Michigan Healthcare Freedom

Michigan’s Narcissist

by | Apr 6, 2023

Ever notice how state Medicaid policy is like a narcissist?

MDHHS NarcissistToo many of us have had a narcissist in our lives. Out of all characteristics, the manipulative mind games may strike the deepest:

You are too stupid/ugly/incompetent to make it on your own.
No one else would want you.
You need me.
You’d better comply.
I control you.

Medicaid Rules are Back

Months ago, news trickled out that Congress pulled the plug on continuous Medicaid enrollment, rules to keep people enrolled through COVID. Suspended enforcement of qualifications and current contact information swelled the Medicaid rolls. This includes Healthy Michigan, which is expanded Medicaid under Obamacare.

In Michigan, 24% of the population is on welfare – unsustainable economically, even if everyone did qualify.

Unqualified enrollment is fraud, and enforcement resumed this week. Soon, all Medicaid participants nationwide will have to re-enroll. The theory is that states will tighten up procedures before accepting sign-ups. Michigan’s unwinding chart is as complicated as its billing.
However, states like high Medicaid enrollment. It means more federal funding.

So what’s a state to do with the threat of numbers dropping?

In Michigan, the program goes into Narcissist Mode.

You need me.

Monday, MDHHS announced it was expanding Medicaid dental to include the expensive stuff: root canals, crowns, sealants, and treatment of periodontal disease.

The observant reader will note, perhaps bitterly, that Michigan has a shortage of dentists. For many, the real problem is getting any dental care at all.

At current Medicaid reimbursement rates, most dentists limit how many welfare patients they take. Many accept none at all. For example, my county of Allegan hasn’t had a dentist taking new Medicaid patients in years, despite high demand.

Oh, but look! In the fine print of Monday’s press release, MDHHS announced it was raising the reimbursement rate for basic dental to 100% of commercial rates.

So I have two questions.

  1. Is this a win for the dental lobby? After all, they do limit the number of new dentists in order to keep prices high. Did they simply hold out long enough to get more money from the state?
  2. Where is MDHHS planning to get the money to keep this benefit going – the money saved from dropping fraudulent enrollments? I doubt it. Remember, Medicaid states make money by how many they enroll.

Increasing benefits is how the state advertises

It’s important to know that Medicaid is no great bargain in Michigan. Enrollment paperwork is a pain, finding a doctor is difficult, getting treatment paid for is even worse.

Increasing benefits creates constituency (that is, people who believe in a program, and will oppose change).

Increasing benefits right now – April, 2023 – raises constituency when many may be planning to drop out. In fact, some predict Michigan enrollment will drop by over 700,000. That’s big bucks from the federal money machine.

Question: Who benefits when people depress their income (or how they report it) in order to stay on welfare?

Answer: the MDHHS bureaucracy. Maintaining enrollment sustains the MDHHS budget, and its rulemaking power over more patients and clinicians. Higher enrollment during 2023 justifies higher budget requests from the 2024 Michigan legislature.

If this were private insurance increasing benefits, it would need to invest in marketing to enroll more clients. MDHHS does use some of our taxes for marketing, but its biggest boost, by far, comes from media coverage and public attitudes normalizing welfare.

Each of us makes up the society that supports MDHHS Medicaid. We support it in concept, in enrollment, in our payroll deductions, and in our loss of independence.

Do we think about ourselves (or our neighbors) as a state-serving narcissist would?

You are too poor/incompetent/victimized to afford healthcare.
You need me.
You’d better comply.
I control you.

There is a better way. To learn more about state health policy and how it impacts your life, get MHF Insights.

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