Census-Guided Health Funds in Michigan
Michigan received over $5 billion in census-guided health funds in FY 2022. Accurate census data is essential to properly distribute funds across the state.
(Photos: Getty Images; Illustration: Leslie Garvey / POGO)
The health and wellness of our people is the cornerstone upon which our society is built. Healthy individuals are integral parts of robust communities: They are happier, more productive and more engaged.1 Given the importance of health and wellness, numerous government programs have been established to assist households and communities, ensuring families have enough nutritious food, and that they have access to medical services.
Many federal health programs use census data to help allocate funds for these programs to states and local communities. These programs use census counts at the subnational level (such as state, county, city, or zip code) to help determine where the assistance funds should be sent. Some health programs are geared toward specific age groups, such as children or seniors. Many focus on low-income households, while some consider geographic factors, such as the challenge of accessing food and medical services in rural areas. Determining where and how people fall into these age, income, and geographic groups is a key use of census data.
Census data helps inform federal programs that provide crucial support at the community level — but only if we get the census count right. Miscounts — under- or overcounts — can lead to communities not receiving their fair share of health assistance funding. And the amount of money from these programs can be very significant.
The Project On Government Oversight (POGO) tracked the spending for five census-guided programs focused on health and wellness down to the county level in Michigan in fiscal year (FY) 2022. The goal of the research is to quantify how important census accuracy is to each community, to underscore the impact of the census by putting its effect in real dollars directed toward critical issues such as health and wellness.
Accurate census counts not only determine the size of the pie Michigan receives from the federal government but often impact the amounts distributed to local jurisdictions as well. Under- or overcounts in key populations can result in some communities receiving less than their fair share, while others may receive more. A significant local miscount could even result in a double penalty for a community, first reducing the amount of money allocated to the entire state of Michigan for an assistance program, then allocating a smaller percentage of that reduced total to the miscounted community.
Our Approach
The Programs
We researched the local distribution of funds from the following five federal census-guided health programs in Michigan.
- Supplemental Nutrition Assistance Program (SNAP)
- SNAP is the largest nutrition assistance program in the country, serving as a foundational safety net program. The program provides monthly cash benefits via electronic benefit transfer cards to eligible low-income households to assist with purchasing food.2
- Children’s Health Insurance Program (CHIP)
- CHIP helps provide coverage for low-income, uninsured children in families that are above the cut-off for Medicaid but cannot afford private health insurance.3
- Child Care and Development Block Grant (CCDBG)
- This program provides childcare assistance to low-income parents and children under the age of 13. States have the option to serve children under the age of 19 if the child is physically or mentally incapable of self-care or under court supervision.4
- National School Lunch Program (NSLP)
- NSLP helps ensure that children in public and nonprofit private schools (from childcare institutions to high school) have access to a nutritious lunch. Under this program, children have access to a free or reduced-price lunch.5
- School Breakfast Program (SBP)
- SBP funds provide free and reduced-price nutritious breakfasts to eligible children in grade levels high school or below.
The Regions
Our research identified spending totals in each of Michigan’s 83 counties, which we then grouped into seven state regions based on the regions used by the Michigan Department of Transportation.6
- Metro Region
- This region includes Macomb, Oakland, and Wayne counties.
- Bay Region
- This region includes Arenac, Bay, Clare, Genesee, Gladwin, Gratiot, Huron, Isabella, Lapeer, Midland, Saginaw, St. Clair, Sanilac, Shiawassee, and Tuscola counties.
- Grand Region
- This region includes Allegan, Barry, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, and Ottawa counties.
- University Region
- This region includes Clinton, Eaton, Hillsdale, Ingham, Jackson, Lenawee, Livingston, Monroe, and Washtenaw counties.
- Southwest Region
- This region includes Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, and Van Buren counties.
- North Region
- This region includes Alcona, Alpena, Antrim, Benzie, Charlevoix, Cheboygan, Crawford, Emmet, Grand Traverse, Iosco, Kalkaska, Leelanau, Manistee, Missaukee, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle, Roscommon, and Wexford counties.
- Superior Region
- This region includes Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, and Schoolcraft counties.
Overview: Regional Allocations of Census-Guided Health Funds
Local allocations of the five census-guided health programs resulted in the distribution of $5.24 billion across the state of Michigan in FY 2022. This represents a significant annual investment in supporting the well-being of Michigan citizens. A miscount in Michigan’s census numbers, especially within key subpopulations (like lower-income households or school-aged children), could result in the entire state receiving less health funding than it truly needs for its inhabitants. And a financial shortfall due to census miscounts would not only impact a single year of funding: It would affect state allocations until the next decennial census.
The regional distribution of the $5.24 billion in tracked health funds in FY 2022 shows major disparities in where the funds went within the state. The Metro Region received more than 40% of the federal health assistance funding for the state, at $2.29 billion. The region’s sizable population understandably includes a high number of school-age children and low-income households.
The Bay Region and Grand Region also received significant allocations of health funds, with $842.55 million and $743.88 million respectively. Both regions include heavy urban populations in sizable cities such as Flint and Grand Rapids.
The North and Superior Regions, which are Michigan’s most rural and least populated areas, received the least money in the state, $228.07 million and $126.93 million in health funding respectively. However, from some of the health programs, many counties with lower populations in these regions received similar or even greater funding than counties with larger populations, clearly demonstrating that the funding distribution is not solely based on general population numbers.
Given that accurate census counts are critical to funding programs that support our communities, advocates in Michigan should encourage officials at the local and state levels to prioritize preparation for a successful 2030 decennial census. Officials can work with the Census Bureau to update residential addresses through the Local Update of Census Addresses (LUCA) Program, which allows early participation by state, county, tribal, and city officials to ensure local address files are up to date and complete. As the decennial census approaches, advocates and community leaders can play a crucial role in educating the public about the process and its importance. Elected officials should allocate sufficient resources to conduct more targeted outreach to hard-to-count and historically undercounted populations, such as young children and Black Americans.7
Advocacy and local engagement can have significant impact on the census results both in terms of the completeness of the count and the process of what exactly gets counted. Until recently, the Census Bureau defined people with origins in the Middle East and North Africa (MENA) within the White racial category. Since Michigan is home to a large Arab American population, local advocates have been pressing for changes in the race and ethnicity categories to ensure better representation of those communities in the census results.8 The Census Bureau recently updated its standards and will include a Middle Eastern or North African classification on the 2030 Census. The Census Bureau will also combine its race and ethnicity questions for the next decennial census, which the agency hopes “will produce more accurate race and ethnicity data for our nation.”9
Metro Region
The Metro Region consists of three counties located in the southeastern part of the state. The region is Michigan’s most densely populated and highly urbanized area, encompassing the city of Detroit, along with its surrounding suburbs and towns. In addition to Detroit, the region includes cities such as Warren, Sterling Heights, and Dearborn.
The region includes more children than other regions in the state.10 Wayne County, which includes Detroit, was ranked last among Michigan’s 83 counties in a 2022 health study by the University of Wisconsin’s Population Health Institute.11
In FY 2022, the Metro Region received $2.29 billion in census-guided health funds from the five health programs we tracked. Wayne County received the highest amount in the state at $1.5 billion, with over $1.2 billion going to SNAP alone. Oakland and Macomb counties both received around $400 million in census-guided health funds from the five programs. Oakland County received slightly more from National School Lunch, School Breakfast, and Child Care and Development Block Grants than Macomb County, while Macomb County received more SNAP and Children’s Health Insurance Program funding.
Concerns have been raised about the accuracy of the recent census population numbers in this region, specifically for Detroit. In 2022and again in 2024, the City of Detroit sued the Census Bureau, claiming the bureau undercounted certain neighborhoods in the 2020 Decennial Census. In the lawsuits, the city argued two points: First, the bureau’s uniform methodology for counting housing units was flawed, and second, the methodology discriminates against Black and Hispanic residents.12 This undercount likely deprived the residents of Detroit millions of dollars of support from federal health programs.
Bay Region
The Bay region in Michigan, also known as “the thumb,” covers a 15-county area in the east-central and southeastern part of the state, extending from the Saginaw Bay area along Lake Huron to the northern parts of the Detroit metropolitan area. The region is a mix of urban, suburban, and rural communities.
The largest cities in the region are Flint in Genesee County, Saginaw in Saginaw County, Midland in Midland County, and Bay City in Bay County. The region includes significant areas devoted to agriculture, particularly in the more rural counties like Tuscola, Sanilac, and Huron.
The ongoing environmental and infrastructure problems in Flint have created serious health issues for the community, with notable equity concerns given the community’s high population of lower income households and that it is predominantly Black.13
In FY 2022, the Bay Region received a total of $842.55 million in health program funding. Genesee County, the most populous county in the region (home to Flint), received the largest amount from the five federal health programs we tracked: $303.15 million.
Saginaw County received $145.58 million in health assistance funding. Though less than half of the funding Genesee County received, this level is consistent with the population difference between the two counties. However, St. Clair County, which has a total population fairly close that of Saginaw, received just over half of Saginaw’s funding. This drop in funding may indicate less need among the communities of St. Clair County, or it could indicate a miscount of populations in the county that are used to determine health funding levels.
More than half of the counties in the region (Midland, Shiawassee, Lapeer, Tuscola, Isabella, Clare, Sanilac, and Gratiot) received fairly similar health funding levels from the five tracked programs, ranging from about $20 million to $35 million for the year, despite relatively larger differences in overall populations. For example, Lapeer County, which received $32.5 million, has almost triple the population of Clare County, which received $22.96 million. This general consistency seems to be driven by similar levels of SNAP funding to the various counties, despite population differences. Funding for Child Care and Development Block Grants and National School Lunch funding showed greater variability among the counties.
Grand Region
The Grand Region consists of 13 counties located in the western part of Michigan’s lower peninsula, bordering Lake Michigan. The region includes a mix of urban, suburban, and rural counties. The region includes both highly developed urban centers, like Kent County’s Grand Rapids (the second largest city in the state after Detroit), and more rural areas with more agricultural and natural spaces.
In addition to Grand Rapids, the region includes notable cities Wyoming and Kentwood in Kent County, Georgetown township in Ottawa County, and Muskegon in Muskegon County.
The Grand Region received $743.88 million in census-guided health funds from the five federal programs in FY 2022. Kent and Muskegon counties received more than half of the money allocated to the 13-county region: $301.37 million and $129.82 million, respectively. Ottawa, which has a much higher population than Muskegon, received $80.25 million in health funds, ranking it the region’s third in funding. This difference is likely explained by Muskegon having a higher percentage of lower income households in need of health assistance. According to data from the National Institute on Minority Health and Health Disparities, Muskegon has a 9.5% rate of families below the poverty level, while Ottawa has the second lowest family poverty rate in the state at 3.8%.14
Most of the remaining counties in the region received relatively similar funding levels, ranging from roughly $20 million to $40 million. Three counties — Mason, Osceola, and Lake — received the smallest portions of the tracked health funds in the region. These counties had the smallest populations in the region as well. Lake County, for example, has a little more than 12,000 residents.
University Region
The University Region consists of nine counties located in the southern and central parts of Michigan’s lower peninsula. The region includes a mix of urban and suburban areas, as well as rural communities. The area includes the University of Michigan in Ann Arbor and Michigan State University in East Lansing, as well as the state capital, Lansing.
The three most populated counties in the region are Washtenaw, Ingham, and Livingston. Washtenaw has more than 350,000 residents, Ingham has around 280,000, and Livingston has almost 200,000. Collectively, the three counties are home to more than half of the region’s population. Three other counties — Jackson, Monroe, and Eaton — each have between 100,000 and about 150,000 residents, demonstrating the widely urbanized clusters in the region.
The largest cities in the region are Ann Arbor in Washtenaw County and Lansing in Ingham County, which are the fifth and sixth largest in the state, respectively.
In FY 2022, both Ingham and Washtenaw counties received more than $100 million in health assistance funds. Despite having significantly fewer residents, Ingham County received almost 50% more than Washtenaw. This could be because Ingham has 9.1% of families living in poverty compared to 6.2% in Washtenaw.15 If that is the case, the health funding for Ingham County could be at greater risk from potential future census miscounts of those communities.
Despite having the third highest population in the region, Livingston County received some of the lowest levels of health assistance in the region. Livingston has the lowest rate of families below the poverty level in the state with just 2.9% of families falling in this category.16 This much lower poverty rate may explain the lower level of health assistance to the county despite the larger overall population. The possibility also exists that a previous census miscount of those communities may also be impacting current funding levels.
Southwest Region
The Southwest Region consists of seven counties located in the southwestern corner of the state, bordering Indiana. This region includes a mix of urban, suburban, and rural areas. Kalamazoo, Calhoun, and Berrien counties are the most populated counties of the region. Kalamazoo County is the most urbanized county in the region, with more than a quarter of a million residents, while Berrien and Calhoun each have close to 150,000 residents.
Kalamazoo is home to Western Michigan University and Kalamazoo College. The region also has the sizable city of Battle Creek in Calhoun County, which is known as the Cereal City for its history with companies like Kellogg’s.
The Southwest Region received $424.31 million in census-guided health assistance funds from the five tracked programs in FY 2022. Kalamazoo County, with the largest population, received the largest amount of health assistance at $126.69 million. In addition to being similar in population size, Calhoun and Berrien received similar amounts in health funds: $89.84 million and $85.79 million, respectively. While the other counties in the region received smaller amounts, they all received tens of millions in health assistance. Branch County received the smallest amount in the region.
North Region
The North Region consists of 21 counties in the northern portion of Michigan’s lower peninsula, extending from the shores of Lake Michigan to Lake Huron. The region is primarily rural and remote, with small towns, seasonal populations, and limited urban development. Its economy is largely driven by tourism, agriculture, and forestry.
Grand Traverse County is the most populated county in the region, with almost 100,000 residents. Most of the other counties have between about 10,000 and 35,000 residents.
The North Region received $228.07 million in census-guided federal health assistance across its 21 counties in FY 2022. Given the significantly higher population in Grand Traverse, it is not surprising that the county received the most funding: $28.05 million. Wexford, with about one-third the population of Grand Traverse, still received $21.27 million.
While many of the rural counties included in the region received only a few million in federal health assistance funding, those funds can be critical to helping many living in smaller remote communities that may have less access to health care services or face challenges with food security.
Superior Region
The Superior Region, also known as the Upper Peninsula (UP), consists of 15 counties located in Michigan’s northern peninsula and separated from the rest of the state by the Straits of Mackinac. The region is predominantly rural and remote, with small towns and few urban centers. Economic activities focus on tourism, mining, forestry, and some manufacturing.
Marquette is the most populated county in the region, with around 65,000 residents. Houghton, Delta, and Chippewa counties each have populations of around 36,000 residents. The region includes several of the least populated counties in the state, including six counties with fewer than 10,000 residents each: Alger, Baraga, Schoolcraft, Ontonagon, Luce, and Keweenaw.
The Superior Region received $126.93 million in census-guided health assistance funds from the five tracked programs in FY 2022. Marquette County, the region’s population leader, received the largest amount of health assistance at $23.73 million for the year. Delta County ranked second with $18.09 million, despite having nearly half the population of Marquette. The difference between the two counties is almost entirely attributable to Delta receiving $5 million less than Marquette in SNAP funding.
Keweenaw County, with about 2,000 residents, is the most sparsely populated county in the state. It has the lowest amount of health assistance tracked in the entire state at just $511,000 for the year. The county appears to have received no funds for three of the five tracked programs — National School Lunch Program, School Breakfast Program, and Child Care and Development Block Grants.
Children’s Health Insurance Program (CHIP)
In response to POGO’s Freedom of Information Act request, the Michigan Department of Health and Human Services (MDHHS) provided each transaction record in FY 2022 organized by county. POGO then aggregated each transaction by county to calculate county totals.
Supplemental Nutrition Assistance Program (SNAP)
The USDA Food and Nutrition Service reports county level SNAP participation data for January and July each year. The data is part of the Bi-Annual (January and July) State Project Area/County Level Participation and Issuance Data.17 POGO combined these county participation numbers and then compared them to the total reported participation for the entire state for the combined months to produce a percentage for each county.
POGO then applied the two-month county participation percentages to the total amount of federal funding from the SNAP program to produce county estimates. The state spending total was sourced from the USDA’s National and/or State Level Monthly and/or Annual Data.18 The FY 69 through FY 24 zip file contains spreadsheets on each fiscal year with state spending totals reported on regional tabs.
National School Lunch Program (NSLP)
The Michigan Department of Education (MDE) responded to POGO’s Freedom of Information Act request and provided FY 2022 payments to each school district. During FY 2022, there were two different types of payments allocated, the traditional National School Lunch Program and the Seamless Summer Option (SSO). Typically, SSO operations are only permitted from May through September. However, the U.S. Department of Agriculture issued national waivers to extend the SSO beyond summer, allowing it to operate throughout the entire school year due to the COVID-19 pandemic.19
The payment information from MDE was separated into two datasets. The first dataset consisted of payments made to specific local school districts. For this data, POGO sorted the school districts by county and calculated county totals. The second dataset consisted of payments made to Intermediate School Districts (ISDs), which are larger regional districts providing administrative services to multiple local school districts in their area. Payments to ISDs were allocated to the counties included in their coverage based on the county student enrollment listed for the ISD. Then, the county numbers for local school district payments and ISD payments were combined to obtain each county total.
School Breakfast Program (SBP)
In response to POGO’s Freedom of Information Act request, the Michigan Department of Education (MDE) provided POGO with FY 2022 payments to each school district. During FY 2022, there were two different types of payments allocated, the traditional School Breakfast Program and the Seamless Summer Option (SSO). Typically, SSO operations are only permitted from May through September. However, the U.S. Department of Agriculture issued national waivers to extend the SSO beyond summer, allowing it to operate throughout the entire school year due to the COVID-19 pandemic.20
The payment information from MDE was separated into two datasets. The first dataset consisted of payments made to specific local school districts. For this data, POGO sorted the school districts by county and calculated county totals. The second dataset consisted of payments made to Intermediate School Districts (ISDs), which are larger regional districts providing administrative services to multiple local school districts in their area. Payments to ISDs were allocated to the counties included in their coverage based on the county student enrollment listed for the ISD. Then, the county amounts for local school district payments and ISD payments were combined to obtain the grand county total.
Child Care and Development Block Grant (CCDBG)
The Michigan Department of Health and Human Services (MDHHS) oversees the CCDBG program. MDHHS provided monthly reports on the number of total cases, children, and payments in the Green Book, a public and comprehensive source published monthly with key program statistics from the department.21 POGO reviewed and exported CCDBG payment data in every Green Book in FY 2022 (October 2021 – September 2022) to an Excel sheet and aggregated the data by county. POGO then summed the aggregated data to get county totals.
Population data
The U.S. Census Bureau and the Michigan Department of Technology, Management and Budget’s Office of the State Demographer provided the state’s population information broken down by county.22
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