ADEA State Update

Centers for Medicare and Medicaid Services Approves Michigan’s Plan to Expand Medicaid

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On December 30, the Centers for Medicare and Medicaid Services (CMS) approved Michigan’s Section 1115 waiver to allow its Medicaid program to be expanded to cover more than 300,000 additional residents of Michigan.

According to Gov. Rick Snyder (R-MI) the Healthy Michigan Plan will extend health care benefits to 322,000 low-income Michigan residents in spring 2014 and ultimately cover nearly half a million Michiganders. The Medicaid expansion plan will be implemented on April 1.

The Michigan plan, unlike the recently approved Arkansas and Iowa plans, does not place new beneficiaries into the health insurance marketplace. However, the Healthy Michigan Plan will establish accounts for the newly eligible beneficiaries that will include some innovative forms of cost-sharing, and beneficiaries that comply with some of the healthy behaviors can see a reduction in these charges. The state has 90 days to submit additional details to CMS regarding how the accounts will work along with more information on what kinds of healthy behaviors will be rewarded.

Under the plan, beneficiaries between 100-133% of the federal poverty level will have to pay 2% of their income in premiums into the new accounts though they cannot be denied enrollment for nonpayment. For those under the poverty line in Michigan, individual accounts will be established that reflect a person’s usage of services over the prior six-month period, and beneficiaries will pay the appropriate copay amounts. The copays will not be paid to providers at the time of service but placed into these new accounts on a regular basis. Many details are still to be determined, however, the overall expected payment cannot exceed maximums allowed in Medicaid cost-sharing rules as no waiver was given in this area. Additionally, providers cannot turn people away for failure to pay.

Health coverage under the Healthy Michigan Plan includes both federally and state mandated Essential Health Benefits, such as pediatric services, including oral and vision care, and other medically necessary services as needed. To learn more about the Healthy Michigan Plan, click here to view a FAQs document released by the Michigan Department of Community Health.

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