The Healthy Michigan Plan, an expansion and modification of the Medicaid program, provides comprehensive healthcare coverage to Michigan’s low-income, uninsured residents. The program was implemented April 1, 2014, and by the end of the first year achieved an unprecedented enrollment of 600,000 residents, surpassing all projections.
For calendar years 2014, 2015 and 2016, the federal government pays 100% of the cost of the program. In calendar year 2017, the state must contribute 5% of the cost, still a great deal for the state.
The program is currently operating under a federal waiver, and state law specifies a second, more difficult waiver must be approved for the program to continue after April 2016.
WHO IS ELIGIBLE?
Individuals between the ages of 19 and 64, not currently eligible for Medicaid or Medicare, who:
- Are citizens or lawfully admitted to the U.S.,
- Are not pregnant at the time of application, and
- Have incomes less than 133% of the federal poverty level (up to $15,521 for an individual or $31,721 for a family of four).
WHAT SERVICES ARE COVERED?
The comprehensive services required by the Affordable Care Act, including doctor visits, prescriptions, hospital services, lab services, X-rays and maternity services—plus additional key services such as dental, vision, hearing, and enhanced mental health and substance use disorder services are covered. Most people will select and be enrolled in the managed care plan of their choice.
After the first six months, nearly everyone enrolled in the program will be responsible for copays, for certain services such as doctor visits ($2), prescriptions ($1 or $3) or dental services ($3). Copay amounts are the same as the current Medicaid program. There are no copay requirements for preventive services or emergency services. Copays can be waived for services that allow enrollees to better manage chronic diseases or prevent complications.
(Note: Calculation of the monthly copay amount starting in the seventh month of participation will be based on usage over the prior six months.)
Individuals with incomes between 100% ($11,770 for an individual, $24,250 for a family of four) and 133% of the federal poverty level are required to make an income-based contribution to a MI Health Account. This amount will be up to 2% of annual family income, and must be contributed on a monthly basis beginning the seventh month of enrollment. Contributions are not required during the first six months of enrollment. Contributions can be made by the enrollee, by an employer, charitable organization, family member or other entity on the enrollee’s behalf.
Both the copay amounts and the 2% contributions can be reduced with “healthy behaviors,” which include completing an annual health risk assessment and agreeing to address or maintain healthier behaviors, such as weight loss, smoking cessation, obtaining immunizations, follow-up and managing chronic diseases. Together the cost-sharing cannot exceed 5% of family income.
WHAT HAPPENS WHEN REQUIRED PAYMENTS ARE NOT MADE?
The plan approved by the federal government specifies that no enrollee will be terminated from the program for failure to pay copays or contributions into the MI Health Account. However, those who do not make required payments could lose their “healthy behavior” reductions, or be referred to the Michigan Department of Treasury for collection from tax refunds.
HOW WILL PAYMENTS BE MADE?
Required copays and contributions are detailed on the MI Health Account statement and can be paid by U.S. mail or through the online payment system. Copays will not be made at the time a service is provided; they will be paid monthly based on the prior six months’ service usage.
A streamlined application and eligibility process, using the new tax-related income methodology and no asset test, is used. Applications are available online, by phone or in-person.