CMS approves Medicaid expansion
Jan. 15, 2014
On Dec. 30, 2013, the Centers for Medicare and Medicaid (CMS) approved Michigan’s waiver request to expand Medicaid through the Healthy Michigan Plan. This removes the last significant barrier to expanding Medicaid coverage to adults who have incomes up to 138 percent of the federal poverty level, at least until the next waiver approval is due on Dec. 31, 2015. The state can now focus on implementing its plan to expand Medicaid coverage to adults up to 138 percent FPL effective April 1, 2014.
While the state of Michigan received approval for Medicaid expansion and its basic structure, CMS requested further detail about certain reforms, such as the MIHealth Account and the Healthy Behaviors Incentive Program.
About 300,000 to 500,000 individuals are expected to enroll in the new Healthy Michigan Plan. BCBSM is waiting for more information on transition plans for those who have coverage today. For example, individuals who have incomes between 100 to 133 percent of FPL and enroll in a qualified health plan (QHP) will be moved to Medicaid after April 1, 2014. However, specific details about when and how this will happen have not been provided. The state must submit its plan to CMS later this month.
Individuals enrolled in the Adult Benefits Waiver, a limited benefit Medicaid program for low-income childless adults, will transition to the Healthy Michigan Plan on April 1, 2014.
The waiver also indicates the state will go back and look at Medicaid and Marketplace applications received after Oct. 1, 2013, to identify individuals who may be eligible for Medicaid expansion and will send them an eligibility notice and enrollment packet.
As a reminder, the Healthy Michigan Plan requires additional cost sharing and provides for health savings accounts and similar arrangements. The purpose of the account is to allow individuals to become actively engaged in their health care experience. Beneficiaries must contribute to the account to pay for required copays and other covered benefits. Higher-income beneficiaries have additional cost-sharing obligations but in no case will beneficiaries contribute more than 5 percent of their income through cost sharing.
Where can I find more information?
More information can be found in the CMS letter.
The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.