Understanding service deserts and waitlist delays
Some Michigan counties simply don’t have the service you need, at any price, on any waitlist. That’s not a failure of your advocacy. It’s a service desert, and it has a specific, documented cause.
If a service genuinely doesn’t exist in your county, ask your CMH directly and in writing whether telehealth delivery or an out-of-area placement can be authorized. Don’t accept silence as a no. Make them answer the specific question.
A desert is not a waitlist
A waitlist means the service exists and demand exceeds supply. A desert means no provider offers the service in that area at all.
Rural Michigan bears the brunt
Specialized behavioral services concentrate almost entirely around metro Detroit and Grand Rapids, leaving large swaths of the state without local access.
Low Medicaid rates drive it
Reimbursement rates too low to sustain a specialized practice mean providers simply don’t open in lower-population, lower-revenue counties.
This isn’t your fault
Service unavailability in a desert reflects a systemic funding and provider-network failure, not inadequate advocacy on your part.
Some CMH regions have skeletal networks
Certain PIHP regions have provider networks so thin that even willing providers are stretched across enormous geographic areas.
Telehealth is a real workaround
Requesting telehealth delivery of a service unavailable locally is a legitimate, increasingly common request worth making explicitly.
What to request when a service doesn’t exist locally
Ask whether the service can be delivered remotely
Ask whether CMH will authorize and fund travel or placement elsewhere
Ask about caregiver-delivered service models with remote clinical support
Build community and peer connections while formal options remain thin
Get every ‘no service available’ response in writing, with the reason given
Karen lives in a rural county with zero autism-specialized day programs, a fact she discovered only after calling every provider listed by her CMH and getting the same answer each time. She asked directly whether telehealth or an out-of-area placement could be authorized. CMH approved a three-hour round trip twice a week to a program in a neighboring region, funded through the waiver, rather than nothing at all. It wasn’t the solution she wanted. It was the one that existed.
When the service you need doesn’t exist locally, here is what to do
Escalation ladder
- 1Confirm with CMH, in writing, that no local provider exists.
- 2Ask specifically whether telehealth delivery is an option.
- 3Ask whether CMH will authorize and fund out-of-area placement.
- 4Ask about parent-coaching or caregiver-delivered models with remote support.
- 5Document every ‘unavailable’ response with the reason given.
- 6Escalate to the PIHP if CMH offers no workaround at all.
Have ready
- A written list of every provider contacted and the response given
- Your CMH supports coordinator’s contact information
- Your regional PIHP’s contact information for escalation
- Notes on transportation feasibility for out-of-area options
- Documentation of every ‘no service available’ response, with reasons
A service desert is a funding and network failure, not a verdict on how hard you’ve advocated. Document it and push for a workaround anyway.
Karen called every provider listed by her CMH looking for an autism-specialized day program and got the same answer from every single one: they didn’t serve her county, or they didn’t exist there at all. It wasn’t a waitlist. There was no list to be waiting on. She’d spent months assuming she was doing something wrong, missing some form or some phone call that would unlock an option everyone else seemed to have. She wasn’t missing anything. The service simply didn’t exist where she lived.
What a service desert actually is
A service desert is a geographic area, often rural Michigan, where a specific service type simply isn’t offered by any provider, regardless of funding or willingness to pay. This is different from a waitlist, where a service exists and demand outstrips supply. In a desert, there’s no line to stand in, because nobody built the service there in the first place. Entire counties have zero autism-specialized day programs. Some regions have no providers accepting new Medicaid clients at all due to inadequate reimbursement rates.
What actually creates a service desert
Medicaid reimbursement rates too low to sustain a specialized practice mean providers concentrate where population density makes the economics work, overwhelmingly metro Detroit and Grand Rapids. A rural provider serving a smaller client base at the same low rate simply can’t keep the doors open. This is a documented, structural funding failure, not a mysterious absence of interest or effort from providers.
Why this isn’t a reflection on your advocacy
Families in service deserts often blame themselves, assuming a more persistent phone call or a better-written request would surface an option that genuinely doesn’t exist. It won’t, because the problem isn’t administrative friction you can advocate your way through. It’s an absent provider network. Recognizing that distinction matters, because it changes what kind of advocacy actually helps.
What to actually request instead
Telehealth delivery, out-of-area placement funded through the waiver, and parent-coaching models with remote clinical support are all legitimate requests when a local service doesn’t exist. None of these are consolation prizes offered automatically. They require asking CMH the specific question, in writing, and pushing when the first answer is silence rather than a real response.
Karen wasn’t missing a form. The service wasn’t there. Once she understood that, the question changed from “what am I doing wrong” to “what workaround exists instead,” and that question actually had an answer.
Jim Palasty is the founder of OASIS for Autism and a single father of an adult autistic daughter in Michigan.