Why is Medicaid Important to Older People?

THE IMPORTANCE OF MEDICAID FOR OLDER PEOPLE


The recent discussions in Congress about rolling back Medicaid expansion, capping payments or converting the program to block grants will have a significant impact on older Americans.

Overall, one in five adults is covered by Medicaid and half of those adults are over age 50.  

For people who are 50-64 and not disabled, they are eligible for Medicaid under the Medicaid expansion, or the Healthy Michigan Plan. So if the Medicaid expansion goes away, they will lose their access to Medicaid. 

For adults who are 65+ or who are disabled, the Medicaid program works closely with Medicare to ensure they have access to the care and services they need.  In fact, 11 million Medicare beneficiaries rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.  

To find out if you are eligible for Medicaid to help with Medicare, call the Area Agency on Aging and set up an appointment with a Medicare/Medicaid Assistance Program counselor.  You can also look at the Medicare Savings Program (MSP) categories and income limit chart.  If you believe you are eligible, apply for Medicaid and indicate that you have Medicare. 

Whether a person wants to age in their home or an assisted living facility, Medicaid fills the gap in services not covered by Medicare by serving as the primary payer for nursing home and community-based long term services and supports (LTSS) which would otherwise be altogether unaffordable for low-income older adults and people with disabilities.  Two in three nursing home residents on Medicare are also enrolled in Medicaid and two-thirds of all Medicaid spending for people on Medicare is for long-term services and supports.

Medicaid also pays for most home and community-based services that allow seniors and persons with disabilities to receive support services in their home as opposed to institutions.

Medicaid has been shown to break down barriers to treatment.  Of adults 50-64 with Medicaid, 50% suffer from multiple chronic health conditions.  These adults are less likely to skip refilling their prescriptions meaning their health problems are addressed instead of becoming the source of expensive hospitalizations.  Medicare recipients can qualify for Extra Help with their prescriptions.  The program is similar to Medicare Savings Program and you must apply.  Contact the Medicare/Medicaid Assistance Program.  

Federal cuts to Medicaid brought about by per-capita caps or block grants would drive states to make hard choices, likely leading states to scale back benefits, impose waiting lists, implement unaffordable financial obligations, or otherwise restrict access to services for older adults.

Adapted from Community Catalyst

Read more about Medicare/Medicaid programs

At the Washtenaw Health Plan, we can help you apply for the Medicare Savings Program.  We can also make appointments for you here with a Medicare/Medicaid Assistance Program counselor.  Call to make an appointment 734-544-3030 or just walk-in Monday through Friday 9am-4pm.  

Sources:

-Meredith Buhalis

Leave a question or a comment below and WHP staff will respond.  

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The AHCA: Who Loses?

Medicaid Expansion and Current Medicaid Funding

One of the provisions of the Affordable Care Act allowed states the option to expand Medicaid to cover adults under 138% of the Federal Poverty Level who previously had little or no access to affordable health insurance.  From 2014 through 2016, the ACA’s Medicaid expansion population was funded 100% with federal dollars. Beginning 2017, states gradually have to pick up some costs, but the federal government still picks up 90% or more of Medicaid expansion through 2020. Medicaid programs that existed before the ACA are funded via a much less generous split between state and federal tax dollars.  

What is a Medicaid Block Grant? 

Medicaid is currently an entitlement program, which means that everyone who qualifies is guaranteed coverage. States and the federal government combine funds to cover the costs.  Conservative Republicans are currently endorsing a change to this funding called "block granting" which is included in the health care bill that recently passed the House of Representatives, the American Health Care Act (AHCA).  Instead of an entitlement, states would take control of the program and the federal government would cap what it spends on it each year.  AHCA supporters claim it will save the federal government money and give states more control.  It would be a drastic change to the current system and the Congressional Budget Office projections are that at least 14 million people would lose affordable coverage.

 

Who would lose coverage? how? why?

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Working poor people who gained Medicaid under the ACA

14 million working poor people gained coverage under the ACA's Medicaid expansion program.  In Washtenaw County, over 17,000 people gained coverage. The AHCA would freeze funding for Medicaid by the year 2020, effectively ending Medicaid expansion. The AHCA would keep paying for people who signed up before January 1, 2020, but would not cover people who signed up after that date.  Many low-income people cycle on and off Medicaid as their employment changes seasonally, moves from part-time to full-time or as the economy fluctuates.  Once coverage ends, they would not be able to re-enroll.  

Seniors,  disabled people, and others who qualified for Medicaid before the ACA

The AHCA would adopt a policy known as a “per capita cap” for Medicaid that would hurt all beneficiaries. Currently the federal government matches state spending on Medicaid for everyone, not just those who get Medicaid under the Medicaid expansion. In 2020,  the AHCA would give each state a set amount of money per person and it would increase based on inflation, but it is not expected to keep up with medical costs. Consider the different costs to cover a 24-year-old, a 65-year-old and an 87-year-old. What would happen to the disabled, who need more coverage?  The federal government requires that certain populations are covered by Medicaid, but states would have to decide who would be covered with less money for Medicaid. States could spend less on Medicaid by removing either particular populations or certain types of benefits.

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Pregnant Women and New Mothers

Under the AHCA, states could apply for waivers that would allow them to not cover the 10 Essential Health Benefits covered under the ACA.  Prior to the ACA, 88 percent of independent market plans did not cover maternity care.  Read more here: Essential Health Benefits Under the AHCA (ACA Replacement).

 

States hit hard by the opiate crisis

The opioid epidemic has many more patients needing substance use disorder treatment. A per capita cap would cause problems if an epidemic hit or if new, expensive medications became available.  Medicaid programs are currently covering many people receiving treatment for substance use disorder. If  Medicaid funds were capped any advances or new outbreaks would financially burden the state.  

People in states that take a Medicaid “block grant”

A full "block grant" would mean that states receive a fixed amount of money for Medicaid over a 10 year period, only increasing with the normal inflation rate.  There are no provisions to increase funds based on increased state population or economic recessions.  States could cut benefits or change eligibility requirements and many people would lose coverage.  

"Block grants" would encourage more states to "innovate"  alternatives to current Medicaid coverage. Michigan's current MIHealth Account requires all Healthy Michigan Plan participants to pay into a health account as a way of collecting co-pays for many services.  The amount is determined by prior usage of services and participants are sent payment coupons quarterly.  Participants do not lose coverage for not paying, but delinquent payments can be recouped from state tax refunds.  Indiana also has a waiver that requires participants to contribute before their coverage starts.  If they don't pay the premium they are locked out of Medicaid coverage for 6 months.  

 

People with Pre-existing Conditions

Under the MacArthur Amendment added to the bill in late April 2017, states would also be allowed to waive an ACA provision that bans insurers from charging higher premiums to sicker people.  We would return to the pre-ACA world of people with pre-existing conditions being charged much more for insurance.  Here is an estimate from Sam Berger and Emily Gee using data from CMS, the Center for Medicare and Medicaid Services.  

Families with Chronic Conditions

Because of the Essential Health Benefit waiver, states could also choose to eliminate  "lifetime limits," which let insurers decide how much they would spend on one person.  Before the ACA, most caps were between $1 million and $2 million.  These types of caps dramatically affect families with very ill children. Prior to the ACA, families went bankrupt trying to get healthcare for their children. 

Low-income Americans not on Medicaid

The ACA offered tax credits based on income for people to purchase insurance on the Health Insurance Marketplace (healthcare.gov).  Under the AHCA, tax credits are much lower for many people because they are based on age, and not on income.  In addition, there would be no cost-sharing. Under the ACA, people who are lower-income have cost-sharing--much lower deductibles and lower maximum out-of-pocket costs. Under the AHCA, those cost-sharing supports are eliminated.

Older People on the Health Insurance Exchanges

Older people would receive a bigger tax credit but the increase would not cover for the fact that they could be charged up to five times more than younger people. 

Children in Special Education Programs

Under per capita caps and block grants, Medicaid funded school programs for students with disabilities could be reduced or cut completely. Because special education requirements are mandated, schools would need to pay for special education out of general funds.

Planned Parenthood Patients

The AHCA includes provisions banning federal dollars from going to groups like Planned Parenthood.  So even though the majority of Planned Parenthood services are birth control, pregnancy and STD tests, as well as cancer screenings such as breast exams and Pap smears, the AHCA will deny women access to these services.  Planned Parenthood is the largest provider of reproductive health services in the country. In fact, in many places across the country, Planned Parenthood is the only birth control clinic. Without Medicaid funding (which does not pay for abortions), these clinics will be forced to close, denying millions of women access to health care.  

Almost Everyone Loses

Many provisions in this bill will make it easier for insurers to charge more for premiums, require more cost-sharing and shift costs to the consumer.  High income (over $250,000/year) people win and everyone else loses.

The Washtenaw Health Plan

believes that healthcare is a human right. The Washtenaw Health Plan board is on record opposing repeal and weakening of the Affordable Care Act.

Questions? Leave a comment below and we will do our best to answer.  

-Meredith Buhalis

 

Sources:

Current Status of State Medicaid Expansion Decisions Map http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/

A 50-State Look at Medicaid Expansion  http://familiesusa.org/product/50-state-look-medicaid-expansion

Affordable Care Act Medicaid Expansion http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx

State Medicaid and CHIP Profiles  https://www.medicaid.gov/medicaid/by-state/by-state.html

Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans  http://khn.org/news/block-grants-medicaid-faq/

These Are All the People the Republican Health Care Bill Will Hurt  https://www.vox.com/2017/5/4/15542990/republican-health-bill-ahca-medicaid-victims

An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/

9 Things People Get Wrong About Planned Parenthood  http://nymag.com/thecut/2017/01/misconceptions-about-planned-parenthood.html

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Essential Health Benefits Under the AHCA (ACA Replacement)

What are Essential Health Benefits (EHB)?

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.
— The Center for Consumer Information & Insurance Oversight - https://www.cms.gov/cciio/resources/data-resources/ehb.html

 

Prior to the ACA, health insurance was not required to cover the benefits above.  Health insurance could exclude prescriptions, pediatric services,  hospitalization, maternity and prenatal care and mental health services.  The EHBs are also tied to the limits on consumer spending for these services.  Currently, out of pocket costs for an individual cannot be more than $7,150 and for families the cost cannot be more than $14,300. Under the AHCA, states could apply for waivers and the costs for EHBs would no longer be capped.   

 

Let's compare the benefits in the ACA to the AHCA. 

While it is true that your monthly premium might be less under the AHCA, if you live in a state that gets a waiver, all the EHB may not be included in your health plan. If your health situation changes, you could pay much more for services that are currently included in all health plans.  

An Example

For example, a state could remove coverage for maternity or newborn care from the essential health benefits. Prior to the Affordable Care Act, most health plans did not cover maternity care, and pregnant women would have to pay the full cost of prenatal care, labor and delivery. That could happen again. 

In fact, women's healthcare is particularly targeted. Under the AHCA, Planned Parenthood would not be able to get Medicaid reimbursals for pap smears, birth control, or cancer screenings. Since Planned Parenthood is the largest reproductive health care provider in the country, it is likely that removing them as a provider--with or without removing the essential health benefit of contraception--will mean many more unintended pregnancies. For middle-income women, over the income cap for Medicaid, the birth and expenses would not be capped so you could pay $15,000 or more for a birth with complications.

The AHCA--the "replacement" for the ACA--goes next to the U.S. Senate. If you support comprehensive and affordable health care, let your senator know that you oppose the repeal of the ACA. 

Have questions?  Ask them in the comments section and we will do our best to answer. Call 734-544-3030 or Walk-in to the Washtenaw Health Plan office Monday - Friday from 9am - 4pm.   

-Meredith Buhalis and Ruth Kraut

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Pre-existing conditions, the ACA and the AHCA

Under the Affordable Care Act (ACA) of 2014, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. They cannot limit benefits for that condition either. Once you have insurance, they can’t refuse to cover treatment for your pre-existing condition.
— U.S. Department of Health and Human Services https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html

On May 4, 217 Republican Representatives voted to approve the American Health Care Act.  This Act is meant to repeal and replace the ACA.  One provision of this act is a change to the way pre-existing conditions are treated.  The bill in its current state does continue to cover pre-existing conditions under certain circumstances.  You must have continuous care.  Because this plan also removes the mandate that everyone must have health insurance, you can choose to not buy health insurance.  If you get cancer, you will have to pay a penalty and then you are allowed to get coverage.  The insurance company can CHARGE YOU whatever they want.  Let's just say that again.

Yes, you can have health insurance if you have a pre-existing condition but the health insurance company can charge you a lot of money. many people will not be able to afford that coverage.

High Risk Pools: We've been here before 

Click the image above to go to the video from Kaiser Health News 

Click the image above to go to the video from Kaiser Health News 

What about the high risk pools (HRP)?  What about them?  In the past, many states had high risk pools. They were extremely expensive, and many people did not get the care they need. Julie Rovner explains why this "sounds like a good idea" but isn't.  Sounds Like A Good Idea: High Risk Pools

 

 

If you are wondering what's included in the list of pre-existing conditions, so are we.  This is a partial pre-existing conditions list from CNN:  

Acne

Acromegaly

AIDS or ARC

Alzheimer's Disease

Amyotrophic Lateral Sclerosis

Anemia (Aplastic, Cooley's, Hemolytic, Mediterranean or Sickle Cell)

Anxiety

Aortic or Mitral Valve Stenosis

Arteriosclerosis

Arteritis

Asbestosis

Asthma

Bipolar disease

Cancer

Cardiomyopathy

Cerebral Palsy (infantile)

Chronic Obstructive Pulmonary Disease

Cirrhosis of the Liver

Coagulation Defects

Congestive Heart Failure

Cystic Fibrosis

Demyelinating Disease

Depression

Dermatomyositis

Diabetes

Dialysis

Esophageal Varicosities

Friedreich's Ataxia

Hepatitis (Type B, C or Chronic)

Menstrual irregularities

Multiple Sclerosis

Muscular Dystrophy

Myasthenia Gravis

Obesity

Organ transplants

Paraplegia

Parkinson's Disease

Polycythemia Vera

Pregnancy

Psoriatic Arthritis

Pulmonary Fibrosis

Renal Failure

Sarcoidosis

Scleroderma

Sex reassignment

Sjogren's Syndrome

Sleep apnea

Transsexualism

Tuberculosis

The Kaiser Family Foundation, a nonpartisan research group, has estimated that 27 percent of Americans younger than 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under the system that existed before the Affordable Care Act. (New York Times, 5/6/17)  

One last point, this bill was passed by the House of Representatives and has a long way to go before it is signed by the President and becomes law.  Please make your voice and opinion heard by your elected officials.  It does make a difference. 

If you have questions, post them in the comments section and we will do our best to answer.  

-Meredith Buhalis

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What Is The Maximum I Can Make For...?

The Department of Health and Human Services begins using revised Federal Poverty Level Guidelines each April.  Many federally and state funded programs use the income guidelines to determine eligibility for programs and services.  Healthcare subsidy programs, Medicaid and Medicare all use the guidelines in their calculations.  The Federal Poverty Guidelines can be found here.

The chart below is what we use at the Washtenaw Health Plan to help people figure out what health care coverage is best for themselves and their family.  Our chart includes a 5% disregard.  We use the chart for determining eligibility for MAGI Medicaid. (What is MAGI?)

This is the document which includes disregards we use to determine eligibility for Medicaid, Marketplace tax credits and cost sharing, and other programs.  pdf

This is the document which includes disregards we use to determine eligibility for Medicaid, Marketplace tax credits and cost sharing, and other programs.  pdf

Our website has been updated with the new numbers.  Maybe you are very close to the edge of the income limit for MIChild or you need to check the income limit because you have a new baby.  Both Medicaid and MIChild have been updated.  Not sure where to go? Start Here

Many other programs use the Federal Poverty Guidelines as a baseline for their programs including:

Free and Reduced School Lunch Program

MOMS Medicaid is for pregnant women who are not eligible for full Medicaid because of their immigration status. 

Pregnancy Medicaid

WIC (Women, Infants and Children Supplemental Nutrition Program) provides food, nutrition counseling, and breastfeeding support to mothers and young children. 

Hospital charity care and financial assistance including M-Support and McAuley Support

Medicare/Medicaid programs help low-income Medicare recipients pay their health care costs. 

And many more! 

If you have questions, contact the Washtenaw Health Plan.  734-544-3030 or walk-in Monday through Friday from 9am - 4pm at 555 Towner St. in Ypsilanti. 

-Meredith Buhalis 

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WHP Staff Profile: Kelly Stupple

“The first few years of a child’s life make a world of difference, shaping who he or she will become, what he or she will achieve and how he or she will contribute to society as an adult.”--Kelly Stupple, Child Health Advocate

The first few years of a child’s life make a world of difference, shaping who he or she will become, what he or she will achieve and how he or she will contribute to society as an adult.

--Kelly Stupple, Child Health Advocate

 

Kelly Stupple is the Child Health Advocate for Success by 6 and is based at the Washtenaw Health Plan.  Kelly assists families in obtaining and retaining publicly-funded health insurance and quality medical, dental and mental health services for children, as well as prenatal and family planning care and insurance for women. 

WashtenawSuccessBy6

Irionna, a happy client, with Kelly. 

For several years, Kelly was the co-chair for Barrier Busters, a collaborative working to remove barriers to housing and health for low income county residents.  Kelly co-chairs the Spanish Health Care Outreach Collaborative (SHOC) with Spring Quinones. SHOC is a networking organization of Washtenaw area health, education and human service professionals who serve the Latino community.  Kelly is also a member of the Mental Health and Substance Use Disorder Care Work Group of the Washtenaw Health Initiative. She works with children's oral health and infant mortality prevention with an emphasis on disparities. Collaborating with area agencies, schools and medical providers, Kelly works to ensure that all families, regardless of income, country of origin or language spoken, have access to comprehensive and compassionate health care. 

Kelly has an AB from Harvard with a major in African American Studies and an MSEd in Guidance and Counseling from Hunter College. Her work history includes counseling for students of color, managing grant funds, and working extensively with low-income families and families with complex medical issues, navigating the health system.

Buddy's Pizza in Detroit. Kelly's favorite! 

Buddy's Pizza in Detroit. Kelly's favorite! 

Kelly also LOVES Buddy's Pizza in Detroit, likes to go for walks, and is married to a public school teacher/musician.  She is passionate about Michigan, Ypsilanti, Detroit and Ann Arbor.  Her daughter is in 8th grade at Slauson Middle School and will be following in her mother's footsteps, attending Community High School next year. She also has 3 cats and a part-time dog. 

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The Benefits of the ACA Go Beyond Health #thanksACA

The ACA is here to stay! For the moment. People talk about the Patient Protection and Affordable Care Act being beneficial for the health of individuals, but that is only the beginning.  There are benefits for women, hospitals, the economy, people who need mental health services, access to health care and much more! 

Maybe you know someone who quit a job they hated and started their own business because they could buy their own affordable insurance.

Maybe you know a family with a sick child who benefited from the removal of insurance spending caps.  

Maybe you know someone who was able to qualify for Medicaid and receive mental health services that allowed them to find a job and find stability in their life.

The expansion of Medicaid created the Healthy Michigan Plan and is making Michigan a better place to live. 

Please share widely or copy and paste.  jpg or pdf

Please share widely or copy and paste.  jpg or pdf

P.S. Remember these days?

On the left, President Obama signs the Patient Protection and Affordable Care Act of 2010. Note Rep. John Dingell on the right. On the right, Governor Snyder signs the bill authorizing the Healthy Michigan Plan.

On the left, President Obama signs the Patient Protection and Affordable Care Act of 2010. Note Rep. John Dingell on the right. On the right, Governor Snyder signs the bill authorizing the Healthy Michigan Plan.

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Actualizado ** Entendiendo el Deducible de Medicaid, o "Spenddown"

coinsStethoscope

In English - Updated** Understanding A Medicaid Deductible, or "Spenddown"

La mayoría de los programas de Medicaid cubren todos los beneficios esenciales de salud, como visitas al médico y al hospital, servicios de atención dental y de visión. Sin embargo, algunos programas sólo cubren beneficios limitados. Por ejemplo, el Medicaid de Servicios de Emergencia y el programa MOMS (información aqui) proporcionan servicios parciales a los inmigrantes. Otro programa "parcial" se llama el programa Deducible de Medicaid (anteriormente llamado Medicaid Spenddown).


El programa de Deducible de Medicaid está disponible para personas con discapacidades, ancianos, niños y padres de niños que están sobre el límite de ingresos para el Medicaid completo. A fin de calificar para un deducible, también tendría que cumplir con una prueba de activos (que tiene en cuenta sus activos, excluyendo una casa y un coche). Un individuo que está sobre el límite de ingresos para Medicaid y tiene muy pocos activos puede ser aprobado para el programa de deducible. El Departamento de Salud y Servicios Humanos (DHHS) especificará la cantidad del deducible, un número que oscila entre menos de cien dólares y varios miles de dólares. Este número se basa en los ingresos de su hogar.

LA IDEA ES SIMPLE, PERO LA ACCIÓN ES COMPLICADA

Con un deducible mensual de Medicaid, para que Medicaid llegue a ser completamente activo, las facturas que ascienden al deducible deben ser alcanzadas en un mes determinado. El individuo es entonces responsable del deducible y DHHS paga el resto. Por ejemplo, digamos que el deducible de Martha fue fijado en $ 800, y Martha tiene una factura del hospital en Mayo por $ 5,000.

Martha es responsable de pagar los $ 800 al hospital y DHHS paga $ 4,200. Para que DHHS pague, se debe presentar un informe de deducible.

Si la factura fue incurrida el 1 de Mayo y se presentó un reporte de deducible, durante el resto del mes Martha tiene Medicaid completo y Medicaid pagaría por cualquier servicio médico necesario, como gafas, limpieza dental o medicamentos. A partir del 1 de Junio, Martha no tiene Medicaid, pero de nuevo tendría que cumplir con un deducible.

Si Martha ingresó al hospital el 31 de Mayo y no tenía gastos médicos antes de esa fecha, no alcanzaría el deducible hasta el 31 de Mayo. A partir del 1 de Junio, el deducible / spenddown se restablecería, por lo que probablemente no sería posible de que le limpien los dientes en Mayo! Algunas personas, particularmente las personas que viven en hogares de ancianos, cumplen con su deducible cada mes, pero la mayoría de la gente no.

Recuerde: Para que Medicaid se active, las facturas y un Reporte de Deducible deben ser enviados al trabajador social del DHHS. El deducible debe ser alcanzado de nuevo cada mes para que Medicaid se active.

 

LOS DEDUCIBLES DE MEDICAID PUEDEN AYUDAR, PERO NO SE CUENTAN COMO COBERTURA DE SALUD COMPLETA

Importante: El programa de Deducible de Medicaid no cumple con los mandatos de la Ley de Cuidado de Salud a Bajo Precio. Esto significa que si esta es la única cobertura que tiene, se le puede aplicar una multa al presentar los impuestos al final del año.
La buena noticia es que usted puede tener un plan del mercado de seguromedicos o una cobertura de seguro de su empleador junto con un deducible de Medicaid. (Recuerde, Medicaid puede ser un seguro secundario.)


¿CONSEGUÍO LA COBERTURA CORRECTA?

A veces un individuo es aprobado para el programa de deducible pero realmente debe tener Medicaid completo. Si usted piensa que debe tener cobertura completa, la oficina del Washtenaw Health Plan ofrece una evaluación gratuita. Para obtener ayuda para presentar las facturas de su deducible de Medicaid o si cree que debe recibir Medicaid completo, vaya a la oficina del Washtenaw Health Plan. El horario de atención es de lunes a viernes de 9:00am a 4:00pm. Estamos ubicados en 555 Towner, Ypsilanti, MI.


¿Preguntas? Llame (734) 544-3030.

-Haley Haddad, Ingrid Fonseca, Ruth Kraut and Meredith Buhalis

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MIChild esta cambiando, y generalmente significara una mejor cobertura para los niños de Michigan.

MICHILD ESTÁ CAMBIANDO, EFECTIVO EL 1 DE ENERO DEL 2016.

Primero - ¿qué es MIChild? MIChild es el Programa Estatal de Seguro de Salud Infantil para niños que tienen ingresos mayores para Medicaid, pero cuyas familias siguen siendo de bajos ingresos. Si una familia tiene un hijo o más, el costo para la familia es $10/mes.

¿QUÉ NO ESTÁ CAMBIANDO?

  • MIChild seguirá costando $ 10 / mes por familia. Los pagos todavía se harán directamente a  MIChild.
  • MIChild todavía ofrece a sus hijos servicios médicos, dentales y de visión.
  • Las aplicaciones para MIChild continuarán a través del sistema DHHS MIBridges.
  • No habrá copagos para los servicios de MIChild.


Visite michigan.gov/mibridges y solicite cobertura de salud.

Visite michigan.gov/mibridges y solicite cobertura de salud.

¿QUÉ ESTÁ CAMBIANDO? 

Los niños recibirán una tarjeta (Medicaid) mihealth en lugar de una tarjeta MIChild. La mayoría de los niños también recibirán una tarjeta de un plan de salud. Nota: Si alguna vez ha tenido una tarjeta de mihealth, y todavía no la tiene, tendrá que llamar y solicitar una. Llame al 1-888-367-6557.

La cobertura dental tiene tres cambios: la cobertura ahora se llevará a cabo a través del programa Healthy Kids Dental (en muchos casos, esto significará más acceso a dentistas); No habrá límite máximo en dólares para los costos dentales; y la cobertura dental se limitará al beneficio dental de Medicaid.

Ya no habrá acceso a la acupuntura.

Los servicios de visión se limitarán a un examen ocular de rutina cada dos años. (Pero si necesita ver a un oftalmólogo para un problema ocular con más frecuencia, eso será cubierto.)

Su especialista en DHHS será responsable de ayudarle si necesita transporte para citas. (A menos que viva en los condados de Wayne, Oakland o Macomb, en cuyo caso llamaría al 1-866-569-1902).

MICHILD ENROLLEES TAMBIÉN TENDRÁN ACCESO A SERVICIOS ADICIONALES:

  • Ayuda con el transporte hacia y desde los servicios cubiertos (si no tiene transporte)
  • Ampliación de los servicios relacionados con la audición
  • Servicios de Podología
  • Ampliación de los servicios de enfermería
  • Algunos servicios basados n la escuela (por ejemplo, terapia física y del habla para individuos elegibles), a menos que estén cubiertos por su plan de salud
  • Beneficios ampliados para las mujeres embarazadas y los infantes (Programa de Salud Maternal Infantil)
  • Servicios de ayuda a domicilio
  • Beneficios ampliados de bienestar infantil

ADMINISTRACIÓN DEL PROGRAMA

La oficina local del DHHS ahora procesará las inscripciones, y usted puede ser inscrito tan pronto como el mes después de su solicitud. Los cambios en los ingresos, el tamaño del hogar y las renovaciones serán procesados través de su oficina local del DHHS.


La mayoría de las personas tendrán que elegir un plan de salud para sus hijos, y las opciones del plan de salud serán las mismas que las de los planes de salud de Medicaid. Si desea cambiar su plan de salud, llame al 1-888-367-6557.

Encuentre aquí el folleto de Preguntas Frecuentes de MDHHS.


ACTUALIZACIÓN DE LA COBERTURA MICHILD 1/14/2016

Bajo las viejas reglas de MIChild, una solicitud recibida durante diciembre tendría una fecha de inicio de elegibilidad en febrero, las solicitudes de enero serían elegibles para marzo, etc. Las nuevas reglas promulgadas el 1 de enero del 2016 permiten que el niño sea inscrito en el mes de aplicación y permiten cobertura retroactiva por 3 meses o hasta la fecha en que el programa entró en vigencia, que en este caso es el 1 de enero del 2016. La cobertura retroactiva no puede aplicarse a diciembre del 2015 porque las reglas de MIChild no permitieron una cobertura retroactiva durante ese período.

-R. Kraut, I. Fonseca, S. Quinones

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