https://www.mackinac.org/blog/2026/michigan-needs-more-nursing-homes-why-are-we-still-blocking-them

Michigan needs more nursing homes; why are we still blocking them?

Certificate of Need laws deliberately limit health care for seniors

Jeffery L. Degner    |    July 28, 2026

Imagine being confined to a nursing home bed, falling out and breaking a femur. When you complain of the pain, you aren’t offered any pain medication, and you have to wait 20 hours before being sent to an emergency room.

This situation isn’t fiction for one Michigan-based patient. While the facility and many like it maintain a respectable online rating, inspections by the Center for Medicare and Medicaid Studies paint a different picture. Unfortunately, Michigan’s nursing homes and long-term care facilities are characterized by overloaded staff, bed shortages, and decreased quality of care.

The pathology that causes these sub-standard outcomes in all but 11 states has a name: Certificate of Need, or CON. Most Michigan residents are unaware that Certificate of Need laws deliberately limit their supply of nursing homes, MRI machines, and psychiatric beds. These goods and services are in high demand, and limiting supplies inevitably results in higher prices.

Michigan’s Certificate of Need Board determines the supply of medical care. It has two inherent flaws. The first is conflict of interest. While board members themselves may not directly benefit from their roles on the board, the hospital systems and insurers they represent stand to gain financially by blocking new competitors or from limiting their own services.

Michigan’s CON Board is filled by 11 unelected members who are appointed by the governor and approved by the Senate. They are required to declare conflicts of interest in every meeting. However, the board’s bylaws only vaguely define conflicts and leave it to board members to decide whether one exists.

This sets the stage for problematic incentives that tend to result in tit-for-tat voting patterns. Most people would view this set of incentives and probable outcomes as being full of conflicts of interest. Likely due to this weak definition, in the nine meetings held in 2024 and 2025, there was only one record of a voting abstention due to conflict of interest.

The second flaw is what’s known as “technocratic washing.” The CON Board outsources its bed-need decision to a complicated, 47-year-old clustering algorithm. Some CON board members have voiced concerns about the need to increase the number of nursing homes and beds, particularly in rural areas. But ultimately, the determination of whether the state needs new beds is not made by physicians or patients. Instead, the decision comes from a mathematical formula.

In meeting transcripts from January 2025, the statistician who developed the algorithm reported to the CON Board that for 2024, the state only needed 41,400 beds. The actual number at that time was 44,689. In other words, the algorithm’s output said that the state should eliminate 3,289 beds. In 2025, the same calculation would have the board believe that there were 2,792 too many nursing homes and long-term care beds.

According to the state of Michigan, the 75-84 age group may grow by approximately 45% by 2039. With Michigan seniors already paying $485 per day for nursing home beds, it’s no time to limit their supply. That daily price is nearly $30 more than the national average, and $75 per day more than it is in states without CON regulations (excluding California and Pennsylvania). The difference adds up to more than $2,000 more per patient per month in Michigan. Higher-than-average costs and higher-than-average occupancy would unquestionably invite more competition in a free market. Instead, Michigan’s CON board calls for the opposite.

Nursing facility expansion is a decision that should be handled by doctors, patients, or elder-care advocates. Instead, Michigan maintains a system that limits competition, reduces availability, and provides worse patient outcomes. The obvious solution would be to allow new competitors into this critical area of need.

State lawmakers may be unaware that special interests on the CON Board limit competition under the guise of high-sounding mathematics. In states where these boards don’t exist, citizens pay nearly 25% less per nursing home bed than in states like Michigan. In an age where affordability is on everyone’s mind, and where the senior population is surging, our lawmakers must set aside partisan differences and special interest loyalties in order to unleash competitive forces that better serve our aging population.

First, a Daily Signal op-ed gives the national the national perspective. 

What does your college student say?

https://www.dailysignal.com/2026/08/04/hidden-health-college-dorms/

The Hidden Health Risk in College Dorms

August 4, 2026

Every student knows the smell.

The musty odor from an air vent. The dark stain spreading across a dorm ceiling. The damp corner of a communal bathroom.

Most students barely notice it. Others joke about it.

What many do not realize is that mold is more than an ugly stain or an unpleasant odor. Federal health agencies have linked mold exposure to a plethora of health issues. Yet mold in college housing remains one of the least-discussed student health issues on American campuses.

One of the authors of the present piece knows several college students who have experienced headaches and persistent coughs that were seemingly caused by moldy living conditions.

College dormitories are highly susceptible to mold growth. Aging buildings, shared bathrooms, poor ventilation, plumbing leaks, high humidity, and delayed maintenance all create ideal conditions for moisture to accumulate. Educational buildings frequently experience moisture-related issues.

When water intrusion from leaks or flooding is not addressed quickly and thoroughly, mold can begin growing within 24 to 48 hours. Yet students are forced to trust and rely on universities to identify, remediate, and communicate potential hazards.

In the last five years, dorm mold has been reported at colleges and universities in 42 out of the 50 states, with media reports of mold issues at 75% of Ivy League institutions. Even at schools known for offering some of the nation’s most prestigious educations, many students have often been denied something far more fundamental: a safe and healthy place to live. Academic excellence means little if students are forced to learn in housing conditions that may compromise their health.

Too often, mold in college housing is dismissed as little more than a maintenance issue rather than the public health concern it can become. The Centers for Disease Control and Prevention links exposure to damp, moldy environments with respiratory symptoms, chronic coughing, asthma attacks, and allergic reactions, while noting that persistent moisture and flooding create ideal conditions for mold growth.

Public health experts estimate that roughly half of U.S. homes have conditions associated with dampness or mold, and one widely cited analysis found that approximately 21% of asthma cases in the United States are attributable to dampness and mold exposure. Emerging research also suggests that mold may affect more than just the respiratory system, with a 2020 study in Brain, Behavior, and Immunity finding that mold inhalation triggered neuroinflammation and cognitive changes in animal models.

Additionally, it can be difficult for students to recognize when their living environments may be contributing to their health problems. Fatigue, frequent headaches, respiratory issues, or recurring illnesses are often dismissed as a normal part of adjusting to college life, which may include late nights, increased stress, poor sleep, or less-than-ideal dining hall food. As a result, a dorm’s indoor air quality or mold exposure as a culprit for health hazards is often overlooked, delaying both recognition of the problem and action.

This issue rarely receives the attention it deserves, and many colleges require students to live on campus for at least the first year—often at significant monetary cost. With that requirement and expenditure comes a responsibility to provide housing that is safe, healthy, and properly maintained. Students should not have to choose between pursuing their education and protecting their health.

A clean, well-maintained dormitory is not a luxury; it is the foundation of student success. Universities invest enormous resources in student wellness, but wellness begins with the place students sleep, study, and live.

Institutions cannot claim to prioritize student health while treating mold as an insignificant facilities problem. If colleges are truly committed to investing in the next generation, providing safe, healthy housing should not be optional—it should be the standard.


Romey Crumbaugh is a member of Heritage’s Young Leaders Program.

Jennifer Galardi is a senior policy analyst, Restoring American Wellness at The Heritage Foundation.

This model's concept, pioneered by Scott L. Zeller, MD, takes off from Julius Caesar's conquest of Gaul - divide and conquer. No matter who tries to legislate physical/mental health parity, they are very different things in an emergency.

I can only imagine how relieved these ED staff are to be able to focus on heart attacks, overdoses, and traumatic injuries. 

https://www.beckersbehavioralhealth.com/care-coordination/how-1-uk-healthcare-unit-cut-ed-boarding-time-92/

How 1 unit cut UK HealthCare’s ED boarding time 92%

Ella Ruder    |    August 11, 2026

University of Kentucky HealthCare based in Lexington opened an Emergency Psychiatric Assessment, Treatment and Healing (EmPATH) unit in July 2024 to treat behavioral health patients outside its emergency departments — a design choice that differs from many models nationally.

The unit sits near Eastern State Hospital in Lexington and serves both of UK HealthCare’s EDs, at Good Samaritan Hospital and Chandler Hospital. About 5,000 patients a year come through its doors, and it has treated more than 10,000 people in its first two years — more volume than leaders initially expected, said Marc Woods, DNP, RN, chief nursing officer for Eastern State Hospital, the EmPATH unit and the Good Samaritan behavioral health unit.

The unit follows the EmPATH model developed by Scott Zeller, MD, though Mr. Woods said implementation varies widely by health system. “I think the statement is if you’ve seen one EmPATH, you’ve seen one EmPATH,” he said.

A model built on inclusion

UK HealthCare’s unit accepts patients other crisis programs might turn away, including those who are aggressive or violent, according to Mr. Woods and Lindsey Jasinski, PhD, chief administrative officer and director of psychology services at Eastern State Hospital.

“We use a statement of ‘find a way to say yes to this patient in front of you.’ Finding a way to say yes not just in fancy meetings or report offs — we say it to our staff. Traditionally in behavioral health, that hasn’t been the case,” Mr. Woods said. Dr. Jasinski described the shift as moving to “how do we operate on inclusion criteria,” rather than exclusion criteria.

Despite treating a broader patient population, Dr. Jasinski said restraint use on the unit is below 0.01%. She attributed that to staff building rapport with patients immediately, offering food and drink on arrival, allowing patients to keep their clothes and belongings when safe, and watching closely for signs of escalation throughout a patient’s stay.

The unit also employs peer support specialists — staff with lived experience of mental illness or substance use disorder — a role Mr. Woods said EDs typically lack. He recalled a patient telling him, “You don’t know what I’ve been through. You can’t help me,” before a peer support specialist stepped in and said, “He can’t, but I can, and I’ve been where you are.”

Suicidal ideation is the most common presentation, accounting for almost 60% of patients, according to Mr. Woods. Patients arrive by ambulance, police transport, family, rideshare, bus or on foot, Dr. Jasinski said, and the unit has drawn patients from roughly 30 states, though Mr. Woods attributed some of that reach to Lexington being a college town. If a patient presents at either UK HealthCare ED instead, staff arrange an ambulance transfer to the unit.

The program is built around a 23-hour observation stay. “Our No. 1 goal is that after 23 hours, you leave here with hope,” Dr. Jasinski said. “We’ve turned a crisis into an outpatient appointment.”

Very few patients progress to inpatient admission, Mr. Woods said, which he said helps preserve scarce behavioral health beds for the most acute cases. The unit has expanded capacity since opening with 12 chairs to roughly 20 today.

Fewer repeat visits, more follow-through

Leaders pointed to a decline in frequent ED use among behavioral health patients since the unit opened. In its first six months, Dr. Jasinski said, patients who had previously been coming to the ED an average of 5.5 times every six months were instead returning to the EmPATH unit about twice in six months.

Follow-up appointment attendance has also improved. Before the unit opened, patients discharged from the hospital attended follow-up appointments about 29% of the time, according to Dr. Jasinski; since then, that rate has held at 65% for two years. A community mental health center co-located inside the unit helps patients schedule follow-up care, typically within 24 to 48 hours of discharge, before they leave.

First-year data showed a 63.5% reduction in inpatient admissions and a 92.1% reduction in ED boarding time tied to the unit’s opening. Asked about year two, Dr. Jasinski said those operational gains have held steady, while Mr. Woods said tracking restraint use against ED baselines has been a harder metric to capture consistently.

“Each is a new opportunity for us to reevaluate what that person needs,” she said. “We might start treatment, but the biggest thing that we do is connect them to those resources in the community.”

Kentucky has proposed using CMS rural health transformation dollars to fund additional EmPATH units across the state over the next five years, Dr. Jasinski said, citing the model’s effect on access to care. The unit also arranges transportation home for rural patients who arrive by ambulance but have no way to get back.

Effects on the emergency department

Before the EmPATH unit opened, Good Samaritan’s emergency department relied on four specially secured rooms within its 21-bed unit to hold behavioral health patients, Eric Reid, MD, Medical Director of Good Samaritan emergency department and medical director of EMS, said. The hospital also has a partnership with Eastern State Hospital that could typically move patients within about 12 hours.

Even with that arrangement, those rooms were routinely full during peak evening hours. Since the EmPATH unit opened, Dr. Reid said, it’s now rare for more than one or two patients to need those secured rooms at once, freeing space for other ED patients.

The timeline for behavioral health patients has also shortened: Providers can typically connect with the EmPATH team within about 30 minutes of finishing an ED evaluation, he said. Patients now often receive definitive care within an hour and a half to two hours of arrival — down from a typical three to four hours, and sometimes as long as eight to 10 hours, before the unit existed.

The change required upfront work, Dr. Reid said, including training EMS partners to manage behavioral health patients in transit and coaching ED staff on how to talk with patients about being transported to a separate facility without adding to their anxiety.

He also linked the model to less strain on ED staff.

“We often talk about the moral injury that leads to burnout in the emergency department, where we are trying to do the correct things for patients, but the system logistics around it make it difficult,” Dr. Reid said, adding that the EmPATH unit “is a great way to circumvent that.” He pointed to decreased use of restraints, sedatives and sitters as further evidence the model improved care rather than simply speeding it up. “It’s very satisfying to get these patients the care that they need,” he said.

Dr. Reid said other ED leaders considering a similar model should expect it to require sustained collaboration across disciplines, including standing meetings that bring together community-based providers, hospital staff and outpatient follow-up teams.

“It takes a lot of collaboration and communication,” he said, “but it really has had a great payoff.”

When local health facilities, clinicians, and ancillary resources talk, good things happen. Respect is essential. Being owned by the same mother ship is not.

Big Health defines continuity of care as "a patient receiving consistent and coordinated medical attention throughout their healthcare journey, ensuring that all healthcare providers work together to support the patient's needs. This approach helps improve health outcomes and patient satisfaction by providing a seamless experience across different stages of care."

https://www.beckersbehavioralhealth.com/care-coordination/henry-ford-behavioral-health-pilot-sees-up-to-85-drop-in-work-queues-after-1-year/

Henry Ford behavioral health pilot sees up to 85% drop in work queues after 1 year

Ella Ruder    |    August 11, 2026

Detroit-based Henry Ford Health’s Same-Day Solutions Ambulatory Pilot Program increased the number of patients who completed a behavioral health appointment after being referred for care by 50% at pilot sites.

The program, launched in July 2025, connects patients who express mental health concerns during a primary care visit with a licensed behavioral health provider for an assessment and guidance to the appropriate level of care, according to an Aug. 10 news release from the system.

One year after its launch, the program is deployed in 14 Henry Ford Health primary care clinics across Metro Detroit. Behavioral health referrals increased by 22% over the last year, while the number of patients waiting to be scheduled declined across Henry Ford Health’s behavioral health services by up to 85%. Referrals to specialty services that were not the right fit declined by 76%.

“Instead of asking patients to fit themselves into a particular service, Same-Day Solutions allows us to understand what they need first and build the path from there. That is what a more responsive behavioral health system should look like,” Michael Burton, director of Behavioral Health Integration at Henry Ford Health, said in the release.

Communication, communication, communication.

Alternatives to psychiatric residential placement include Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and outpatient care, which allow for varying levels of support while enabling the child to remain at home. These alternatives can provide structured treatment without the need for full residential care.

https://www.beckersbehavioralhealth.com/care-coordination/nevada-cuts-psychiatric-residential-placements-for-children-from-35-to-16/

Nevada cuts psychiatric residential placements for children from 35% to 16%

Ella Ruder    |    August 14, 2026

Nevada reduced the percentage of children with behavioral health disabilities placed in psychiatric residential treatment facilities from 35% to 16% since January 2025, The Nevada Independent reported Aug. 13.

The decline comes as the state works to comply with a five-year settlement agreement with the Department of Justice, signed Jan. 2, 2025, after findings that Nevada violated the Americans with Disabilities Act. The state has also invested more than $100 million in children’s behavioral healthcare through Nevada Medicaid.

Here are five things to know:

1. Among youth covered by Nevada Medicaid who are tied to the settlement agreement, 404 youth out of a population of 1,147 were placed in psychiatric residential treatment facilities at 35%, compared with 382 youth out of a population of 2,408 at 16%.

2. In fiscal year 2020, more than 1,700 Nevada children were admitted to psychiatric hospitals and more than 480 children were admitted to psychiatric residential treatment facilities. Children remained in those facilities for an average of nine to 12 months, with about 27% staying more than a year.

3. Nevada is launching a short-term therapeutic home model intended to provide an intermediate, community-based residential treatment option. The goal is for stays to last between one and three months.

4. The state has invested more than $100 million in children’s behavioral healthcare through Nevada Medicaid. The funding will help raise reimbursement rates for rural and in-home therapy services, specialized foster care services and residential psychiatric treatment for children with complex needs.

5. Ann Jensen, administrator of Nevada Medicaid, said a day at a psychiatric residential treatment facility costs the state between $800 to $950 per child. Ms. Jensen said inpatient care for children is more expensive than offering community-based outpatient services.

https://www.regulations.gov/docket/FDA-2026-N-7874

Deadline Oct. 19.

Off hand, not having read the FDA discussion paper as yet, some questions for your consideration:

• Will I have access to my personal health information?
• Who else will have access, and will they be able to use it without my knowledge or against my wishes?
• Do I trust FDA regulations to protect me?
• When Big Data helps write the FDA regulations (as only they have the expertise to do), will they serve me or their own interests?
• Am I better off with start-ups being completely free to innovate in health AI, including potential ways to protect my health data?

MedTech Intelligence is an online journal & newsletter providing insight & expert opinions on regulatory compliance, QA, product development & market access.

https://medtechintelligence.com/feature_article/fda-seeks-public-feedback-to-inform-regulatory-approach-for-generative-ai-enabled-medical-devices/

FDA Seeks Public Feedback to Inform Regulatory Approach for Generative AI-Enabled Medical Devices

August 18, 2026

GenAI-enabled medical devices hold transformative promise for patient care and the broader health ecosystem. At the same time, these devices may introduce unique risks when compared to traditional software and AI-enabled medical devices.

The U.S. Food and Drug Administration today issued a discussion paper on considerations for the regulation of generative artificial intelligence (GenAI)-enabled medical devices, seeking feedback from interested parties on risk assessment, premarket evaluation, postmarket monitoring, and other topics relevant to the regulation of GenAI-enabled medical devices.

“Artificial intelligence is transforming medicine, and the United States must lead in shaping how this technology is developed and used safely and responsibly,” said Acting FDA Commissioner Kyle Diamantas, J.D. “Today’s announcement reflects the FDA’s commitment to advancing innovation for health care professionals and leveraging AI to improve care and patient health outcomes.”

The Digital Health Center of Excellence (DHCoE), within the FDA’s Center for Devices and Radiological Health, is leading this discussion paper which supports the FDA’s Public Health Pillar on Innovation and Global Leadership. This strategic pillar includes key priorities to advance regulatory frameworks for AI and digital health technologies.

“Patients and clinicians deserve a regulatory approach that keeps pace with the rapid innovation of digital health technologies,” said FDA Center for Devices and Radiological Health Director Michelle Tarver, M.D., Ph.D. “By inviting input from the public, we are launching a transparent process to inform the development of an approach that safeguards patients and consumers, advances innovation, and serves as a potential model for regulators around the world.”

GenAI-enabled medical devices hold transformative promise for patient care and the broader health ecosystem. At the same time, these devices may introduce unique risks when compared to traditional software and AI-enabled medical devices.

“Generative AI-enabled medical devices are poised to reshape the health technology landscape, and the FDA has an important responsibility to provide thoughtful leadership for this new era,” said DHCoE Director Rick Abramson, M.D. “This discussion paper advances the frontiers of regulatory science and propels a critical conversation about how to enable beneficial innovation, protect public health, and preserve trust.”

The discussion paper begins by outlining a possible two-axis framework for risk assessment that might be used to inform regulatory expectations. It then discusses a potential approach to premarket evaluation built on the concept of competency assessment, inspired at a high level by how physicians are trained and evaluated, consisting of non-clinical device benchmarking and clinical confirmation to evaluate whether a GenAI-enabled medical device performs as intended before reaching patients. The paper also describes several potential approaches to risk-proportionate postmarket monitoring and discusses considerations around foundation models and agentic AI systems. For each of these areas, the FDA poses targeted questions to inform the development of a regulatory framework that is scientifically rigorous, prioritizes patient safety, and aligns with the novel capabilities of GenAI-enabled medical devices.

The FDA encourages feedback on the discussion paper from device manufacturers, clinicians, consumers, researchers, the public, and other interested parties, to be submitted under the docket FDA-2026-N-7874 on Regulations.gov by October 19, 2026.

The discussion paper supports the FDA’s efforts to advance health care by fostering the responsible innovation of safe, effective, and high-quality digital health technologies.

Note the ideological, authoritarian emphasis on Social Determinants of Health (SDOH) and Public-Private Partnerships (PPP). 

https://www.michigan.gov/leo/news/2025/12/18/new-state-report-examines-how-work-impacts-mental-and-physical-health

New state report examines how work impacts mental and physical health

December 18, 2025

Report shows how healthy, safe workplaces support worker well-being, prevent health risks, and help employees stay safe, productive, and succeed on the job

LANSING, Mich. — The Michigan Department of Labor and Economic Opportunity (LEO) released a new Workplace Mental Health and Well-Being report that builds knowledge and offers a comprehensive look at how chronic stress affects a worker’s mental and physical health along with the substantial social and economic burden for employees and employers. The report also includes actionable recommendations aimed at supporting healthy work environments to propel high quality jobs, productivity and a stronger economy in Michigan.

“When employers prioritize mental health, it’s a win-win – employees feel supported, healthier and more engaged at work, and employers see productivity increase and absenteeism decline,” said Susan Corbin, LEO director. “Our latest workplace mental health report shows that investing in healthy work environments delivers real returns for businesses and meaningful benefits for the people in those jobs, expanding economic opportunity and prosperity for all Michiganders.”

Key themes in the report include:

Work as a social determinant of health. Work is an important determinant of worker health that is deeply interconnected with factors (e.g., income, education, access to health care) that have a profound impact in our life trajectories and can impact future generations.

Work-related organizational culture, policies and practices are modifiable. Work is an essential driver of population health and has numerous and cascading impacts on worker’s mental health and well-being. Work-related programs, policies and interventions can be modified to support and improve employees’ health.

Chronic stress can lead to structural and functional changes in the brain, influencing cognitive processes, emotional regulation and overall health. Unsafe, hazardous or chronically stressful work environments can have a negative impact on employees’ quality of life that goes beyond the job.

A healthy workforce is crucial for the social and economic development of Michigan. Investments in employees’ mental health and well-being start by creating high quality jobs and healthy work conditions for all employees.

“The new Workplace Mental Health and Well-Being report expands on our deep foundation of workplace mental health by synthesizing current research on how stress — including stress directly related to work — affects the body and influences long-term health outcomes,” said LEO Office of Labor Deputy Director Sean Egan. “The report highlights that work and health are closely intertwined, noting that employment conditions significantly shape a person’s overall well-being and quality of life.”

Improving employment conditions is an intentional, collaborative effort across workers, businesses, policymakers and academic partners. The report is designed to support the continued development of healthy, resilient workplaces that help build stronger communities throughout Michigan.

Curated by LEO epidemiologist Lisbeth Iglesias alongside Sean Egan, this latest publication builds on LEO’s first workplace mental health report, released in June 2022, which emerged from a months-long workgroup examining the current data on workplace mental health, the impacts of stress and the conditions that contribute to healthier workplaces. Those initial findings and recommendations continue to guide the state’s ongoing implementation plans.

View the report and learn more at www.Michigan.gov/HealthyWorkHealthyMind.

About half of the links are available at the Aug 17 MDHHS press release.
https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2026/08/17/vaccine-rec

Conspicuously lacking in both: the waiver so frequently referenced here. More about that in the reply to follow.

Back-to-school vaccines: Engaging families, providing clarity and protecting kids
Public Health Bulletin for Health Care Providers - August 2026

Dear colleagues,  

With vaccine-preventable diseases (VPDs) like measles and whooping cough already circulating in Michigan and the school year starting, now is the time to engage families in serious conversations, providing support and guidance regarding their child(ren)’s immunizations.

In December 2025, the Michigan Department of Health and Human Services (MDHHS) issued a Standing Recommendation supporting vaccine recommendations grounded in rigorous scientific evidence and transparent decision-making. The Standing Recommendation advises clinicians to continue following the evidence-based childhood immunization schedule produced by the American Academy of Pediatrics (AAP), which has been endorsed by 12 leading medical and health care organizations including the American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists, American Medical Association, as the standard of care for immunization practices in our state.

While a federal executive order was recently issued on changes to the childhood immunization schedule, please note that MDHHS continually reviews evidence regarding vaccine safety and effectiveness, and there is no new data to support changes to the vaccine schedule at this time. Combination vaccines, including the MMR (measles, mumps and rubella) vaccine, have a long history of safety and effectiveness and can reduce the number of injections that children need.

The back-to-school season is a natural check-in point for families and their health care providers — and the clock is ticking. Many school districts have already begun classes, including Detroit and Grand Rapids. Encourage parents and caregivers to schedule back-to-school health care appointments now and ask them about catching up on any missed doses and getting this year’s flu vaccine.

Together we can work to ensure all Michigan kids are protected from VPDs before they return to the classroom. Thank you for your continued partnership and for providing excellent care.

Sincerely,

Natasha Bagdasarian, MD, MPH, FIDSA, FACP
Chief Medical Executive, State of Michigan

Sarah Lyon Callo, MS, PhD
Senior Deputy Director and State Epidemiologist, MDHHS Public Health Administration

Key points on Executive Order
Executive Order 14420 was signed Monday, Aug. 10, directing federal agencies to adopt “gold‑standard childhood vaccine recommendations” for Americans.

It recommends reducing the schedule from 18 to 11 routine vaccines, e.g., shifting vaccines like hepatitis A, influenza, COVID‑19 into “high‑risk” or “shared decision-making” categories.
It calls for splitting the combined MMR vaccine into separate measles, mumps and rubella doses and spacing out immunizations across multiple visits. However, this order serves as federal guidance only.
Michigan’s position — no changes
Childhood vaccine recommendations remain the same.
Michigan continues to endorse the AAP’s childhood immunization schedule.
Robust vaccine safety and effectiveness data.
The AAP, AAFP, U.S. Centers for Disease Control and Prevention (CDC) and peer-reviewed research consistently affirm the safety and high efficacy of the current childhood vaccine schedule.
Insurance coverage.
State laws continue to mandate coverage of all routine childhood vaccines — no changes to policies or billing standards in Michigan.
Waiver process.
Michigan’s established medical and non-medical waiver procedures remain unchanged — there have been no alterations to eligibility or submission requirements.
Bottom line for providers
Continue administering the full AAP/AAFP-recommended childhood vaccine schedule.
Vaccines remain covered by insurance under state-regulated plans.
There are no changes to the waiver process or school entry requirements.
If families express concerns about vaccine schedule alterations linked to the federal executive order, reassure them that Michigan’s standards have not changed and remain focused on safety and effectiveness.

The big picture
Keep the big picture in mind as you approach vaccine and VPD discussions, and help Michigan parents, caregivers and kids prepare for school.

Measles and whooping cough
The U.S. just recorded its worst measles rates in 35 years.
As of August, the country has already reported more measles cases in 2026 than in all of 2025, the highest annual totals since measles was declared eliminated in the U.S. in 2000.
Michigan has identified two measles outbreaks so far this year in Washtenaw and Ottawa counties, representing 78% of the state’s cases.
Pertussis (whooping cough) also remains a concern.
There have been 122 cases reported in Michigan as of May 31, including 33 infants under 2 years of age.
Severe complications are common with pertussis: one in three babies who contract it require hospitalization, one in five will develop pneumonia and some develop seizures or brain swelling.
Statewide vaccination is not high enough to prevent outbreaks of these highly contagious diseases.
In Michigan, MMR vaccine coverage among children 19 to 35 months stands at just 75.7%.
Diphtheria, tetanus and pertussis (DTaP) vaccine coverage is 67.8%.
Both are below the levels needed to prevent outbreaks.
Influenza (flu)
Recent flu seasons have hit children especially hard.
At the peak of the last season in Michigan, one in four emergency department visits among children ages 5 to 12 years were flu-related, and 12 pediatric deaths were confirmed — the second-highest total on record (2024-25 remains the highest at 14 deaths).
Despite this severity, childhood flu vaccination coverage has fallen to an all-time low of 19.4% in Michigan.
Children ages 6 months through 8 years receiving the flu vaccine for the first time need two doses spaced at minimum four weeks apart.
It is recommended to start the series now so they can complete both doses before respiratory illness season peaks. All children 9 years and older are recommended to receive a flu vaccine in October.

COVID-19
COVID-19 also presents substantial risks for children.
During last season’s peak, 421 children were hospitalized in Michigan. COVID-19 is especially risky for infants. Of the five confirmed COVID-19-associated pediatric deaths in Michigan, the median age was just 9 months.
Despite this risk, only 3% of Michigan children received a COVID-19 vaccine last season.
Current AAP recommendations call for unvaccinated children ages 6 to 23 months to receive two doses, spaced four to eight weeks apart.
Children ages 2 through17 years are recommended to receive one COVID-19 vaccine in October. Updated guidance is expected to be released by AAP on Wednesday, Sept. 2.

Key points
Michigan’s school vaccine waiver rate is the highest since 2013, leaving school systems at a greater risk for disruption and missed class time; and children who cannot be vaccinated for medical reasons or who are immunocompromised are more vulnerable.

Let's not go back in time.
In 1952, the U.S. saw more than 57,000 cases of polio; in 1958, there were 763,000 cases of measles nationwide. Vaccines made those numbers — and those diseases — history. With vaccination rates now falling, that history is threatening to repeat itself. Infants, young children and medically vulnerable kids face the highest risk of severe illness, hospitalization and death from these diseases.
Every missed or delayed vaccine is a missed opportunity to protect a child and their entire classroom.
Michigan is following AAP-recommended immunization schedules.
Talk to parents about which vaccines their child or children need.
If asked about recent updates to the U.S. childhood immunization schedule, please refer to MDHHS’s statement issued on Jan. 6.

Action steps
Provide parents with a copy of their child’s immunization record.
Encourage parents to know their child's risk: look up a school's immunization and waiver rates on the MDHHS website.
Remind them to check the vaccination status of every child in the household, not just the youngest. Nearly half of this year’s national measles cases are kids and teens ages 5 to 19 years.
Ask parents about catching their children up on any missed doses and ask about this year's flu vaccine during their appointment.
Direct parents and caregivers to visit IVaccinate.org for accurate, evidence-based vaccine information.
Sign up for the Michigan Health Communications Initiative’s monthly newsletter and search the resource library at any time for the information your community needs most. Social media content, printable flyers and other resources are available for download across a variety of health topics. All resources are free to use and share — no attribution required.
Review trends for VPDs and immunization rates on MDHHS Immunization Data and Statistics webpage.

None of these ED admissions are paid for by the taxes collected on recreational marijuana, of course.  Your health insurance premiums and taxes pay for scromiting admissions.

The CDC’s National Syndromic Surveillance Program data were analyzed to examine trends in CHS-involved ED visits before and after implementation of a new, CHS-specific International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code on October 1, 2025.  This code allowed ED personnel to more accurately report cases of scromiting.

A huge increase in scromiting cases was found due to more accurate reporting.  Even so, the new numbers still likely underrepresent the full number of actual cases.

The Summary, Abstract, and Introduction to the CDC report, as well as its Implications for Public Health Practice at the end:

https://www.cdc.gov/mmwr/volumes/75/wr/mm7530a2.htm#contribAff

https://www.cdc.gov/mmwr/volumes/75/wr/pdfs/mm7530a2-H.pdf

Trends in Emergency Department Visits Involving Cannabis Hyperemesis Syndrome Identified Using a New Diagnosis Code — United States, January 2023–May 2026
August 6, 2026 / 75(30);391–396

By: Alana M. Vivolo-Kantor, PhD; Stephen Liu, PhD; Lauren J. Tanz, ScD; Christine L. Mattson, PhD; Josh Schier, MD
All from: Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC

Summary

What is already known about this topic?

The prevalence of cannabis hyperemesis syndrome (CHS), a condition characterized by cyclical nausea and vomiting associated with frequent cannabis use, increased sharply in the United States during 2016–2022.

What is added by this report?

The proportion of all-cause emergency department visits that involved CHS were higher after implementation of a new International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code, suggesting improved recognition and previous underestimation of the public health impact of CHS. Higher proportions were observed among younger persons and females.

What are the implications for public health practice?

The new CHS-specific diagnosis code has improved CHS surveillance and estimation of public health impact. However, increased clinical recognition and education about risks of frequent cannabis use are still needed, particularly in younger populations.

Abstract

Cannabis hyperemesis syndrome (CHS) is a condition characterized by cyclical nausea and vomiting and is associated with frequent cannabis use. Data from CDC’s National Syndromic Surveillance Program were analyzed to examine trends in CHS-involved emergency department (ED) visits before and after implementation of a new, CHS-specific International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code on October 1, 2025. Monthly CHS-involved ED visits per 10,000 all-cause visits were assessed overall and by demographic characteristics. During January 2023–May 2026, a total of 199,565 ED visits involved CHS. During January 2023–September 2025, the proportion of ED visits that involved CHS remained mostly steady. In the first month after implementation of the new diagnostic code, the proportion of CHS-involved ED visits increased from 3.35 per 10,000 ED visits in September 2025 (preimplementation) to 11.26 per 10,000 ED visits in October 2025 (postimplementation). During the first 8 months after implementation of the new code (October 2025–May 2026), average monthly proportions of CHS-involved ED visits were 3.7 times as high as the monthly average during January 2023–September 2025. Higher proportions of CHS-involved ED visits were observed among persons aged 15–24 years and females, with more pronounced impacts among some demographic groups after code implementation. The abrupt, sustained increase might partly reflect improved recognition and coding of CHS rather than a true rise in incidence. These findings highlight a likely underestimated impact of CHS, suggesting the need to strengthen education about the risks associated with frequent cannabis use, expand ongoing surveillance efforts, and improve clinical recognition of CHS through continuing medical education and implementation of routine cannabis use assessment in ED settings.

Introduction

Cannabis hyperemesis syndrome (CHS) is a syndrome attributed to prolonged, frequent cannabis use, characterized by sudden episodes of severe nausea, vomiting, and abdominal pain (1). Reports of suspected CHS increased sharply during 2016–2022, with the largest increase occurring during the COVID-19 pandemic (2); the increase also coincided with widespread state-level cannabis legalization in the United States, although cannabis use remains illegal under federal law (3). Persons with CHS often seek medical care because symptoms can be severe and debilitating, with outcomes ranging from symptom resolution after cessation of cannabis use to, in rare cases, death (1).

Trends in cannabis use might be contributing to the increasing prevalence and recognition of CHS. The prevalence of past-month and daily or near daily cannabis use has been increasing, particularly among young adults and females (4). In addition, concentrations of tetrahydrocannabinol (THC), the primary psychoactive compound in cannabis, have increased in cannabis products over time (5). Higher THC concentration (>10%) is associated with continued and more frequent cannabis use among adolescents and young adults (6). Although THC concentration has not been directly linked to CHS, higher-potency products are associated with more frequent use, the primary risk factor for CHS (1,6).

CHS is likely underrecognized in both adolescent and adult populations. Clinicians might not routinely assess or document patients’ cannabis use; CHS can be misdiagnosed as other gastrointestinal conditions, such as cyclical vomiting syndrome (7). To improve clinical identification, a specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) discharge diagnosis code for CHS was introduced on October 1, 2025. This report examines trends in CHS-involved emergency department (ED) visits before and after implementation of this code.

<snip>

Implications for Public Health Practice

These findings highlight the need for increased awareness of CHS among clinicians and the public, but further educational efforts might be needed to prevent the cause of CHS: cannabis use. They also emphasize the importance of implementing evidence-based strategies to prevent cannabis use initiation and mitigate the consequences of cannabis use.

The observed higher proportions of CHS-involved ED visits after the new code was implemented in October 2025 potentially more accurately reflects true impact than previously observed proportions, underscoring the need for preparedness in emergency care settings, including appropriate clinical recognition and management of CHS. Clinicians can consider CHS in the differential diagnosis for patients with nausea, vomiting, and abdominal pain and can routinely assess cannabis use, including frequency, duration, product type, and route of use. Screening for substance use disorders and comorbid psychiatric conditions might also be warranted among patients reporting regular cannabis use (10).

Educational materials and communications campaigns should convey that younger age groups had high proportions of ED visits with CHS identification and that CHS might occur after shorter durations of cannabis use than was previously recognized (7,8). Expanded and tailored messaging might also be needed to raise awareness of CHS and other potential adverse health effects of cannabis use, particularly among younger populations. Communities can identify a wide range of effective substance use prevention and intervention strategies using CDC’s ENGAGE: Evidence-Based Strategies to Prevent Youth Substance Use resource for action.

Continued surveillance is important to better understand CHS epidemiology, including the potential role of high-potency THC and hemp-derived products and information on cannabis product characteristics (e.g., potency, type, or route of use) and to observe trends after code implementation to better assess prevalence. Monitoring trends across demographic groups and geographic areas can help identify populations at greatest risk and guide tailored prevention and intervention strategies.

https://www.freep.com/story/news/health/2026/08/22/blue-cross-blue-shield-michigan-mental-health-coverage-limited-licensed-practitioners-policy/91383390007/

Backlash roils against Blue Cross mental health billing policy change
By Kristen Jordan Shamus - August 22, 2026

• Outside the Blue Cross Blue Shield of Michigan headquarters Aug. 20, protesters said a new company billing policy will hit the mental health workforce hard and limit access to services.
• Starting March 1, Blue Cross says it will no longer cover limited-licensed mental and behavioral health providers in private practice. Only those working in accredited facities will be covered.
• The change, Blue Cross says, is to standardize billing processes across its Michigan health insurance plans and eliminate waste, fraud and abuse.
• Mental and behavioral health providers say, however, that the move will have far-reaching fallout that could cost lives and constrict an already too-narrow pipeline for new clinicians in training.

Blue Cross Blue Shield of Michigan is changing how it covers mental and behavioral health services, saying that as of March 1, it will no longer cover counselors, therapists and social workers with limited or provisional licenses as well as temporary limited licensed psychologists working in private practice in Michigan.

As the state's biggest insurer with about 70% of Michigan's commercial health insurance market, Blue Cross says the change comes as part of an effort to rein in waste, fraud and abuse in medical billing and to ensure its members get high-quality care.

The announcement sparked immediate backlash from people who work in the state's mental and behavioral health field, who call it a corporate cost-cutting strategy that will limit access to care for some of Michigan's most vulnerable people and constrict an already too-narrow pipeline for new clinicians in training.

"This policy, they make it seem harmless and that it's there to protect people, but that's not what it's going to do," said Christopher DeBoer, president of the Michigan Mental Health Counselors Association.

"Limited-licensed practitioners make up roughly 20% of the behavioral health workforce in the state of Michigan. With Blue Cross Blue Shield being the largest payer in the state, that means a large portion of the behavioral/mental health workforce wouldn't be able to bill for those members at all anymore. That's a huge loss of access for thousands and thousands of Michiganders."

DeBoer was among the protesters Friday, Aug. 21, who lined Lafayette Boulevard in Detroit, carrying picket signs and chanting, "Hey, hey! Ho, ho! Corporate greed has got to go!" and "When mental health is under attack, what do we do? Stand up! Fight back!" outside Blue Cross Blue Shield of Michigan's headquarters.

Several politicians, including Dr. Abdul El-Sayed, who is running as the Democratic candidate on the November ballot for the U.S. Senate, joined mental health providers and others to speak out on the change.

Jess Riley, the policy and advocacy manager for the National Association of Social Workers Michigan, held the microphone and told the crowd of more than 100 people that it is going to take a coalition made up of the entire mental health workforce to push Blue Cross to change its policy.

"Not a single profession is affected by this policy, and no single group is going to solve it alone," said Riley, who is macro master social worker and is working toward becoming a limited-licensed master social worker. "Together, what have we done? We've written letters. We have collected data. We've made calls. We've met with policymakers. We've organized and we've protested. And today, all of those different voices have come together here at the Blue Cross headquarters. Let them hear you!"

They heard the voice of Ashley Mosley, 42, of Muskegon, a mother of four whose husband, Brandon Mosley, died unexpectedly about year and a half ago at the age of 36 — leaving her alone to raise their daughters and manage their grief along with her own.

"Our world just kind of flipped," Mosley said. "We found Miss Heather, a limited-licensed therapist who can see us in the evening. Her schedule fits ours.

"All four have built a trusting relationship with her. They have been seeing her for almost a year now, and they can't lose another person in their life that they have built a trusting relationship with after losing their dad so unexpectedly. They cannot lose her," Mosley said through tears.

She held up a poster bearing photos of her girls — who range in age from 4 to 10 years old — and said it was worth the drive to Detroit on Friday to fight for them and do her part to ensure they will have continued access to the limited-licensed therapist who has made such a difference in their lives.

They heard the voice of Samm Heberlein, a limited-licensed professional counselor from Lansing.

"When this takes effect in March, I am potentially losing eight of my eight clients," Heberlein said. "A lot of them are dealing with a lot of trauma. I work with a lot of the queer community and they need support. They need people that look like them and are representative of them. This is going to directly impact them and me. How am I supposed to get my hours to become fully licensed if they're taking away clients for me to work with? That's why I am in this field. It's the clients."

Mental health care crisis could be on horizon

The Blue Cross policy change, DeBoer said, could cost some people their lives — as those with mental and behavioral health disorders who can't afford to pay for therapy or counseling services out of pocket will either have to find new, fully licensed providers amid a workforce shortage — or go without treatment. That could fuel a rise in mental health crises and drive up suicide rates in the state.

"We're talking about people who are among the most vulnerable in the population," said DeBoer, who also works as a licensed professional counselor at Spring Forest Counseling in Lansing. "If they have a depressive disorder or if they have some other mental or behavioral health disorder, and they get this news, it's just like, 'I tried to do everything right. I tried to get better, and then it was taken away from me.'

"Do people end up feeling hopeless from that, from care being taken away based on a bureaucratic decision? ... I would be crushed by that. I would feel as if I don't have a lot of power in my own life and can't even choose my own provider."

For small business owners with private practices or professional offices who employ newly graduated limited-licensed therapists, counselors, social workers and psychologists in training, it could affect their ability to operate.

"It's not just their bottom line, but their viability," DeBoer said.

The association conducted a survey of 2,700 Michigan mental health providers, clients and practice owners, DeBoer said, and found that many private practices would have to undergo major restructuring to remain in business after the policy change, and some would be forced to close.

"There were a few that said they were thinking about just calling it quits," he said.

Other potential downstream effects also worry DeBoer.

"When people go into crises, where do they go for help? They go to the ER. They go to community mental health centers," DeBoer said, noting that both Michigan hospitals and community mental health agencies already report being overtaxed and understaffed. "Neither of those two venues are going to be able to deal with an uptick from that."

Policy change to align Blue Cross plans, billing standards

Blue Cross said it doesn't expect the kind of fallout DeBoer described from the policy change.

If a member is getting treatment through a limited-licensed counselor or therapist and loses coverage with that person in March, Blue Cross can ensure its members can get an appointment with a different, fully licensed behavioral health professional through its network of 22,000 providers "typically within 48 hours" for online appointments and within a week for in-person care, said Julia Isaacs, the company's director of behavioral health strategy and planning.

The company has "worked really diligently over the last five years to expand access ... by over 46%" to mental and behavioral health providers, Isaacs said. It also has "more than 200" outpatient mental and behavioral health facilities in the network. "That's in addition to the hospitals and community mental health spaces that also qualify as these facility-based settings. So, there are hundreds of options for people to either transition care or transition their care to."

She told the Detroit Free Press that this Blue Cross policy change will align all of its commercial health insurance plans with long-standing Blue Care Network policy.

Blue Care Network, she said, has never covered temporary or limited-license mental and behavioral health providers — people who have completed their education but practice under the supervision of fully licensed clinicians to meet the work hours and other requirements needed to become fully licensed — only when they work in accredited, inpatient or outpatient facility-based settings.

The fully licensed supervisors who oversee their work bill Blue Cross for their services using their own National Provider Identification number, a practice called "incident-to" billing.

"This is really making sure that we have more quality standardization across our commercial products," Isaacs said. Incident-to billing for limited-license practitioners can continue after March 1 only in accredited, facility-based settings, according to the new policy. Supervising clinicians in private practices and professional offices will no longer be able to bill in that way.

Isaacs said the shift will provide Blue Cross with more transparency when it comes to claims.

"Currently, we have no line of sight to services that are being delivered incident-to," Isaacs said. "So, when we receive a claim here at Blue Cross that is submitted by one of our behavioral health providers in the network, it could be submitted by that behavioral health provider or it could be submitted by somebody else who is billing under that behavioral health provider and we have no way of knowing that.

"We are trying to balance ensuring quality standards ... oversight and accountability. We have had instances, in response to complaints or other inquiries, where we have found improper coding, lack of documentation and potential fraud for services delivered by incident-to providers. Of course, this is not everybody universally, but in one instance, we did review 176 medical records and 175 failed due to quality or incomplete recordkeeping. So, really, this is about standardizing the way we treat provisionally licensed graduates."

It's also similar to the way Blue Cross handles billing for medical residents who have recently graduated from medical school, Isaacs said.

"They are physicians, but they have to be in an accredited GME (graduate medical education) program," she said. "This is really about treating the behavioral health provider the same. They are able to continue providing those services as long as they are in an accredited facility to ensure that quality and oversight is really consistent across the network."

The company has given providers until March to either find work at an accredited inpatient or outpatient mental health facility or transition their clients to a different therapist who is either fully licensed or working at a facility with accreditation.

"We have provided a lengthy transition time to help those providers and those patients prepare," Isaacs said.

Counselors, therapists form deep bonds

Noel Spring, a licensed master social worker who practices in Detroit and uses somatic therapy as well as trauma center trauma-sensitive yoga, said it won't be easy for everyone who's getting care from a limited-licensed mental health practitioner to just switch to a new provider.

That's especially true for people who need gender-affirming care, for people of color and for those who live in rural communities where there aren't many options.

"I think a lot of people will stop therapy because it's already very difficult to find a therapist you vibe with," Spring said. "Sometimes it's really difficult to find a therapist who has the personal experience or the skills to help you. People spend a lot of time finding the right fit."

If Michiganders with Blue Cross plans are shuffled to just anyone in the company's network of 22,000 providers, Spring said they may drop out of therapy altogether.

"A lot of people, when they lose that right fit, it can be very difficult to want to go out and seek it again. So, I think a lot of people will not continue care. The populations that I'm particularly concerned about are people who hold nondominant identities. Particularly, I'm transgender. I have a supervisee, a limited-licensed social worker who I supervise right now who is a transgender woman. She specializes in gender-affirming care and over half her caseload is people with Blue Cross Blue Shield.

"She is one of a only handful of transgender women therapists in the state of Michigan. All of her people need a very specific type of care. So, where do they go?"

Pushing both limited-licensed providers and their clients toward accredited outpatient and inpatient mental health facilities also feels like a misstep, Spring said.

"Facilities are not made for people of nondominant identities," Spring said. "Those facilities are not made for queer folks. I've worked in them. It was hard for me to work in a facility. It's hard to seek help and treatment in a facility that's not made for you."

For people of color, finding a therapist who understands all of the complexities involved with racial identity also can be challenging. That's especially true in Detroit, Spring said, a majority Black city "where there are very few Black therapists practicing because of the obstacles that exist to become a therapist in the first place. Facilities and therapy in general, have a pretty extensive history of committing harm against people of color, specifically Black folks. And so a lot of Black folks won't trust facilities for very good reasons."

For Blue Cross to suggest people of color, and especially Black Michiganders, are going to receive better care at mental health facilities, Spring said, "is abjectly incorrect."

Isaacs at Blue Cross said that while it isn't ideal to ask members to find new counselors and therapists, the company is giving practitioners and facilities plenty of time to make the transition. It initially issued notice to providers in June, and the change doesn't take effect until March 1.

Noting that, on average, Blue Cross members are in psychotherapy for less than six months, and across all categories of mental and behavioral health, she said it's "somewhere in the realm of 12 to 14 months," a nine-month notice, Isaacs said, is "significant time to either complete treatment or transition care."

"There certainly could be individuals that need continued care, and it is the responsibility of the treating provider to appropriately clinically transition care. ... This happens when people move or change jobs. It is not something that is ever ideal, but it does happen, and it is important in a broader perspective to really make sure that care is being delivered in a more systematically quality-driven way."

David Sniderman, a licensed professional counselor and art therapist who specializes in working with children, teens, and adolescents, bristles when he thinks about the coming change, which feels like a cost-cutting measure to him.

"Mental health is one of their largest expenses," he said of Blue Cross. "These are appointments that you don't just do once a year, twice a year. ... It's something you do every week or every other week.

"I think they saw that people are starting to take care of themselves more often now, especially since the COVID pandemic, and more people have been going to counseling. Blue Cross is trying to create barriers to that because it's a big expense. And so they figure if they can create that barrier, people won't go."

That's an assertion Blue Cross denied, however.

"This policy is not about cutting costs," Isaacs said. "This policy is about protecting our members and ensuring standard of care."

When El-Sayed took the microphone Friday, he accused Blue Cross of putting profits over people and said he's especially concerned about what this policy change will mean for access to mental health care in rural parts of Michigan, where the options are especially limited.

"They are stuck under the health care auspices of one corporation that dominates 70% of the health insurance market in this state. ... I'm not a legislator yet ... but, God willing, with your support, I can be a legislator in just about three months.

"I'm running against a system that says corporations like Blue Cross Blue Shield, which has spent I don't know how much to beat me in the elections I've run in, cannot dictate who your politicians are. Because if they get to pick your politicians, they also get to pick your policy.

"This fight is about sustaining the critical mental health lifeline that you all offer for your patients, but it's also about the kind of politics that protects that lifeline in the first place."

Blue Cross: Private practices can become accredited

Earlier in August, Blue Cross invited mental and behavioral health practitioners to a forum to discuss the policy change, and explained that there is a way for private practice and professional offices to continue to work with limited-licensed providers and get reimbursed by Blue Cross plans after March 1, Isaacs said.

If those private practices work to become accredited outpatient psychiatric care facilities, also known as OPCs, the company said it would extend the deadline until Sept. 1, 2027.

To do so, the practice would need a board-certified or board-eligible psychiatrist on staff or contracted; a fully licensed psychologist, a master's level limited-licensed psychologist, a limited-licensed psychologist with a doctorate with a supervisory or consulting licensed psychologist either on staff or contracted; along with a licensed master's social worker.

That's just the beginning of the requirements, which also include being staffed to handle emergency services 24 hours a day, while also becoming fully accredited through one of the following organizations: the Joint Commission, the American Osteopathic Association, the Council on Accreditation of Services for Families and Children, the Commission on Accreditation of Rehabilitation Facilities or the National Council on Accreditation, or getting a certification letter for community mental health services from the state health department.

"There are certainly some practices that just don't want us to make this change, but back to kind of balancing the network quality across the entire state of Michigan. With what these requirements are and the changes we're making to this reimbursement policy, you know, we continue to think it's the right thing to do," Isaacs said.

"We have modified the outpatient model to allow for part-time, contracted psychiatrists to be part of the care team and oversee the medical care for that practice. I think this really goes back to ensuring that there's consistent quality and oversight, and having a physician as part of that model is really critical, especially for new graduates."

Spring said mental and behavioral health providers running small businesses in private practice aren't likely to be able to jump through all the hoops needed to become accredited outpatient psychiatric centers — nor will most be able to afford it.

Given the shortage of psychiatrists in the state, even if a practice could find one willing to join the staff or become a contractor, the cost would exceed $11,000 a year, Spring said.

"I can't afford that," Spring said. "Small practices can't afford that. ... Does this put small practices out of business? Yes, I absolutely think it will put a lot of small practices at risk of going out of business."

Isaacs said the Blue Cross doesn't have the resources to fully audit the depth of fraud, waste and abuse within the billing practices of mental health providers.

"What I can say is it is something that we routinely see, but I can't give you a specific number," Isaacs said. "My biggest concern is that there is this lack of oversight and established policies and procedures to ensure that clinical care is being delivered and documented properly."