NORTON SHORES, Mich. — An organization that manages health benefits for several West Michigan counties is in jeopardy. The Michigan Department of Health and Human Services is giving the Lakeshore Regional Entity, or the LRE, 30 days to fix a long list of problems.
The Lakeshore Regional Entity is responsible for the Medicaid benefits management of seven counties, including Allegan, Kent, Muskegon, and Ottawa.
A letter issued by the Department of Health Human Services last week demanded the LRE (a Prepaid Inpatient Health Plan or PHIP) fix five issues and if they don't, their contract will be canceled.
"The state will no longer provide funding for Medicaid funding for Medicaid-funded community mental health services through LRE," Lynn Sutfin with the Michigan Department of Health and Human Services said, as she spoke about what would happen if the LRE does not meet their goal within the time frame.
In 2017, LRE received just under $254 million in Medicaid funding.
The State wants LRE to address:
-Risk management strategy
-Structural changes within the organization
-Managed care functions
-Data Accuracy
-Communication between the LRE and the State
"We were not surprised by the letter. We've been in discussions with the Department since the Beacon report several years ago," Stan Stek the LRE Chairman of the Board of Directors said.
Stek says they have been working on solutions for years, since a report released in 2015 highlighted some of these issues.
They're confident they'll clear the issues up in time.
"We are committed to continuing to work cooperatively with them [the state] to see if we can find an agreement a resolution in which they're reasonably satisfied with the issues they would like to see addressed and we're satisfied," Stek said.
"I think we can move forward."
But if the LRE doesn't correct these issues in time, state officials say it should not affect LRE's clients like Ottawa County Community Mental Health.
"Medicaid funding will continue to the five community mental health programs in the region," Sutfin said.
"PHIP's and Community Mental Health they're not allowed to cut or reduce Medicaid programs due to budgetary problems or revenue changes."
►Make it easy to keep up to date with more stories like this. Download the WZZM 13 app now.
Have a news tip? Email news@wzzm13.com, visit our Facebook page or Twitter.