Understanding the Healthy Michigan Plan

• About 10 million more people have insurance this year as a result of the Affordable Care Act

• The biggest winners from the law include people between ages 18 – 34, African Americans, Hispanics, and people who live in rural areas

• The National uninsured rate fell from 16% to 11%

• To date, the Healthy Michigan Plan (Medicaid Expansion) has enrolled over 439,000 people, exceeding Michigan’s initial goal of 322,000 enrollees

The New Health Law: It’s Working!

The Healthy Michigan Plan• Governor Rick Snyder signed Michigan’s Medicaid

expansion into law on September 16, 2013• Michigan Department of Community Health

(MDCH) submitted a waiver amendment to Centers for Medicare & Medicaid Services (CMS) on November 8, 2013 for approval

• The waiver was approved by CMS in December 2013

• HMP enrollment started April 1, 2014– 52,000 Adult Benefit Waiver beneficiaries have

already transitioned through an automatic enrollment process

Overall Coverage Shift

• The number of nonelderly residents, ages 19 to 64, enrolled in Medicaid or CHIP is expected to grow from 1.4 million to just over 2 million by 2019

• The number of uninsured residents is projected to drop from 1.1 million to just over 500,000 during the same period

• The majority of those still uninsured would most likely be eligible for Medicaid or tax credits but not enrolled in either program due to lack of awareness or not wanting to participate

Who is eligible?The Healthy Michigan Plan provides comprehensive, affordable health care coverage to Michigan residents. Individuals are eligible if they:

•Are age 19-64 years

•Have income at or below 133% of the federal poverty level* ($16,000 for a single person or $33,000 for a family of four)

•Do not qualify for or are not enrolled in Medicare

•Do not qualify for or are not enrolled in other Medicaid programs

•Are not pregnant at the time of application

•Are residents of the State of Michigan*Eligibility for the Healthy Michigan Plan is determined through the Modified Adjusted Gross Income methodology. There is no asset test.

What is covered?The Healthy Michigan Plan covers the essential health benefits required by the Affordable Care Act, as well as other services and benefits. With these benefits available, it's never been easier to protect your health. The following services are covered:

•Ambulatory patient services

•Emergency services

•Hospitalization

•Maternity care

•Mental health and substance use disorder treatment services, including behavioral health treatment

•Prescription drugs

•Rehabilitative and habilitative services and devices

•Laboratory services

•Preventive and wellness services and chronic disease management

•Pediatric services for 19 and 20 year olds, including oral and vision care

What are the costs?• The Healthy Michigan Plan has small co-pays for services

received

• Most co-pays will be paid through a special health care account called the MI Health Account

• Those with incomes between 100% and 133% of the federal poverty level will contribute 2% of their annual income for cost sharing purposes

• Annual contributions and co-pays can be reduced by maintaining or addressing healthy behaviors, such as smoking cessation

• Co-pays will not be required for certain services that help individuals get or stay healthy, like preventive services and services that help manage a chronic condition

Co-Pay RequirementsCovered Services Co-Pay

Physician Office Visits (including Free-Standing Urgent Care Centers); Podiatric Visits; Vision Visits

$ 2

Outpatient Hospital Clinic Visit; Chiropractic Visits

$ 1

Emergency Room Visit for Non-Emergency Services• There is no co-payment for true emergency services

$ 3

Inpatient Hospital Stay (with the exception of emergent admissions)

$ 50

Pharmacy $ 1 generic, $ 3 brand

Dental Visits $ 3

Hearing Aids $ 3 per aid

Services Exempt from Co-Pay Requirements

Groups Exempt from Co-Pay Requirements

• Emergency services• Family planning services• Pregnancy-related services• Preventive services• Federally Qualified Health Center, Rural Health Clinics, or Tribal Health Center services• Mental health specialty services and supports provided/paid through the Prepaid Inpatient Health Plan / Community Mental Health Services Program• Mental health services provided through state psychiatric hospitals, the state Developmental Disabilities Center, and the Center for Forensic Psychiatry

• Beneficiaries under age 21• Individuals residing in a nursing facility• Individuals receiving hospice care• Native American Indians and Alaskan Natives• Women who are enrolled in the Healthy Michigan Plan and receive services through the Breast and Cervical Cancer Treatment Program.• Beneficiaries dually eligible for Healthy Michigan Plan and Children’s Special Health Care Services

Healthy Michigan Plan

Co-Payment Exemptions

Next StepsHow to enroll

•Visit www.EnrollMichigan.com for in-person application help with a trained navigation partner

•Visit www.HealthyMichiganPlan.org to apply online (with instant approval/denial information in most cases)

•Call toll free, 1-855-789-5610, to apply by phone

•Visit the local Department of Human Services office to apply

After enrollment

•Complete health plan selection through Michigan Enrolls and identify a primary care provider (PCP)

•Complete the Healthy Michigan Plan Health Risk Assessment form below. The questions in Section 1 may look familiar if you called MI Enrolls to choose your health plan during enrollment. It is okay to complete them again, even if your answers don't match each time you answer. There are no wrong answers. Health Risk Assessment form (DCH-1315) PDF Word

•Schedule and receive a check-up with your PCP

Stay Connected• www.healthymichiganplan.org

– For clients– 1-855-789-5610 to apply by phone

• www.michigan.gov/mibridges– The Application

• www.enrollmichigan.com– Information– Local help locator

• www.mibenefitsaccess.org/partners• Become a community partner• Get MI Bridges training

Questions?