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.