0295 Medicaid Michigan

https://www.healthcare.gov/

• 9/28/16
• Card Deck: 298966 - 0295 Medicaid Michigan

1. How do we answer questions when clients don't have proofs (medical expenses etc.)

2. Have advice on how to have clients keep track of records better?

3. How proofs on DHS 1004 factor into the decisions of whether or not someone gets Medicaid

4. What are the income thresholds/limits for someone to get    a. Medicaid     b. Spend-down

5. If someone is on a spend-down for a year and consistently meets her monthly spend down, can we make a case for full coverage due to the need being so high?

• 9/27/16
• Card Deck: Medicaid Michigan

1. Governor Rick Snyder

2. 2013

3. Michigan Public Act 107 of 2013

Source: http://www.michigan.gov/mdch/0,4612,7-132-2943_66797-325160--,00.html - google search "medicaid faq michigan"

• Are age 19-64 years
• Have income at or below 133% of the federal poverty level under the Modified Adjusted Gross Income methodology
• 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

1. No seniors

2. 65 yo

Modified Adjusted Gross Income methodology

People with disabilities will stay in Medicaid. Their income limits will not change but they will apply using the MI Bridges application.

The Healthy Michigan Plan uses Medicaid’s citizenship and residency rules.

Children born to pregnant women enrolled in the Healthy Michigan Plan will be automatically eligible for Medicaid. Women who become pregnant while in the Healthy Michigan Plan do need to inform their case worker of their pregnancy, due date, and subsequent birth.

The State of Michigan will not count the things you own to determine if you qualify for the Healthy Michigan Plan

The application will be available online at www.michigan.gov/mibridges, by phone and in-person.

There is not a separate application. Eligibility for the Healthy Michigan Plan can be determined using the Michigan Application for Health Coverage & Help Paying Costs (DCH-1426).

When applying you will need information about each person applying for coverage. This includes birthdates, social security numbers, income information, and citizenship or immigration status.

DHS will continue to help people apply for State of Michigan health programs, including the Healthy Michigan Plan.

Yes. Healthy Michigan Plan beneficiaries can have other insurance. The other insurance would be primary and the Healthy Michigan Plan would be secondary.

The Healthy Michigan Plan must provide 10 essential health benefits, defined as:

• 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 & 20 year olds, including oral and vision care
• Other services such as dental, home health, and family planning

Source: www.michigan.gov/healthymichiganplan

Yes, the Healthy Michigan Plan covers family planning services with no out-of-pocket cost to patients.

Dental services are provided by the beneficiary’s health plan.

Healthy Michigan Plan participants, with some limited exceptions, must enroll in a health plan that will pay your doctor for your care. Check with your doctor to find out whether they participate with one of these plans.

Healthy Michigan Plan participants will have some cost-sharing responsibilities.If you make between 100 and 133% of the federal poverty level, you will need to pay 2% of your annual income. Co-pays, in amounts consistent with the current Medicaid program requirements, will also be utilized for all Healthy Michigan Plan participants. Your total cost sharing, including co-pays, can’t be more than 5% of your annual household income and will be paid through the use of a dedicated health account called the MI Health Account.

Details about how you pay will come later from your health plan.

You can reduce your annual cost-sharing by participating with your health plan in healthy behavior activities, which include completing an annual health risk assessment and changing unhealthy activities.

Current Adult Benefits Waiver beneficiaries will be converted to the Healthy Michigan Plan by April 1, 2014, automatically. Adult Benefits Waiver beneficiaries have been notified of this change.

Medicaid spend-down will keep all of the existing rules the same, however some people who were previously only eligible for spend-down may now be eligible for the Healthy Michigan Plan.

Beneficiaries can stay in spend-down but it does not give the minimum essential coverage that the Affordable Care Act requires. They may have to pay a tax penalty.

The waivers and state plan amendments will be posted on the Healthy Michigan Plan website at www.michigan.gov/healthymichiganplan when they are available.

TDL 3/22/2015

1. 603,681

2.

• Source: 1630
• https://www.michigan.gov/documents
• /mdch/Website_Healthy_Michigan_Plan_
• Progress_Report_12-01-2014_475355_7.pdf

19.9%

1. Just under 500,000 people under FPL

2. Over 100% FPL - just over 100,000

26.75

regarding the auto-assigned thing, most of Michigan Medicaid is managed through private health insurance companies and their managed care plans (HMOs). The steps for someone to enroll in Medicaid are:

1. apply for Michigan Medicaid (including Healthy Michigan Plan)

2. get approved and enrolled in whatever program you're eligible for (Healthy Moms Medicaid, Healthy Michigan, etc.)

3. Medicaid sends a blue & green MIHealth card, and an info packet including info on health insurance plans to pick

4. pick a plan and send in that info to get enrolled in a plan

5. the health insurance plan then sends a packet of info to the new patient, and asks them to pick a PCP

6. select the PCP and return that info to the health insurance plan

7. for Healthy Michigan Plan people, they must then complete a Health Risk Assessment, part of which must be completed by their PCP

8. for Healthy Michigan Plan people, they must go to their PCP within 60 days of picking their health insurance plan (step 4 above)if someone doesn't pick their plan within some certain amount of time (45 days? 3 months?), Medicaid will assign them to a plan in their county that has openings. Then follow steps #5 and beyond.

1. It's possibble that under the "spend down" process a person may become eligible for Medicaid, even if he or she has too much income to qualify otherwise.

2. this process allows someone to "spend down," or subtract, medical expenses (like for prescription drugs) from his or her income to become Medicaid eligible.

3. ...can lower income so it's below the maximum amount allowed by a state's Medicaid plan

4. "...can include prescriptions for drugs not eligible for coverage by Medicare prescription coverage. Except in limited cases, Medicaid can't cover drugs for people who are enrolled, or who could be enrolled in a Medicare drug plan."

• 11/22/16
• Medicaid
• Source: google search "what happens when someone doesn't meet medicaid spend down" first result titled "Medicaid Spend Down"
• Source link: https://www.cms.gov/
• Outreach-and-Education/Outreach/
• Partnerships/downloads/11249-P.pdf
• CMS PRoduct No. 11249-p Revised March 2014

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• 12/5/16
• Source: https://questions.
• medicaid.gov/
• Medicaid Michigan