Michigan is laying the groundwork to privatize its $2.8 billion Medicaid nursing home and long-term care services.

A brief proposal included in the state’s 2017-2018 budget calls on the Department of Health and Human Services to “explore the implementation of a managed care long-term support service” by July 1.

The approach is similar to controversial 2016 budget language that will shift a $2.7 billion quasi-public behavioral health system to health-plan control over the next several years, according to Crain’s. Pilot projects for that plan are being developed to test integration of mental and physical health and measure cost savings and service increases.

Dom Pallone, director of the Michigan Association of Health Plans, told Crain’s his membership wanted the change for long-term care too.

“We asked for much more detail,” he said. “Legislators compromised in the process, and the House and Senate agreed with the generalized approach, to evaluate using managed care in the long-term care system.”

Providers have bristled at the switch to insurer-managed long-term services in other states. The trend continues despite concerns, notably in Iowa where three for-profit companies running the Medicaid program reported catastrophic losses and asked for government help in recouping $450 million.

At least 22 states are exploring ways to integrate long-term care services into their Medicaid programs to reduce costs, increase services and improve quality, according to a report issued by the Center for Healthcare Research and Transformation.