered by the joint state-federal health care program for the needy. But Republicans, who control the Michigan legislature, are reluctant to use that power.
Snyder, also a Republican, has said one of the benefits of opting in is that it would allow the state to significantly expand assistance for those who need mental health care. Last month, he asked the Michigan Department of Community health to review the mental health care system.
He told The Associated Press that mental health care is "one of the factors" he will take into account when he presents his budget for the coming year on Feb. 7.
Approximately 70 percent of state psychiatric hospitals have closed since the mid-1980s, and the bulk of mental health services are now provided by the state's 46 Community Mental Health boards. The state cut non-Medicaid mental health funding by about $44 million between fiscal years 2007 and 2012, and advocates say those reductions have left the system underfunded.
Michigan Department of Community Health Director James Haveman said he expects Snyder to allocate about $5 million more under the new budget for the creation of youth mental health programs.
An expansion of Medicaid would "be a wonderful first step in his commitment" toward improving mental health, said Malisa Pearson, executive director of the Association for Children's Mental Health.
But Snyder can expect backlash from GOP lawmakers if he chooses to go through with the Medicaid expansion. Sen. Bruce Caswell, a Hillsdale Republican, introduced a bill last week that would prohibit Michigan from expanding eligibility.
Republicans want to fully understand the long-term effects before agreeing to expanding Medicaid, said Ari Adler, spokesman for House Majority leader Jase Bolger. "There is no guarantee that the federal government won't change its mind and provide less funding at some point."
The needle that Snyder must thread on mental health runs both ways: He would have to persuade reluctant Republican colleagues who are no fans of a government program that they see as overreaching, and deal with Democrats still smarting from what they see as his about-face on right-to-work legislation that limits union power.
"He's not going to get this done without a willingness to work with both parties," said Robert McCann, spokeswoman for Senate Democratic Leader Gretchen Whitmer, adding the Democrats support to expanding Medicaid.
"It is something that definitely should be considered," he said. "We need to do a complete review of it from top to bottom because it isn't working. There's been a decade or more dismantling the system. We need to get it back up to speed."
Under the federal health care law, a family of four with an income of $31,809 or less in 2012 would become eligible for Medicaid, according to the Kaiser Family Foundation. The federal government would provide Michigan with the full cost of coverage through 2016, eventually dropping down to a 90 percent share.
Haveman acknowledges that the state has already increased Medicaid mental health funding to account for a growing number of Michigan residents who qualify.
But historically about half the people who approach mental health services do not have continuous Medicaid eligibility, said Mark Reinstein, president of the Mental Health Association of Michigan.
In the face of budget cuts, Community Mental Health centers have been forced to prioritize and can often serve only those with severe mental illnesses, said Michael Vizena, executive director of the Michigan Association of Community Mental Health Boards.
Many low-income residents who have been denied mental health care because they are not severely ill would become eligible for Medicaid and accepted for treatment if Michigan opts in to the expansion, Vizena said.
Pearson, whose 17-year-old son has been in and out of Michigan's mental health system since the age of 3, said many families "simply can't afford the hundreds of dollars an hour to take their children to get (mental health) services."
Haveman said that, based on conversations he and other department officials had with Snyder, he expects the governor to introduce programs that include mental health first aid training for teachers, physicians and others who often come into contact with children and young adults.
The training "will go through a whole series of how to understand the mentally ill person," Haveman said. Participants will also be educated about the services available in the community so if someone identifies a person in need of help they can "point them in the right direction," he said.