Jackie Prokop, RN,MHA
Director, Program Policy Division
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 Presentation
overview:
◦ The Healthy Michigan Plan
◦ New eligibility methodology – Modified
Adjusted Gross Income (MAGI)
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Affordable Care Act (ACA) authorization
◦ New eligibility category.
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Funding must be appropriated by State.
House Bill 4714
Public Act 107 of 2013 was signed into law
by Governor Snyder September 16, 2013.
This is called the Healthy Michigan Plan.
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State law requires certain cost-sharing
requirements (co-pays and contributions).
Some of these requirements are not stated in
federal regulation.
Need a waiver amendment to implement what
is in state law.
◦ Amended our current Adult Benefits Waiver.
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Waiver Amendment was submitted 11-82013. Approved December 30, 2013.
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Public Act 107 0f 2013 did not have an
immediate effect.
Cannot implement prior to 90 days after the
end of legislative session.
The Adult Benefits Waiver beneficiaries will be
transitioned to the healthy Michigan Plan on
April 1, 2014.
Enrollment will open for others to apply April
1, 2014.
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Federal government will pay 100% of the
program cost for the first three years.
Will decrease federal match to 90% by 2020.
Current Match is about 64%
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Provides Health Insurance Coverage for Low
Income Citizens
Dramatic Reduction in Uninsured in Michigan
Primary Care Is Available
Health Coverage Improves Health Status
Improves Employability
Anticipated that up to 400,000 – 500,000
people could be eligible for the Healthy
Michigan Plan
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Includes people ages 19-64
Not receiving or eligible for Medicare
Not eligible for current Medicaid
programs
Not pregnant at the time of
application
Covers up to 133% of the federal
poverty level (5% disregard = 138%)
No asset test
Must meet other federal requirements
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Eligibility for Healthy Michigan Plan and Current Medicaid
Medicaid expansion fills the gap between current coverage
and private health insurance coverage offered on the Exchange
400%
350%
% of federal poverty level
300%
Medicare
250%
Exchange
Expansion
200%
Current
150%
100%
50%
0%
Children
0-6
Children
7-18
Parents Caretaker 19-20 year Elderly
Relatives
olds
Disabled Childless
Adults
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Covered Services
Benefit coverage must be based on federal
benchmark coverage and include the 10 essential
health care services.
1.
2.
3.
4.
5.
6.
Ambulatory patient services
Emergency Services
Hospitalization
Maternity and newborn care
Mental Health and substance
use disorder services,
including behavioral health
treatment
Prescription drugs
7.
8.
9.
10.
11.
Rehabilitative and
habilitative services and
devices
Laboratory services
Preventive and wellness
services and chronic
disease management; and
Pediatric services,
including oral and vision
care.
Other, Dental, vision,
home health
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Healthy Michigan beneficiaries will enroll into
the one of the current Health Plans.
◦ Current populations that are exempt or voluntary
from managed care will remain exempt or
voluntary.
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Will use the current Prepaid Inpatient Health
Plan (PIHP) system of care.
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Required by Public Act 107 of 2013
Cost-sharing
◦ Average co-pays
◦ Contribution of 2% annual income for beneficiaries
with income between 100%-133% of the FPL.
Account will provide information on health
care services cost and utilization.
Will show cost of services and amount of
contribution in account.
Quarterly statements
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Healthy Behaviors
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Health risk assessment form completed
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If beneficiary engages in healthy behavior
can have reduction in cost-sharing.
Goal is to have beneficiary more involved in
health care decisions and improve health
outcomes.
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New eligibility determination methodology
for Medicaid (excludes disabled population)
Uses a single streamlined application
Provides for no wrong door for application
◦ Online
◦ In person
◦ Telephone
Standardizes the calculation of income with
consistent formula
Relies on electronic data matching to the
greatest extent possible
Removes asset test
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For Providers:
DCH Website - www.michigan.gov/healthymichiganplan
 Healthy Michigan Plan policy, waiver amendment and state
plan amendments posted
 Healthy Michigan Handbook posted
 Frequently Asked Questions posted
 Digital brochures and flyers will be available by Apri1 1st
For Beneficiaries: Starting April 1st
Beneficiary Website - www. HealthyMichiganPlan.org
 Eligibility information posted
 Link to www.Michigan.gov/MiBridges
 Link to www. Michigan.gov/HealthyMichiganPlan
Email: -healthymichiganplan@michigan.gov
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Apply for the Healthy Michigan Plan
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Encouraging applicants to apply online using MiBridges
www.mibridges.michigan.gov
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DCH 1426 Paper Application is available online and at
DHS Offices
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New toll-free numbers for MAGI related
activities.
MI healthcare helpline is 855-789-5610.
The phone application assistance helpline is
855-276-4627.
Call-line information had been updated for
the Healthy Michigan Plan implementation.
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