A Michigan Health and Hospital Association presentation to the Senate Committee on Health Policy on March 19, 2025, said delays in community mental health pre-admission screening and inconsistent CMH practices are extending emergency-department stays for behavioral-health patients, particularly Medicaid beneficiaries.

Lauren Lapine, senior director of legislative and public policy at the Michigan Health and Hospital Association, told the committee that MHA data collected from roughly 70 hospitals showed more than 155 behavioral-health patients are waiting in emergency departments on any given day for assessments, inpatient beds or transfers. She said hospitals reported pediatric and geriatric patients board longest and that Medicaid patients make up the largest share of those waiting, with more than 8,000 Medicaid patients boarding over a calendar year compared with about 5,000 commercially insured patients.

“If I'm a Medicaid beneficiary, the hospital psychiatrist can't independently determine I need inpatient care without the approval of a community mental health clinician simply because the CMH who works on behalf of the prepaid inpatient health plan, the insurer, must decide whether or not they are willing to pay for my services,” Lapine said in committee testimony.

Kyle Hoffmaster, a registered nurse and director of patient access at Pine Rest Christian Mental Health Services, said Pine Rest often has available beds but that the CMH pre-admission assessment requirement can block timely transfers. He described cases in which an urgent-care or hospital clinician recommended hospitalization, but the local CMH required the patient go to an emergency department so the CMH could complete its screening. “This process does not make sense and does not serve the patients or our acute care hospital partners,” Hoffmaster said.

Lapine described the current Medicaid pathway as more complex: after a hospital clinician determines a patient likely needs inpatient care, the hospital must contact the patient’s local CMH; that CMH must complete a pre-admission screening and locate a bed. When CMH clinicians disagree with hospital clinicians, Lapine said the disagreement can take days to resolve and leave the patient waiting in the emergency department without starting treatment.

MHA and Pine Rest proposed permitting clinically qualified hospital staff to complete pre-admission screening when CMHs cannot meet the current three-hour requirement for Medicaid patients, arguing that would reduce avoidable boarding, transfers and EMS transports. Lapine said the three-hour standard appears in CMH contracts and that hospitals routinely report it is not being met; witnesses also said some CMHs treat the clock as starting when a voicemail is received rather than when the patient arrives.

Committee members asked about existing crisis centers and alternatives. Sen. Runstead described Common Ground, a 24-hour crisis and recovery center in Oakland County, and urged expanding similar facilities. Senators pressed witnesses about weekend coverage and the qualifications of CMH screeners; Lapine and Hoffmaster said practices vary by county and by CMH and that many CMH screeners are bachelor’s-level social workers while hospital assessments are often made by physicians, psychiatrists or master’s-level clinicians.

Pine Rest staff provided utilization figures in testimony: in the prior year the organization reported serving roughly 7,000 hospital patients, 2,500 partial-hospitalization patients, 6,500 psychiatric urgent-care patients and 50,000 outpatient visits; Hoffmaster said Pine Rest operates nearly 200 inpatient beds. Lapine also said statewide emergency-room data show more than 1.2 million visits last year where behavioral health was one factor in the visit.

There was no committee vote on policy changes at the hearing; the presentation concluded with committee discussion and no formal action. Committee members expressed interest in standardizing the pre-admission process, improving weekend coverage and exploring alternatives to ED and jail for behavioral-health crises.

The committee adjourned after the presentation and questions.