Not bigger government, but better services when Community Health and Human Services merge

“The river of opportunity” – a vision for government that will make it easier to get people on a path to self-sufficiency – is a groundbreaking concept. It’s a model new to state government, and one we can utilize for the betterment of Michigan families.

As the current director of the Michigan Department of Community Health (MDCH) and interim director of the Michigan Department of Human Services (DHS), that’s what I get to do every day: help this vision become a reality.

In his State of the State address, Gov. Rick Snyder laid out his plan to reevaluate the way state services are delivered so they support people in a more holistic way. In February, the governor issued an executive order which will take effect in April to merge MDCH and DHS and create the Michigan Department of Health and Human Services. Our goal is to be fully integrated by Oct. 1, and we know there is much to be done.

Since these announcements, we have received a tremendous amount of feedback and insight. The conversations we’ve had throughout this process have included both opportunities for improvements and ideas regarding challenges we’ll face.

I welcome this dialogue. We understand that to best serve those in need, we need to be thoughtful in our approach. It is essential we engage with our employees, partners, legislators, and stakeholders throughout this process. Most recently, we distributed the first of many feedback opportunities to our employees so they too can provide input on our next steps.

As we continue to hear from all these parties, one thing remains clear – having our programs co-exist as they do now without coordination is not good enough.

Today, if an individual or family walks into a local health department or DHS office, the full range of state government services they qualify for may not be made available to them.

Let’s consider an example of this. A family with two children has experienced family abuse, and Child Protective Services places the children in foster care in separate homes. Because of the loss and trauma throughout their lives, the children may experience severe anxiety, depression and school avoidance, as well substance abuse and behavioral issues.

Addressing the needs of this family can easily involve multiple case workers responsible for a myriad of programs. These programs might include Community Mental Health home-based services and psychiatric services within MDCH, juvenile court, as well as the foster care and child protective services within DHS.

Today, each of these programs includes a different treatment or case plan and goals, with no clear coordination of care across the different systems. This is just one example of how as a state, we can do better.

Bringing our departments together will promote improved outcomes by aligning programs, coordinating treatment plans, and creating common goals. We will be able to address health and human services together under one department, and to treat the whole person, not just pieces of a problem.

We’ve seen evidence of the potential this concept holds in several programs where MDCH and DHS have partnered. There are already more than 572,000 residents enrolled in the Healthy Michigan Plan – an initiative by both departments – giving them access to preventive and primary care services, and helping to get them on the path towards a healthier, more successful life.

Through Pathways to Potential, we are helping remove barriers to success for both students and their families. The program continues to expand and increase school attendance, and caseworkers are now in 207 schools in 21 counties. For the 2013-14 school year, chronic absenteeism in Pathways schools decreased 33 percent.

Additionally, we have been working to expand our private and public Employer Resource Networks to improve workforce retention. By placing a DHS worker – a success coach – in companies to assist with employee support, training and advancement, we are directly helping our hard working residents stay on the path to success.

Creating the Michigan Department of Health and Human Services is the first step toward ensuring we support all of our residents on their path to health, wellness, and self-sufficiency. We’ve seen success in our communities where the concept of the River of Opportunity has already improved lives. This is our opportunity to affect positive change for families across our great state, and we are committed to doing just that.

Bridge welcomes guest columns from a diverse range of people on issues relating to Michigan and its future. The views and assertions of these writers do not necessarily reflect those of Bridge or The Center for Michigan.

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Fri, 03/06/2015 - 5:10pm
This is more about budget cuts to save money than anything else, fewer people doing more work. Good luck.
Jen O'Connor
Sat, 03/07/2015 - 2:22am
I am sure its 99% about budgets, as stated above, but the mom w/ a disabled child, hopes this will Definately help, as long as the State workers you speak to know what the Combined agencies offer. Currently, the workers dont know what their own agencies offer, (in my county at least) so adding more supports and services, without proper training, still isn't going to help the citizens. Lets hope everyone gets the proper training & the different agencies can merge together cooperatively. Currently, all they do is point the finger at each other, and state the opposite agency does not cooperate.
Mon, 03/09/2015 - 11:18am
It may be about budget cuts, but not in the way you may think. Coordinating services will reduce costs. People are always complaining about the amount of overhead in government but this merger could be beneficial in reducing that overhead. Better coordination between the services that DHS and DCH offer will go a long way towards providing more comprehensive benefits/care. This in turn will reduce the economic strain from the decades of misuse of these systems.
Tue, 03/24/2015 - 9:41am
It would be nice if someone would share how this coordination is going to take happen on a day-to-day basis. All we have heard are a bunch of generalized statements. I think they should have Community Health and DHS employees in the same building in each county. Otherwise, how has anything changed?
Sun, 03/08/2015 - 9:21am
As the Executive Director of our County's Community Foundation, I'm supportive of this change. Better coordination of services delivers more care to our citizens. Both cited programs, school-based health centers and Employer Resource Networks (ERN) bring DHS workers TO the people needing services. This is especially important in rural areas with transportation issues. Happy to report both of these programs are set to launch in Oceana County.
Mon, 03/09/2015 - 1:59am
Tammy, How will you know if it is meeting expectations? Do you have any metrics you will use to ensure the claims are delivered? Of are you simply going to trust without verification?
Mon, 03/09/2015 - 2:41pm
Can you not ask the same questions about the existing program and prior organization? Judging from the tales of perpetual misery and woe we've heard for years I gather the answers aren't good.
Mon, 03/09/2015 - 5:49pm
Matt, Yes, these questions should be asked of today's programs. If they were asked and answered we would likely be getting the results that were claimed with all the spending. Why don't the Governor and other elected officials ask these questions?
Sun, 03/08/2015 - 3:54pm
Sounds good in theory but just like when the dept of mental health was folded into the dept of public health with the same rationale, we have seen this used time and again to cut services.
Mon, 03/09/2015 - 10:37am
Vulnerable Adult Search On January 20, 2015 a person on my Meals on Wheels route became missing from his home. Several friends and our Meals on Wheels Coordinator attempted to locate him out of concern for his well being. While searching for him over a three week period, he was finally found at a Health Care Facility near Eaton Rapids. I made many calls and visited two Court Houses and hospitals to try and locate him. I even filed a request to Adult Services in Clinton County for their assistance to no avail. I kept a diary and made a FOIA request of Court records about it from two counties. I am happy to say that he is now back home, but no 72 year adult should be treated like he was. He was declared mentally ill at one hospital, because “he had not” received treatment of his medications while in jail or in one hospital. Once transported to a Health Care Facility and treated with his medications, he was evaluated as normal. I can only hope that the changes that are going to be made improve the system. Dale Westrick, Meals on Wheels driver
Elmer Cerano
Mon, 03/09/2015 - 10:55am
I absolutely support efforts to reduce redundancy and to streamline the way in which vital services and supports are delivered to people with disabilities in Michigan. However, the major systemic improvement inherent in merging the Michigan Departments of Community Health and Human Services needs better details on how the cultures of these two mega state agencies will be blended. The multiplicity of agencies currently in place to provide mental health and other community living supports to people with disabilities - eat-up far too much of the limited financial resources needed for direct "hands-on" supports. By the time federal Medicaid funding get to direct services, it must first pass from the Federal Government: To the State, Then to the Departments of Community Health and/or Human Services, Then to the 10 Pre-paid Inpatient Health Plans (PIHPs) Then to the 46 Community Mental Health Agencies (CMH) Then to the Core provider networks Then to the Provider Agencies Then finally to the direct care staff. Each time the money moves, a portion of the precious funding is used for administrative overhead. This scenario is repeated for similar services provided by both the Department of Community Health and the Department of Human Services. I encourage Director Lyon's efforts to implement Governor Snyder's vision of addressing the needs of the whole person and move away from the administrative over-structures that we have created over the decades. This is refreshing, but give us some of the details.
Mon, 03/09/2015 - 7:29pm
Well, perhaps someone could explain why Ottawa County had it's budget cut 62% yet 6 more counties were added? So now it's some sort of Lakeshore region with less funding. And the decline in quality of services provided by the private contractors has declined over the past 5 years. It's next to impossible to get into a group home, like Benjamin's Hope, since funding has been cut. Oh yes, ad FOOD STAMPS. Young disabled adults living in group homes saw their food stamps cut from $182 per month to $50 per month.
Marguerite Kowaleski
Mon, 03/09/2015 - 10:08pm
I've been working as an advocate to help people deal with government assistance programs for almost 25 years. I have never seen such chaos as there is now in the Dept. of Human Services. Joining that with Dept. of Community Services can only make things worse. Every paper that a client turns in to DHS must first go to Lansing to be copied. Meanwhile the worker is denying the client's case because information due has not been in by the due date. If the Dept.agrees they owe the client money from an error in the past, a "Ticket" has to be sent to Lansing so someone there can investigate the issue and approve it. Tickets can take several months to get cleared up. A client filed 2 or 3 months ago for Medicaid for a family menmber. Where is the application? "In the cloud" they are told. How much worse can things get? Joining those 2 huge Departments will only cause more chaos.
Fri, 03/13/2015 - 3:10am
I know all about that application " in the cloud" Marguerite!! Currently my w-2 and financials are floating around somewhere in that same mysterious Lansing Cloud along with the rest of the pages to the application. But we have such great Wayne county DHS workers, instead of doing what she should have, she approved my disabled daughters medicaid in error, on a blank application (Name & address is all she had i think). How lazy can you be. And do the rest of the offices in our state not have fax machines. Get w/ technology and get a secure fax to the case managers secure email, and avoid the lansing step.
Tue, 03/24/2015 - 9:38am
Employees are only as good as the computer systems they're given to work with. Bridges has had problems from the beginning and has slowed workers down. They're not any happier about it than the clients are.
Sandra McClennen
Tue, 03/10/2015 - 10:43am
Providing services for people in need comes down to size of caseload, training of caseworkers, resulting skills of caseworkers, and truly caring about the people who they are being paid to help. I would like to know how the merger in progress is addressing these four crucial issues.
Judie Doan
Fri, 03/13/2015 - 11:20am
Sandy - that is exactly what my thoughts are about this merger. The case workers really don't have or take the time now to build any kind of a trust relationship with the people they are case managing. And why would any of them 'trust' the government to look at what is in the clients best interest'. Their opinion of the government is always trying to cut their benefits or the delays are so long they have already lost their housing or lost the job due to no child care. Employee training is a Huge issue and it has to be on-going and taken seriously by state workers. They are the ones on the gravy train of benefits and pay - how does the state hire caring, professional, organized and willing to do what needs to be done to help people? People get degrees just so they can be on the state payroll - not always because of wanting to do the right thing. So the question is - What is going to be different for the people we are trying to help be successful?? Two mega mergers mean 2 mega sources of confusion
Tue, 03/24/2015 - 9:46am
I agree, employee training is important, but what you need to understand is that there are deadlines, there are expectations that the clients will do their part to move the case along (getting paperwork in, etc.). And you are just spouting off by saying "They (State Workers) are the ones on the gravy train of benefits and pay." Is that just off the top of your head, or do you actually know what a caseworker, clerk, CPS worker, Secretary, etc., make - and what their benefits are? I agree, there was a time when State Workers got excellent pay and benefits, but that has changed! Specifically - Benefits. State employees are paying a lot for their benefits, same as everyone else (except the Legislators).
Pamela Daniels
Sun, 03/22/2015 - 4:19pm
If caseworkers is already dening a disabled client correct care and service will this aid thedisabled person in getting correct care