Reform Alert - News from the Blues' Office of National Health Reform

The Healthy Michigan Plan

Update: Jan. 15, 2014 — CMS approves Medicaid expansion

Nov. 26, 2013

On November 8, the Department of Community Health submitted a Section 1115 waiver amendment request to the Centers for Medicare and Medicaid Services (CMS) to implement the Healthy Michigan Plan.

The plan expands coverage to adults with income up to 133 percent of the federal poverty level (FPL) (or 138 percent FPL after application of the automatic 5 percent income disregard).

It also requires additional cost sharing and provides for health savings account-like accounts. Obtaining CMS approval of the waiver amendment is the next step required to implement the Healthy Michigan Plan and expand Michigan’s Medicaid program.

Approximately 300,000 to 500,000 individuals are expected to qualify for the Healthy Michigan Plan. The program includes all benefits currently provided under the state’s Medicaid program, as well as additional preventive services, habilitative services and hearing aids. The waiver requires all Healthy Michigan Plan beneficiaries to receive a MI Health Account. The purpose of the account is to allow individuals to become actively engaged in their health care experience. Beneficiaries will be required to contribute to the account, which will be used to pay for required copays and other covered benefits. Higher-income beneficiaries have additional cost sharing obligations—but in no case will beneficiaries be required to contribute more than 5 percent of their income through cost sharing.

Though the President’s proposal grants discretion to insurers to allow people in individual market or small group market plans to stay on their existing plans, there is no guarantee that insurers will do so, or that the states will allow such renewals.

There is no cost sharing during the first six months of enrollment, and cost sharing can be reduced if healthy behaviors are met. Cost sharing includes copays and monthly contributions for higher income beneficiaries. Copays are paid to the health plan and will not be collected by providers.

Any contributions left in the MI Health Account at the end of a year will rollover to offset future contribution amounts. When individuals lose eligibility for the Healthy Michigan Plan, they will receive the balance of their account in the form of a voucher for the sole purpose of purchasing private insurance.

Approximately 70,000 individuals currently enrolled in Michigan’s limited benefit Adult Waiver Program will be enrolled in the Healthy Michigan Plan effective April 1, 2014. The waiver amendment also indicates that, starting in March 2014, the state will identify all applications submitted since October 1, 2013, that received a Medicaid denial—including those submitted through the Federally Facilitated Exchange (FFE). These applications will be resent through the state’s eligibility system to determine eligibility for the Healthy Michigan Plan.

The waiver application indicates MDCH will work with their “federal partners” to transition anyone between 100 and 138 percent of the FPL who is receiving premium subsidies in a Qualified Health Plan (QHP) on the FFE. Further detail about this process will be provided after the waiver amendment is approved.

The Department hopes to obtain CMS approval by the end of the year, and implement the program by April 1, 2014.

Where can I find more information?

A copy of the waiver amendment is available here.