WYOMING, Mich. (WOOD) — Stacey Koetje’s voice broke as she recalled moving her brother, Todd Wallace, into his first adult foster care home 21 years ago.
Wallace, now 44, was born with Down’s Syndrome.
“My husband and I had provided respite (care) for my mom for years,” Stacey explained. “But when we started having children, I pushed her that I couldn’t care for Todd if something happened to her. She’s aging. Todd was aging and needed more care. I wasn’t available as much because I had my own family to take care of.”
Tears welled in Koetje’s eyes as she remembered the heart-wrenching milestone.
“It was a super hard decision,” recalled Koetje. “(But) it was a decision I felt needed to be made before something happened to my mom.”
Over the next 17 years, Wallace would live in four different adult foster care homes.
“Every home was a little different,” said Koetje. “Staffing issues. Always change.”
Wallace is nonverbal so he couldn’t share any misgivings about the homes, at least not verbally. Still, there were signs.
“Sometimes he would have behaviors,” recalled Koetje. “He would hit himself or he’d have a lot of incontinence issues.”
That all changed, said Koetje, when Wallace moved into Wyoming-based David’s House Ministries in 2020.
'HE LAUGHS. HE SMILES'
“It has changed his demeanor,” reported Koetje of Wallace’s new home. “He laughs. He smiles.”
When Koetje and her husband, Nate, arrive to pick Wallace up for an outing, his housemates pepper them with questions.
“His roommates will ask me if he’s going to miss friendship club, or ‘There’s a concert at the tent,’” said Koetje, smiling. “They’re like, ‘Is Todd going to be back in time for those events?’ They look out for him, and they worry about him. So, he has a community.”
When they return to David’s House Ministries after an excursion, Koetje said her brother doesn’t hesitate to go inside.
“He gets out of the car on his own,” reported Koetje. “I don’t (have to) assist him. He knows this is home. He’s happy here.”
A dozen men live in Wallace’s home, which is located on David’s House Ministries’ multi-dwelling campus in Wyoming. The men have their own bedrooms, 24/7 support and community.
“Todd has friends,” said Koetje. “Those men care about him. This is his second family.”
NEARLY $250,000 LOSS ANNUALLY
Now, Koetje worries that continued funding cuts may jeopardize care for her brother and other adults with intellectual and physical disabilities.
Network 180 recently announced a 5% fee cut to the specialized residential programs it funds.
Casey Kuperus, president of David’s House Ministries, told Target 8 the 5% fee cut amounts to a nearly $250,000 annual loss for the adult foster care provider.
“It’s a reduction in the rates, which means we can’t cover our costs, but we still have the expectation to provide the same level of service, (and) the folks we serve deserve that service,” said Kuperus in a recent interview with Target 8. “But there are really no answers to, well, how are we going to fix this?”
Kuperus said David’s House will raise funds to try to make up for the $250,000 loss, and the nonprofit will not cut services. But Kuperus worries about the possibility of more cuts as Congress considers changes to Medicaid.
“Just my direct care staff compensation (wages, benefits, training, payroll tax) was right around $4.2 million last year,” explained Kuperus. “That doesn’t include any administrative expenses. Medicaid should at least be covering that for care, (but) we received just over $3.1 million in Medicaid last year.”
Kuperus offered another example: His six-bed homes cost just over $1,000 in staffing costs per day.
“Depending on the situation, I can get as little as $390 a day in Medicaid total for those six individuals,” said Kuperus. “That was before a 5% reduction.”
Network 180 is the community mental health authority responsible for providing Medicaid-funded specialty behavioral health services in Kent County.
While the authority supplies some of those services directly, it pays outside entities like David’s House Ministries, to provide others.
'NOT AN EASY DECISION'
“At tonight’s Board meeting, the Board of Directors approved a rate realignment to begin bringing our cost in line with reduced state and federal funding,” wrote William J. Ward, executive director of Network 180, in an April 22 email to providers. “Let me assure you this was not an easy decision nor one that we made quickly. Our executive team has been evaluating all our programs and expenses for the past six months in light of a projected $13 million shortfall in funding from the State of Michigan for fiscal year 2025.”
A spokesperson for Network 180 told Target 8 that in the two months since the agency sent that letter to providers, its deficit has risen to $15 million.
“There are far fewer dollars coming into the communities that can help support people with complex behavioral health needs,” explained Don Avery of Network 180 at a May 22 event hosted by Disability Advocates of Kent County. “The communities are seeing fewer dollars and support because fewer people are on Medicaid, and where that becomes a real double whammy for the system is that the people who were coming off Medicaid rolls are not the people Network 180 serves. They’re not the people our providers serve.”
'STRESSED AND UNDER PRESSURE'
More than 100 people attended the “Call to Advocate: Addressing the Medicaid Underfunding crisis” event held at LaGrave Avenue Christian Reformed Church in Grand Rapids.
Avery of Network 180 told the crowd this is among the most “stressed and under pressure” that he’s seen the system. He went on to note that “stressed and under pressure” might actually be an understatement.
Network 180, which did not provide an on-camera interview, blamed the funding crisis in part on decreased Medicaid enrollment and the loss of stimulus dollars that offset rising labor costs during the pandemic.
Medicaid funding is based on the number of people enrolled, which increased during the pandemic because the government temporarily halted the annual requalification requirement.
LESS MEDICAID FUNDING, NO MORE STIMULUS
When that pause was lifted in 2023, Network 180 said 700,000 people statewide lost their Medicaid coverage. As a result, Medicaid is paying out fewer dollars while providers continue to struggle with inflation.
“Additionally, as you are no doubt aware, Medicaid funding remains under scrutiny at the federal level and may face significant cuts," wrote Regina Salma, communications director at Network 180, in an email to Target 8.
Salma said the community mental health authority is tightening its own belt too by freezing some hiring, suspending travel and conferences, shortening hours of operation and deferring the start of projects.
“Finally, we’re facing funding challenges at the federal level,” wrote Salmi. “U.S. DHHS recently announced a series of cuts targeting state funds being used for mental health services, addiction treatments, and other services.”
In his letter to providers announcing the 5% fee cut, William J. Ward of Network 180 said the agency is “seeing contracts and grants being canceled daily.”
Kuperus of David’s House said other counties, albeit smaller than Kent, have managed to avoid cutting provider fees.
PUSH FOR 'FAIR AND EQUAL' FUNDING
“There’s no consistency from county to county or region to region,” said Kuperus. “Though expenses may look different in different parts of the state, at the end of the day, the overall service should be funded fairly and equally across the board, right?”
Kuperus said providers don’t want to turn away potential residents from Kent County due to funding disparities.
“No one wants to be put in a position to say, ‘Well, we can only take people from this area or this county because of funding,'” said Kuperus. “Because that’s not why we’re here and we’re not here to chase rates by any means, but we are here to say, ‘We need to be funded equally and fairly, so that we can continue to provide the services.’”
Kuperus also lamented the number of layers through which Medicaid funding passes in the state of Michigan.
The dollars flow from the federal government to the Michigan Department of Health and Human Services to regional entities called Prepaid Inpatient Health Plans to community mental health agencies and finally, frontline providers.
“There are dollars being absorbed by every single layer,” remarked Kuperus.
MDHHS WORKING TO STRENGTHEN ACCESS
MDHHS is changing the funding model by initiating a competitive bidding process for the PIHPs.
“MDHHS announced it will strengthen behavioral health care access, quality and choice for Michigan families through a competitive procurement process for the state’s PIHP contracts,” wrote Lynn Sutfin, public information officer at the state health department, in an email to Target 8. “MDHHS remains dedicated to working with our partners to ensure individuals within the specialty behavioral health care system have access to the services they need.”
Sutfin noted that the state sets provider rates annually with the help of “contracted actuaries as required by federal law.”
Those rates are then reviewed for federal compliance by the Office of the Actuary in the Centers for Medicare & Medicaid Services, explained Sutfin, adding that MDHHS recently notified the PIHPs of a rate increase totaling nearly $170 million for Fiscal Year 2025.
“I don’t know exactly what channels all that money goes through but the care that (Wallace) receives is amazing,” said Stacey Koetje, sitting in her brother’s bedroom at David’s House Ministries in Wyoming.
She worries that more reductions could jeopardize her brother’s care.
Kuperus of David’s House reassured Koetje that the nonprofit isn’t cutting services.
“But it might happen if eventually cuts keep being made and they can’t provide the services and pay staff wages and do the extra things that they do here,” said Koetje, who shared her family’s story with Target 8 despite her dislike for public speaking.
“This is not my thing to talk in front of people,” explained Koetje. “But to advocate for my brother and for those who cannot advocate for themselves, it needs to happen. Somebody needs to be that voice.”