Jackie Prokop, RN,MHADirector, 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.

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.

Waiver Amendment was submitted 11-8-2013. 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

Eligibility for Healthy Michigan Plan and Current MedicaidEligibility for Healthy Michigan Plan and Current Medicaid

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1. Ambulatory patient services2. Emergency Services3. Hospitalization4. Maternity and newborn care5. Mental Health and substance

use disorder services, including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and habilitative services and devices

8. Laboratory services9. Preventive and wellness

services and chronic disease management; and

10. Pediatric services, including oral and vision care.

11. Other, Dental, vision, home health

Benefit coverage must be based on federal benchmark coverage and include the 10 essential health care services.

Covered ServicesCovered Services

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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.

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

Health risk assessment form completed

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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Encouraging applicants to apply online using MiBridges

www.mibridges.michigan.gov

DCH 1426 Paper Application is available online and at DHS Offices

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Apply for the Healthy Michigan PlanApply for the Healthy Michigan Plan

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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