The Healthy Michigan Plan

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Medicaid expansion, via the Healthy Michigan Plan, is expected to provide coverage to an additional 470,000 Michigan residents, while also implementing numerous reforms.

Overview of the Healthy Michigan Plan:

The Healthy Michigan Plan is Michigan’s health care program for individuals who qualify under the Medicaid expansion criteria. It is operated through the Michigan Department of Community Health.

Enrollment for the Healthy Michigan Plan began on April 1, 2014. It covers individuals who make up to 133 percent of the federal poverty level. That works out to roughly $16,000 a year for one person or $33,000 for a family of four. Additionally, those who are eligible must be:
  • Ages 19 to 64
  • Not currently eligible for Medicaid
  • Not in or qualified for Medicare
  • Not pregnant when applying for the Healthy Michigan Plan
  • Michigan residents

The Healthy Michigan Plan covers the essential health benefits required under the federal Affordable Care Act. These benefits include:

  • Ambulatory patient services
  • Hospital and emergency services
  • Prescription drugs
  • Maternity and newborn care
  • Mental health and substance abuse disorder treatment
  • Rehabilitative and habilitative services and devices
  • Laboratory and x-ray services
  • Preventive and wellness services and chronic disease management
  • Dental and vision care

The Healthy Michigan Plan will cover other medically necessary services as appropriate.

Those who make between 100 and 133 percent of the federal poverty level will contribute up to 2 percent of their income to a health savings account (MI Health Account), which can be used to pay for out-of-pocket medical expenses. The plan offers incentives for healthy behaviors, such as losing weight, quitting smoking, and preventive measures, such as getting a flu shot.

The Healthy Michigan Plan has co-pays. There are no co-pays for preventive services or for beneficiaries with select chronic conditions (as communicated by the respective health plan). See Bulletin MSA 14-11 for the list of co-pays (Table 1) and preventive services (Table 2 - Covered Services). After beneficiaries are enrolled in a health plan, co-pays for covered services will no longer be collected at point of service. Instead, Maximus, the MI Health Account vendor, will track and collect co-pays. Co-pays incurred by the beneficiary during the first 6 months of enrollment will be tracked. This data will be used to calculate average monthly co-pay, which will then be collected from the beneficiary on a monthly basis. Non-covered services will be subject to co-pays and must be collected at the point of service.

For more information about what the Healthy Michigan Plan covers, who is eligible, and how to apply, visit www.HealthyMichiganPlan.org.

Basics for Physicians and Medical Office Staff:

  • Currently enrolled Medicaid providers are automatically providers for the Healthy Michigan Plan
  • Medicaid FFS and the Medicaid managed care plans will use the same fee schedules for currently-eligible beneficiaries and newly-eligible beneficiaries
  • The primary care fee uplift to Medicare rates will continue through 2014
  • Adult Benefit Waiver beneficiaries were transitioned into the Healthy Michigan Plan effective April 1, 2014
  • Beneficiaries will have a mihealth card and will receive an additional health plan identification card when they enroll in a health plan
  • Healthy Michigan Plan beneficiaries are required to contact their primary care physician within 60 days of enrollment to schedule an appointment and practices are expected to make reasonable efforts to promptly schedule an initial appointment
  • Check CHAMPS to verify Healthy Michigan Plan benefit coverage at each visit
  • Bill Medicaid FFS if a beneficiary has not yet been enrolled in a health plan (it may take up to two months for beneficiary to be enrolled in/assigned to a health plan)
  • See Bulletin MSA 14-11 for Healthy Michigan Plan guidance to providers
  • Currently-eligible Medicaid or MA-HMP (Healthy Michigan Plan) = collect co-pays
  • MA-HMP-MC (Healthy Michigan Plan Managed Care) = do not collect co-pays
  • Complete health risk assessments for beneficiaries with Healthy Michigan Plan coverage and receive incentive from health plan (either via new billing code or fixed reward)
  • Direct potentially eligible patients to the following three options for applying:
  • Check-out the Healthy Michigan Toolkit below

Background:

The framework for the Healthy Michigan Plan was created by House Bill 4714 (Public Act 107 of 2013), which was passed by the Legislature and signed into law in September of 2013. The legislation expanded Medicaid, incorporated several Medicaid reform provisions focused on incentivizing wellness and individual accountability, and required the Michigan Department of Community Health (MDCH) to pursue two federal waivers. The first waiver sought to allow certain cost-sharing requirements (including co-pays) to go into effect, as well as special cost-sharing accounts. Newly eligible Medicaid enrollees would contribute a portion of their income into these accounts. Incentives for healthy behaviors could help lower the amount of contribution required.

The second waiver would allow the state to require individuals who had received medical assistance coverage for 48 months under the expanded program and who were between 100 percent and 133 percent of the federal poverty guidelines to choose to either 1) remain in Medicaid but increase their cost-sharing obligations or 2) purchase private insurance coverage through the Michigan’s federally-operated Health Insurance Marketplace (thereby, taking advantage of the federal advance premium tax credit and cost-sharing subsidies).

MDCH received word from the federal government at the end of December that the first waiver had been approved. This enabled the implementation of the Healthy Michigan Plan to move forward with an April 1, 2014 start date. The second waiver is not expected to be addressed until later this fall.

Because children age 0-18 are already covered up to 200 percent of FPL through Healthy Kids and MIChild, the majority of expansion in Michigan will be for childless adults, 19-20 year olds, parents in low income households, and caretaker relatives.