Mental health care access for everybody–no matter what their insurance status is.
This was an ambitious goal of Washtenaw County’s Public Safety and Mental Health Preservation Millage, which residents passed two-to-one, ensuring that everyone in our community has access to mental health care.
Historically, strict state eligibility criteria blocked access to community mental health services
Many people do not realize that Washtenaw County Community Mental Health (WCCMH), while the county’s main provider of community-based mental health services, operates under strict guidelines set by Michigan laws and regulations that determine who is eligible for services.
As a result, WCCMH services have historically only been available to Medicaid recipients–those who qualify for services based on age, income, and financial resources. Furthermore, within this Medicaid population, WCCMH has been limited to serving three key groups:
Adults diagnosed with a serious mental illness–which can include schizophrenia, major depressive disorder, or bipolar disorder
Children diagnosed with a severe emotional disturbance–like anxiety disorders, bipolar disorders, or psychotic disorders
Individuals diagnosed with intellectual and developmental disabilities–such as Down syndrome, brain injury, or other conditions that affect intellectual functions
While these populations remain a key focus, millage funding has opened up WCCMH services to all residents of Washtenaw County who may be in need.
With millage funding, insurance status isn't a barrier
Anyone in Washtenaw County can now call the millage-funded CARES team (734-544-3050) and receive 24/7 access to a live care manager who can assess their needs, answer their questions, and provide service information or links to the right place for care.
Shannon Ellis, the CARES team access supervisor, notes that “before the CARES team was created, people with Medicare, private insurance, or without insurance simply couldn’t access WCCMH services.”
Even people who have private health insurance often lack swift access to high-quality, on-demand behavioral health care–from both long waitlists and a general lack of specialty services.
“In our community, there can be waitlists for up to six months for people to see psychiatry,” says Ellis. “Also, many places don’t offer things like enhanced case management, peer support specialists, or crisis services,” all of which are provided by the millage-funded CARES team at WCCMH.
The CARES team also provides a high level of patient oversight that is simply unavailable from many community providers.
"Many people don’t just need therapy or just need psychiatry services,” elaborates Ellis. “They need somebody actively following up with them–especially if they are severely depressed and have low motivation.”
Even the insured have problems accessing care
Packard Health, a Federally Qualified Health Center in Ypsilanti, provides primary health care services for many WCCMH clients. Packard can also refer clients to WCCMH when they require extra support for their behavioral health needs.
Corey Telin, Packard’s director of behavioral health, explains that Packard “can see anyone, regardless of their insurance status and ability to pay.” Sometimes, these patients are uninsured.
In the past, this meant that some Packard clients were unable to access WCCMH services. But with millage funding, all of this has changed.
“When they passed the millage and the CARES team started, we could easily plug our clients in to both appropriate services and settings,” says Telin, “rather than having them bounce around to random providers. It filled a huge community gap.”
Telin recalls issues with connecting clients to the level of care they needed because of their insurance plan’s coverage limitations.
“I had a client with severe bipolar disorder and a more restrictive insurance plan,” explains Telin. “And I couldn’t find anyone who would take her because of her condition and the level of care needed.”
“And CARES was like, ‘we’ll take her!’ And I knew she was going to get the care she needed. I love the CARES team.”
This type of on and off-ramp partnership between WCCMH and Packard makes it easy to integrate care–and get clients to the right care at the right time--regardless of their insurance status.
“CARES does the case management piece, which is huge,” says Telin. “Those wraparound services that you're not going to get at a regular behavioral health clinic.”
Eliminating insurance restrictions fuels integration
Another Packard provider, Katherine Hoffman, is a family nurse practitioner who’s been with the organization for more than four years. She’s witnessed the millage’s positive benefits for her clients that previously may have been ineligible for WCCMH services.
“The creation of the CARES program has been really helpful,” says Hoffman.
“Previously, there were a lot of these ‘in-between’ people, who may not be as complex as WCCMH used to serve, but needed more oversight and case management than a primary care provider can offer.”
Now, Hoffman can refer these clients to the millage-funded CARES team.
Hoffman also observes the strong mental and physical health connection and how important it is for her patients to have swift access to mental health care.
“Physical and mental health are so linked,” explains Hoffman. “Certainly, when someone’s mental health isn't controlled, their physical health is impacted. For example, they’re unable to manage their diabetes”
Furthermore, several of Hoffman’s patients live in surrounding counties that don’t have the same type of insurance-agnostic behavioral health care system that sees any client in need..
“I get stuck trying to navigate their [behavioral health care] system,” says Hoffman. “And I often don’t know how to connect them to a good mental health provider that they’re eligible for. It’s just so nice that we have robust resources and support in Washtenaw County. And helpful to work together with WCCMH for our shared clients.”
The millage prevents mental health crises from escalating
A key focus of the millage is preventing mental health crises from escalating to something worse. Now, eligibility doesn’t prevent someone from getting help early on.
“People may experience a mental health crisis, but aren’t considered ‘severe’ enough to receive wraparound services and support,” says Ellis. “One crisis turns into a second crisis. And people start to dig themselves into a hole that they can't get out of.”
Now, if someone is experiencing a crisis, the CARES team can provide immediate services based on their situation–not their insurance status.
“CARES is able to address things at the first crisis,” says Ellis. “So that people don't have multiple crises and aren’t going to the emergency room or the hospital multiple times before they get the help they need.”
Hoffman at Packard also notes that addressing a client’s needs early is crucial in preventing a crisis and that insurance status shouldn’t stop them from getting the care they need.
“Sometimes, there are big lapses in people’s care due to insurance, and it causes them to become unstable,” notes Hoffman. “For example, if their anxiety is not properly addressed, they might turn to substance use to control it. We don’t want eligibility to prevent them from getting help.”
And it’s helping Washtenaw County residents live a fuller life
People may not necessarily have a serious mental illness diagnosis, says Ellis, but they can still benefit from the services WCCMH provides.
“We have a client in the CARES program who has post-traumatic stress disorder (PTSD),” recalls Ellis. “She hadn’t been doing great for a long time, but her symptoms were not severe enough to previously meet the criteria for WCCMH services.”
However, with the millage-funded CARES team, she was able to get stable and find a job–something her symptoms had previously prevented her from doing.
“Now, she makes her psychiatric appointments, she’s taking her medication,” says Ellis.
“She’s almost like a whole different person than who I met a year ago. And I think it's just the kind of wraparound support that we can provide. It can really prevent further crises and severity with somebody's mental illness.”
All Washtenaw County residents can access mental health and substance use disorder services from the Washtenaw County Community Mental Health agency by calling the 24/7 CARES line at 734-544-3050.