Federal government approves waiver for Healthy Michigan

Dec. 17--The Centers for Medicare and Medicaid Services has given Michigan a waiver for its Healthy Michigan plan, allowing nearly 600,000 low-income residents to continue with health care coverage.

"We are pleased that we have an agreement with Michigan that will allow nearly 600,000 low-income citizens to continue to have access to quality health services. This agreement is consistent with Michigan's proposal and ensures important beneficiary protections guaranteed under the Affordable Care Act," said Ben Wakana, spokesman for the U.S. Department of Health and Human Services.

The waiver was needed because Michigan lawmakers instituted cost-sharing initiatives for Healthy Michigan recipients, who are getting coverage under an expanded Medicaid program brought about by the federal Affordable Care Act.

"The Healthy Michigan Plan has provided Michiganders with the opportunity to improve their health and wellness by enrolling in health care coverage," said Gov. Rick Snyder in a statement. "I'm proud of this program, our residents, and Michigan's continued leadership in health care innovation. I appreciate the work of the Centers for Medicaid and Medicare Services and thank it for its partnership and approval of our unique approach to keep Michigan moving forward."

The Healthy Michigan plan launched April 1, 2014, and now services nearly 600,000 Michiganders. Under Healthy Michigan, a single person with an income of about $15,521 or a family of four with an income of about $31,721 -- about 133% of the federal poverty level -- may be eligible.

In 2013, Michigan was among about two dozen states that decided to expand its Medicaid program under the Affordable Care Act. For years, its program generally was limited to children, parents of young children, and elderly and disabled people.

The change means many single adults -- including those who work but whose incomes still hover around the poverty level -- are now eligible not only for health care when they're sick, but for preventative services such as regular doctor's visits, mammograms and colonoscopies.

The federal waiver was required because nearly every participant has certain copays -- $2 for visits to doctors or urgent care clinics, for example, and there are incentives in the program for healthy behaviors, such as quitting smoking or losing weight.

Enrollees don't pay the copays for the first six months. The number of times they go to health providers in that time will be tracked to determine their monthly contributions to a health savings account starting in the seventh month. That contribution will be reassessed every six months.

Eligible participants must contribute up to 2% of their income to the health savings account, which will be administered by the state and can be used for out-of-pocket expenses. The exact portion is based on the person's or household's modified adjusted gross income, or MAGI, as well as copays the enrollee would experience in the first six month of the program.

Cost-sharing -- both the contributions to the health savings account and any copays -- would not exceed 5% of the enrollee's MAGI for the first four years and might increase after that to 7% for individuals who are deemed not medically frail.

Starting April 1, 2018, Healthy Michigan Plan participants must work with their physician on strategies to lose weight, quit smoking or adopt other healthy behaviors. If they choose not to do this, they must obtain health insurance through the federal exchange.

"From the beginning, the primary goals of the Healthy Michigan Plan have been to promote healthy behaviors and encourage people to lead healthy, productive lives," said Nick Lyon, director for the Michigan Department of Health and Human Services, in a statment. "The approved waiver goes a long way in helping us achieve those goals, and we are going to continue doing our part to ensure residents understand their benefits and how best to use them."

U.S. Sen. Debbie Stabenow said news of the federal waiver was incredible.

"We thank them (CMS) for being able to thread the needle here," she said. "Families will have a wonderful Christmas present knowing their health insurance is going to continue."

Contact Kathleen Gray: 517-372-8661, kgray99@freepress.com or on Twitter @michpoligal

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