In her May 5, 2009 Executive Order, the Governor eliminated the four Single Point of Entry Demonstration Projects, called “Long Term Care Connections,” effective June 1, 2009. These four sites, located in Detroit, Southwest Michigan, Western Michigan, and the Upper Peninsula, provided one stop shopping and unbiased options counseling and eligibility determinations for long term care consumers. The creation of these agencies was one of the strongest recommendations of the Governor’s Medicaid Long Term Care Task Force in 2005 and they were viewed by many as the cornerstone of long term care reform in this state. Pursuant to MCL 400.109j, the state was required to issue a report on the effectiveness of the agencies but the report, which was to be released within days of the Executive Order, had not yet been issued when the SPEs were slated for elimination. Preliminary information suggests that the report would have shown that the SPEs were already responsible for modest savings because the level of care determinations they conducted to determine eligibility for Medicaid funded long term care were more unbiased and accurate then those performed by long term care providers.

Advocates were deeply distressed by this development, coupled with the Executive Order earlier this year eliminating the other cornerstone of long term care reform, the Office of Long Term Care Supports and Services. They argued that:

• Thirty-three other states have Single Point of Entry systems and both the Administration on Aging and the Centers for Medicare & Medicaid Services consider Single Points of Entry a key element of long term care reform;
• Eliminating both the Single Points of Entry and the Office of Long Term Care Supports and Services endangers both significant and critical current and potential federal grants to support state long term care efforts;
• The decision to eliminate both the SPEs and the Office demonstrate a dramatic lack of commitment to honoring and implementing the recommendations of the Governor’s Task Force
• SPEs were already beginning to demonstrate savings and would have continued to increase their cost-effectiveness;
• Once the system is dismantled, it will take 5-10 years to re-establish this crucial element of the long term care system; and
• If the SPEs had to be eliminated, it is not realistic to assume these agencies can notify vulnerable clients, close or transfer files, store records securely, etc. less than 4 weeks after finding out their fate.

While advocates and consumers made vigorous last minute efforts to save at least partial funding for the SPEs, it is unlikely this will occur, especially after the recent announcement that there is even more bad news with regard to the state’s shrinking revenues. Clients who would have been served by the SPEs will now have level of care determinations performed by their local waiver agents, if they are applying for MiChoice, or the nursing homes to which they are applying. Area Agencies on Aging, local long term care ombudsman, and centers for independent living will now try to pick up some of the duties the SPE staff would have performed.

The Governor’s Executive Order also slashed funding for or eliminated a number of other important services for the last quarter of this fiscal year. Those cuts are expected to continue through FY 2010. The cuts include Medicaid coverage of adult dental care, eye care, chiropractic and podiatric services; 4% cuts in reimbursement to most Medicaid providers; substantial cuts to Michigan Protection and Advocacy Service; harmful cuts in Office of Services to Adults programs like nutrition and respite care; the elimination of the $14/month SSI state supplement for individuals living independently; the elimination of the Mental Health & Aging program and funding for the Alzheimer’s information network; terminating support for health promotion/disease prevention grants for Parkinson’s, Arthritis, Diabetes, Huntington’s, Osteoporosis; and elimination of a $2.1 million housing fund to help low-income individuals. In addition, state employees will be required to take six unpaid days between now and the end of the fiscal year on Sept. 30, 2009.