The Healthy Michigan program, which has extended health care coverage to more than 670,000 Michiganders to date, is one of Gov. Snyder’s most significant achievements. It has served as a role model for other states, and he has fought diligently to preserve and improve it.
The bill signed by the Governor on June 22 making adjustments to requirements for coverage is significantly altered from the original version introduced in March of 2018. The Governor and team worked closely with legislative partners to improve the language and make compliance fair and reasonable.
Does the bill pave the way for an end to the Healthy Michigan program? A trigger was inserted that says if the federal government doesn’t approve a waiver, the program goes away.
Waiver non-approval is not a new provision for Healthy Michigan, nor is the trigger provision new. All states that tailor their Medicaid programs are required to apply for a waiver with the federal government, and the waivers are not permanent. They have to be requested for renewal every 3–5 years. So nothing was certain for Healthy Michigan, even without the changes encompassed in this bill.
There was a non-approval trigger in the bill Governor Snyder signed into law in September of 2013 and it has remained in law for nearly five years. The language in current law could not be clearer — if CMS did not approve the waiver renewal request that needs to be submitted to keep the program going after the current waiver expires at the end of 2018, the Healthy Michigan program would cease to exist.
The language in SB 897 is an improvement in that it at least provides health care coverage for beneficiaries until February 1, 2020, if the waiver renewal request is not approved. This is a good protective measure to account for the unpredictability of an entirely different administration’s review of the waiver than the one that approved the initial Healthy Michigan waiver. It also provides a window that will allow the administration to work with the legislature to make necessary changes, either to the waiver or to statute, that would allow the program to continue. Additionally, the Governor has been proactively engaged with the federal Centers for Medicare and Medicaid Services regarding provisions of this bill before its final passage, to help provide additional levels of comfort and certainty with respect to the waiver approval process.
Some are still saying that this bill takes control of the program away from the state and puts the feds in charge. Why wouldn’t we try to retain better control?
Medicaid is a federal government program — specifically it is run by the Centers for Medicare and Medicaid Services. While the state is responsible for administering and partially funding the program, any modifications to the administration of the program must be approved by CMS. This bill in no way changed the state’s oversight of the program. The federal government already retains the governance of the benefits we offer through our Healthy Michigan program.
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Some advocacy groups are saying this unfairly punishes Michigan families: poor people, the elderly, sick people and kids. How would you refute that?
Healthy Michigan is designed to provide health care services to those who traditionally have trouble accessing them due to affordability issues. This bill was crafted to ensure the program is serving those most in need, by exempting certain populations and requiring those who are fully capable of working to be actively seeking work or participating in other activities such as job training or community service.
Populations exempted from all work requirements under this bill are:
· Anyone age 63 or older;
· Disabled persons;
· Pregnant women;
· Full-time students;
· A parent of a dependent child younger than age 6;
· A recipient of unemployment benefits;
· Someone under age 21 who had previously been in foster care.
How did you settle on the work requirements in the bill? They have been portrayed by some as ill-conceived.
The work requirements in the bill closely mirror those that have been in place for cash and food assistance beneficiaries for over two decades, and will only apply to non-exempt, able-bodied individuals who are participating in the Healthy Michigan Plan, rather than all Medicaid recipients.
Seeking work is a standardized definition, which under this bill qualifies as 80 hours per month of the following:
· Currently enrolled at a postsecondary institution or preparing for high school equivalency testing;
· Job training programs;
· Volunteer work/community service;
· An internship;
· Active participation in substance abuse treatment.
This is significantly modified from the original bill draft, which would have required 30 hours per week of work (120 hours per month).
Is it true that signing this bill will result in 700,000 people losing their health care?
That is not accurate. This bill is not expected to affect the majority of Healthy Michigan enrollees. The Kaiser Family Foundation estimates that of the states implementing work requirements for Medicaid, just 6 percent of total enrollees are not already working and are unlikely to quality for an exemption.
The current enrollment in Healthy Michigan is around 670,000 people. Of that population, many of those enrolled will meet one or more of the following exemptions outlined in the legislation:
· Caring for a young child or a disabled dependent
· Full-time student
· Pregnant woman
· Cash and food assistance beneficiaries already subject to work requirements
· Working or looking for work on a part-time basis
Additionally, the 3-month per year non-compliance cushion and ability for beneficiaries to get back on the program within a month, one of the more generous compliance mechanisms in the nation, helps to ensure that coverage is maintained if life circumstances occur that are not covered by the list of exemptions.
In some states with work requirements for Medicaid, they have actually seen their costs go up. If the whole point is to save money, this bill doesn’t make any sense.
The state was required to re-apply for a Healthy Michigan waiver this year. While going through that process, the state is opting to add requirements for coverage that are more in line with the conditions for food and cash assistance. Lowered costs for taxpayers may be realized over time, but the ultimate aim of the bill was to ensure the standards of our program mirror those of similar programs and other states and make our waiver likely to be approved by the federal government so that the Healthy Michigan program can continue well into the future.