One in four Michiganders rely on Medicaid to meet their health care needs – 1.6 million adults and 1 million children. Medicaid covers nearly half of all the state’s births and one in 10 of the state’s veterans. When Michigan's vulnerable elders in assisted living and nursing homes run through their savings and have sold their homes to cover care, Medicaid picks up their tab. Designed to help those with limited incomes and resources, Medicaid is funded through federal and state tax dollars. In 2024, federal dollars covered about 76% of Michigan’s Medicaid spending.

In 2023, 290,000 of the 316,000 Michiganders receiving behavioral health services at community mental health agencies paid with Medicaid. Federal Medicaid cuts threaten the very lives of those living with serious mental illness, disabilities, and substance use disorders as well as the quality of life and livelihoods of those managing their mental health care with medications and support that Medicaid currently covers.

The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots mental health organization serving people living with serious mental illness and their families. NAMI-Michigan Executive Director Kevin Fischer spoke with MI Mental Health about how Medicaid and other  federal spending cuts will impact the mental health of Michiganders. 

Q. How are federal spending cuts going to affect our community mental health services here in Michigan?

Fischer: I don't think we did enough to protect Medicaid, and I'm angry about it right now. NAMI advocates for behavioral health care, and Medicaid does so much and positively impacts so many more people's lives. I went to Washington, D.C. in May. This was the first time I came back from making congressional visits where I was really disappointed, disheartened by the reception and the conversations that I had with Republican congressional leaders. I tried to impress upon them the impact that Medicaid cuts were going to have on their constituents in their communities. They weren't even listening. 

A lot of people are going to get hurt. People are going to die. 

Where are we going to put people with untreated serious mental illness? Since we closed the state hospitals in the late ‘90s, the jails and prisons have become our de facto mental health treatment facilities. The data we have shows the most expensive place to house people with serious mental illness is in jails and prisons — anywhere from eight to 10 times more expensive than providing treatment through community mental health care. 

I met the Michigan Department of Health and Human Services director at the NAMI State Conference last month, and I asked her, "If this bill goes through, what's it going to cost Michigan?" She said that Michigan would have to make up in excess of a billion dollars to cover the losses of Medicaid dollars coming from the federal government. 

I found irony in May being National Mental Health Awareness Month. The new U.S. Secretary of Education, Linda McMahon, announced on May 1 that they froze a billion dollars in funding that was specific to pay for providing mental health resources in schools, basically social workers and counselors. They took that away. The reason that they gave was that money is just being misappropriated and being used for DEI [diversity, equity, and inclusion] programs. Michigan’s rural counties have the highest rate of mental illness, highest rate of suicide in the state of Michigan and nationally. Do you realize that our rural counties have the lowest minority populations? They are primarily white counties. More than 55% of U.S. counties, most of them rural, don't have one practicing psychiatrist. Sometimes, the only behavioral health care resources these kids are going to have is in the schools, and you're taking that away from them. 

Q. How will Medicaid work requirements impact Michiganders with mental illness?

Fischer: Medicaid recipients will be required to work a minimum of 80 hours a month. Data we get from NAMI says more than 90% of people who receive Medicaid benefits either work full- or part-time jobs, are students or caregivers, are retired, or have a disability that precludes them from being able to work. This presumption that there's widespread waste or abuse among Medicaid recipients is a lie. It's just a lie. 

The data we have shows that work requirements do not increase people working. What was so frustrating about my congressional visits in May is you put this data in front of those elected officials or their staffers, and they choose not to believe the data that's in front of them. They have no data to the contrary. They have nothing. They just simply say, “Well, I don't believe that.”

As it specifically relates to people who live with mental illness or substance use disorder, their disability is not visible to the rest of the world. So, you’re going to force, for example, a person who lives with schizophrenia or bipolar disorder, require them to fill out a form every month to say that they've been looking for a job, or why they have not been looking for a job? Do you know what that takes for a person to be able to do that? That person will end up being cut off from benefits. They'll end up homeless. They’ll end up incarcerated. They’ll end up sex-trafficked. Or they will end up taking their own life because they see no other way out. 

Q. How is NAMI-Michigan responding to this potential mental health emergency?

Fischer: We are going to have more people to help. We were already expanding, adding more NAMI affiliates in rural communities. And some of our affiliates are expanding. NAMI Midland, Michigan just renamed themselves NAMI Middle Michigan because they expanded to 10 additional surrounding counties, which are all pretty much rural counties. So we can offer programming there. NAMI Kent County [now NAMI West Michigan], which was based out of Grand Rapids, recently expanded to include Ottawa and Muskegon counties. We're also in the process of reestablishing an affiliate in Monroe County.

Now we're going to have to do even more. We're going to be establishing a program called NAMI in the Lobby, where we will have NAMI information, hopefully, not only in the 46 community mental health offices across the state but also in hospitals and private practices. That will be in the form of printed literature in the waiting rooms, and, in some cases, NAMI affiliates may actually have in-person staff a few hours a week.

In a mental health crisis, normally, you end up in an emergency department. Oftentimes, it's extremely frustrating, because many public hospital emergency departments aren't really staffed to deal with mental health crises. NAMI is a tremendous resource for family members and caregivers so they can better understand what their loved one’s dealing with, what the treatment plan is going to look like, and what the medication side-effects are. NAMI’s support programs, like Family to Family support groups, really help family members and caregivers get through what that's all about. Caregiving is tough, and it can be scary — it can be very overwhelming.

Estelle Slootmaker spends most workdays as a journalist and book editor. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz. 

Photos: MI Mental Health.

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, LifeWays, Michigan Health and Hospital Association, Northern Lakes Community Mental Health Authority, OnPoint, Sanilac County Community Mental Health, St. Clair County Community Mental Health, Summit Pointe, and Washtenaw County Community Mental Health and Public Safety Preservation Millage.