Presenters tell Ottawa County board CMH funding is at risk under Medicaid managed care and CCBHC grants

Presenters to the Ottawa County Board on Nov. 21 described how Medicaid managed‑care payment structures and recent grant programs can leave local Community Mental Health (CMH) programs financially exposed. County staff and CMH leadership said the county is operating in a managed‑care environment where revenue is a fixed per‑member payment while entitlement obligations and administrative‑law rulings can drive costs higher.

"We have a $5,500,000 deficit, which is kind of an urgent matter to bring to your attention," presenter (speaker 2) told commissioners; the board was told the fiscal year 2024–25 books have not closed and the figure is an estimate. Presenters explained that under the managed‑care arrangement the CMH receives 12 equal payments from a regional entity and must meet entitlement obligations for medically necessary services regardless of revenue. They also said the CCBHC demonstration grant carries higher risk because there is no regional reserve backing that program.

Dr. Brashears (speaker 20), the CMH CEO, described the entitlement framework and its consequences for local costs, saying the system creates situations where some individual beneficiaries can cost hundreds of thousands of dollars a year and regional variation in administrative‑law decisions further destabilizes budgets. Commissioners and commenters asked how much of the deficit could be covered from existing regional internal service funds (ISFs); presenters said some regional funds exist but warned those reserves could be depleted in one to two years.

County officials framed the presentation as an informational step toward an impact analysis and possible governance change, not an immediate operational change. They proposed public hearings and a nine‑to‑12‑month conversion timeline if the board directs staff to pursue creation of an authority.