Overview of the Healthy Michigan Plan

The Healthy Michigan Plan– Michigan’s new Medicaid Expansion Program is a new category of eligibility authorized under the Patient Protection and Affordable Care Act and Michigan Public Act 107 of 2013 that will began April 1, 2014. The benefit design of the Healthy Michigan Plan ensures beneficiary access to quality healthcare, encourages utilization of high-value services, and promotes the adoption of healthy behaviors.  Unlike traditional Medicaid, the Healthy Michigan Plan also offers adult dental care.

Eligibility

The Healthy Michigan Plan provides health care coverage for individuals who:

  • Are age 19-64 years
  • Have income at or below 133% of the federal poverty level under the Modified Adjusted Gross Income methodology
    • Less than $16,105 for an individual
    • Less than $21,707 for a family of 2
    • Less than $27,310 for a family of 3
    • Less than $32,913 for a family of 4
    • Less than $38,516 for a family of 5
    • Less than $44,119 for a family of 6
    • Less than $49,721 for a family of 7
  • 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

*Individuals on ABW (Adult Benefit Waiver) have been automatically transferred and should contact Michigan Enrolls @ 1-800-975-7630 to Select a Plan

*Individuals on Medicaid Spend Down will need to sit down with a CAC to access their personal situation for eligibility determination or contact their DHS Caseworker

Income for the Healthy Michigan Plan will be taken from an individuals personal Income (MAGI-Modified Adjusted Gross Income)

Will Count

  • Job Income
  • Self-Employment Income
  • Social Security
  • Pension
  • Survivor Benefits

Will NOT Count

  • workers compensation
  • child support (currently counted as the child’s income)
  • veteran’s benefits
  • gifts and inheritances
  • SSI
  • TANF-funded FIP benefits  (cash assistance)

 

Household Determination (Medicaid Standards)

  • A household is a group or family size
  • May be different varying on each individual applying –Ex. 2 sisters with 1 child a piece living under one roof would be two separate households or 3 adults under one roof filing separate taxable incomes FAQs for the Healthy Michigan Plan

 

Frequently Asked Questions

Can individuals who have existing health coverage (i.e. a private plan, not Medicaid or Medicare) apply for additional coverage through the Healthy Michigan Plan?

No, The Healthy Michigan Plan is for those low income Michigan residents that are uninsured or underinsured and earning up to 133% if the Federal Poverty level. The Healthy Michigan Plan is not a supplement for additional coverage.

Can patients enrolled in the Healthy Michigan Plan switch health plans monthly? Yearly?

Beneficiaries enrolled in a Healthy Michigan Plan Health Plan can change health plans within the first 90 days of their enrollment or during their yearly open enrollment period.

Currently infants of pregnant women on Medicaid are automatically eligible for Medicaid when they are born. Since the Healthy MI Plan is only for ages 19‐64, would families have to apply for Healthy Kids for their infant?

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.

How will individuals pay required monthly contributions and/or copayments? Will they pay their health plan? What methods of payment will be available? (i.e. cash, check, credit card etc.)

The Healthy Michigan Plan requires those with annual incomes between 100% and 138% of the federal poverty level to contribute between 2‐5% of income annually for cost sharing purposes. More information about the MI Health Account and contributions for cost sharing will be available from the health plan. You can reduce your annual contribution by participating with your health plan in healthy behavior activities which may include completing an annual health risk assessment, and changing unhealthy activities. Cost sharing (including co‐pays) cannot exceed 5% of annual income. We do not yet know what the method of payments will be.

How will my doctor know that I have Healthy Michigan Plan coverage?

When you have the Healthy Michigan Plan, a health care card will be mailed to you (if you do not have a MI Card already)

What type of information will I need to apply for the Healthy Michigan Plan?

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.

When can I apply for the Healthy Michigan Plan?

The State of Michigan has 4 ways of applying: DHS Office, 24-hour Hotline, at a FQHC, and online doing an application on your own.

Will assets be considered for eligibility purposes in the Healthy Michigan Plan?

There is no asset test associated with Healthy Michigan Plan eligibility. (Or any other type of coverage utilizing Modified Adjusted Gross Income eligibility methodology.)

Will current spend down clients have the option of not enrolling in Healthy Michigan Plan if the spend down amount is lower than the 2% income requirement in Healthy MI?

Someone who is eligible for Healthy Michigan could choose to have the spend‐down instead of paying the cost sharing for Healthy Michigan Plan, however, someone who chooses spend‐down is not receiving minimum essential coverage and could be subject to the tax penalty. Since they are eligible for full coverage under Healthy Michigan Plan they would not qualify for the premium tax credits offered through the exchange.

Will I be able to get health coverage through the Healthy Michigan Plan if I have a pre-existing condition?

Yes. The Healthy Michigan Plan will not deny coverage to individuals due to pre-existing conditions.

Will spend down go away for individuals receiving disability who are currently on Medicaid? More broadly, how will implementation of the Healthy Michigan Plan impact Medicaid enrollees with a spend‐down currently?

Existing Medicaid spend‐down is not going away. There are different rules for spend‐down, including group composition, countable income, and a resource test. Disabled individuals who have MAGI income below 138% of FPL can be eligible for Healthy Michigan, as long as they aren’t currently eligible for Medicare. If they have income that exceeds the Healthy Michigan limit, then they may qualify for one of the existing Medicaid spend‐down groups, but they will have to provide more information and verification in order to be considered for one of those groups.

Will the Healthy Michigan Plan allow me to stay with my current doctor?

Healthy Michigan Plan participants, with some limited exceptions, must enroll in a Medicaid 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.

Will the Healthy Michigan Plan offer retroactive active coverage after April 1st? (We know there will not be retroactive coverage before April, but what if someone enrolls in August? Will they have three months of retroactive coverage like the current Medicaid program?)

There will be retroactive coverage for the Healthy Michigan Plan. Beneficiaries cannot receive retro for any dates prior to April 1, 2014.

Would people living in Michigan with refugee status qualify for Healthy Michigan Plan benefits?

Healthy Michigan Plan citizenship and residency rules mirror those used by the Medicaid program.

 

Outreach and Enrollment

Advantage Health Centers’ Outreach and Enrollment Team provides education and enrollment assistance to individuals interested in obtaining health insurance through either the Health Insurance Marketplace or expanded Medicaid (Healthy Michigan). We are currently holding events throughout the community in order to provide helpful information and needed assistance. If you are interested in attending any of our events, please click here to see our calendar.

Contact Information

Jamie Jackson 

Isaiah Johnson 

Candace Hall

You may contact all three staff members by calling 313-574-8482

Partner Organizations

(CMS.govMPCA.netKFF.orgNACHC.comDHS- Michigan.gov, Enrollamerica.org)