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For decades, Congress has poured billions of mental health Medicaid dollars into states. In turn, states poured hundreds of millions into Community Mental Health (CMH) structures.
Yet, local mental health patients continue to experience care shortages. Nobody seems to know exactly how much money has been spent, or where it has actually gone.
What they do know is that Medicaid entitlement benefit qualifications are set at the federal and state level, but that counties can be liable for local service contracts while the state holds or dispenses funds.
Ottawa County, bless its conservative, budget-minded, and disruptive little heart, is is working toward its own CMH authority to protect taxpayers from such liability.
At the same time, Ottawa County renewal for its local mental health millage. This county happens to have the 4th-highest median income in Michigan.
A lot of ins and outs to this complex issue, so multiple posts follow in this thread.
MLive has the most recent summary, largely behind paywall.
Ottawa County seeks renewal of mental health millage
John Tunison | Jul. 13, 2026
OTTAWA COUNTY, MI -- Ottawa County is asking voters on Aug. 4 to approve a 0.30-mill renewal for mental health services over 10 years.
County mental health leaders say the millage is needed to fill essential gaps not covered by state and federal funding.
The millage request is for December 2026 through December 2035. If approved and levied in its entirety, this millage would raise an estimated $5.6 million in the first calendar year after its approval (2026), according to the proposal on the Ottawa County Clerk’s Office website.
WGVU reported on the March 2 County Commissioners' decision.
Scrolling down at this link shows $3.8 Million in federal mental health funds to Ottawa Co. CMH in 2021.
Ottawa County votes to transition Community Mental Health into authority
David Limbaugh | March 2, 2026
Listen • 1:06
Ottawa County officials are moving forward with a plan to restructure the county’s Community Mental Health department to reduce liability from budget deficits
Ottawa County commissioners voted 6-5 to submit an application to the state to become a mental health authority. That vote allows county administrators to create a transition plan over the next few months.
If the state approves the move, it would transition the Community Mental Health department as a county agency, making it a separate entity.
CMH is mostly funded by Medicaid, but Ottawa County officials say the money paid into the department falls below its budget.
As an authority governed by a board of directors, Ottawa County would not have to use general fund dollars to cover budget deficits. Instead, the state would be liable.
According to the county’s 2024 CMH annual report, the department served around 4,500 individuals that year. Among those, over 1,800 were adults with mental illness, 1,040 were adults with substance use disorders, over 900 were children with emotional issues, and over 700 were people with intellectual or developmental disabilities.
The Michigan Department of Health and Human services could take up to a year to approve the county’s plan.
In Michigan, only five counties are not part of an authority.
WHTC (Holland) published video of the January hearing with excellent background on this many-layered issue.
Begins at the 34 minute mark.
Many questions remain.
Which counties are not part of an authority, and how is that going for them?
Will legislators or the courts rein in MDHHS allocation of CMH funds?
What about MDHHS centralizing the regional CMH authorities under its own power? According to testimony here numbers are going from 11 to 3, with the inevitable result of losing local control.
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