MIChild

Open Enrollment Question: Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes)

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For many employees, Open Enrollment period for employer insurance comes in the fall, and is a short two or four week period where you have to make important decisions about health care for the coming year. This can be a lot of pressure, and so it turns out that a little preparation can go a long way. If you are a new employee at a job, you may be offered insurance right away, or after a period of 90 or 180 days.

Know your options, because if this were a relationship on Facebook, you might say, "It's Complicated!" What follows is a series of questions that will hopefully help you figure it out.

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If you are going to turn down your employer insurance, you want to make sure you are clear about the alternatives. Although it doesn't matter to Medicaid if you have an offer of employer insurance, it does matter if you were hoping to get subsidies on the Marketplace. Don't turn down your offer of coverage without studying your options!

1. Does your employer coverage meet Minimum Essential Coverage guidelines?

This would mean the the employer coverage covers:

  • Ambulatory patient services(Appointments and procedures in a doctor's office);

  • Emergency services;

  • Hospitalization;

  • Maternity and newborn care;

  • Mental health and substance use disorder services, including behavioral health treatment;

  • Prescription drugs;

  • Rehabilitative and habilitative services and devices;

  • Laboratory services;

  • Preventive and wellness services and chronic disease management and Pediatric services, including oral and vision care.

If the answer is yes, continue. If the answer is no, consider Marketplace and Medicaid eligibility and enrollment.

BEWARE: Some employers offer very inexpensive medical plans that do not cover hospitalization or emergency services. These do not meet Minimum Essential Coverage guidelines.

 

2. Does your employer coverage meet Minimum Value standards? 

Minimum value standard is a standard of minimum coverage that applies to job-based health plans. If your employer’s plan meets this standard and is considered “affordable,” you won’t be eligible for a premium tax credit if you buy a Marketplace insurance plan instead.

A health plan meets the minimum value standard if both of these apply:

  • It’s designed to pay at least 60% of the total cost of medical services for a standard population

  • Its benefits include substantial coverage of physician and inpatient hospital services

If you are unsure, ask your employer to fill out the Employer Coverage Tool.  

If the answer is yes, continue. If the answer is no, consider Marketplace and Medicaid eligibility and enrollment. 

NOTE: If the answer is no to EITHER the minimum essential coverage or minimum value standard, and you are income-eligible, you should be eligible for advance premium tax credits.

 

3. Is your family income low enough for some or all of your family to qualify for Medicaid?

Look here for the income eligibility tables for Medicaid. If you (or some members of your family) are income-eligible for Medicaid, you can apply for Medicaid instead of or in addition to your employer coverage. Because the income cutoffs for children are higher than for adults, often children can be enrolled in Medicaid or MIChild while the parents enroll in employer coverage. You can also have both Medicaid and your employer insurance--Medicaid will pay co-pays and deductibles not covered by your employer coverage, and this can be useful if you have a high-deductible plan. 

 

4. What is the cost of your insurance, relative to your income? 

To figure this out, look at the lowest-cost plan your employer is offering that meets the minimum standards (see #1 and #2 above), and the cost for the health coverage for the employee alone. 

Example 1: The cost is $100/month for the employee alone, and the employee makes $1000/month. $100/$1000=10% of income.

Example 2: The cost is $100/month for the employee alone, and the employee makes $2000/month. $100/$2000=5% of income.

Generally, if the cost is more than 8% of family income but less than 9.69% of family income, you are exempt from having to take the insurance, but you are not eligible to get advance premium tax credits on the Marketplace. [You may, however, be eligible for Medicaid!]

If the cost is more than 9.69% of family income, you don't have to take your employer insurance, but you can buy on the Marketplace and qualify for advance premium tax credits.

 

5. What about the rest of the family?  The Family Glitch

The Affordable Care Act looks primarily at affordability for the employee only. Different people in a family can get covered in different ways. 

If the cost of insurance for the employee is affordable, and the cost for the rest of the family is not affordable, you fall into what is called the "family glitch." The rest of the family is probably not going to be eligible for subsidized plans on the Marketplace. At this point, help from someone familiar with insurance options can be a big help. You may very well be exempted from the mandate to have health insurance, but that doesn’t help with getting health care. On the other hand, other family members may get covered differently. Possibilities may include: 

Thanks to healthinsurance.org for the image.

Thanks to healthinsurance.org for the image.

Don't forget: in many cases, different people in a family are covered in different ways. For example, each parent may be covered by his/her own employer, and the children may be covered by MIChild.

 

6. What if employer coverage gets offered or dropped in the middle of the year?

Changes in employer coverage in the middle of the year create Special Enrollment Period opportunities. If employer coverage is offered, you should evaluate it. If you have Medicaid and will continue to qualify for Medicaid, you may not want to take it. If you have a Marketplace plan and the employer coverage meets minimum standards, you may need to take the employer coverage because you will no longer be eligible for APTCs. If you take it and have a Marketplace plan, make sure to let the Marketplace know!

If you lose employer coverage during the middle of the year, you may be eligible for Marketplace or Medicaid plans. The Special Enrollment Period on the Marketplace after you lose employer insurance is good for 60 days. Medicaid is open year-round.

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If you have questions, call or walk in to the WHP office.

Washtenaw Health Plan, where We Help People like you!

Monday through Friday from 9am to 4pm

555 Towner, Ypsilanti, MI 48198

 

Resources

Employer Coverage Tool:  Use this tool to gather answers about any employer health coverage that you’re eligible for (even if it’s from another person’s job, like a parent or spouse). You’ll need this information to complete your Marketplace application. Complete one tool for each employer that offers health coverage that you’re eligible for.

Healthcare.gov: Apply here for Marketplace insurance. 

MiBridges: Apply here for Medicaid insurance. 

HealthSherpa:  Use this tool to compare health plans. 

Healthcare.gov Estimator: Compare or preview plans and rates with this estimator. Plans for 2019 should be available during the last week of October.

 

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Don't Be Scared, Healthcare Isn't Spooky! Instead, Get Ready!

If it's Halloween, then Open Enrollment on the Marketplace (healthcare.gov) is just around the corner!  It may also be time for your employer's open enrollment period! 

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Here's What You Need To Get Ready

1. Income information for everyone in your household

For Medicaid and MIChild, you need income information for  the current month/year. If you are applying on the Marketplace, you are trying to project your income and household information for next year (2018).  Income limits for Medicaid and MIChild can help you understand what you are applying for.

2016 Taxes: Your 1040 form (first page), as well as W-2s and  Schedule C or E if you are self-employed. 

Paystubs:  Bring 30 days of the most recent paystubs for anyone who is working.  If you don't have paper copies, make sure you can access your pay information online. 

Self-employment Information: Recent income and expense statement, Schedule C or E. 

Do you have a working teenager in your family?  Read more about whether or not their income counts at  Teens Who Work: Does Their Income Count?

2. Household composition

For the Marketplace, what matters is your tax household. For Medicaid and MIChild, both who is in your tax household and who is living in your house are important. For everyone in your house, you need certain documents. 

Who was in your household this year and who will be in it next year?  (Hint: Is your college senior graduating? Did you just have a baby?)

Social Security Numbers for everyone in the family who has them.

Immigration documents, such as permanent resident green cards, work permits, visas. (People who have DACA status cannot apply on the Marketplace and should contact the WHP for help.)

Home and/or mailing addresses for everyone in the household.

Dates of birth for everyone.

3. Employer coverage

Does your employer offer coverage?  What does it cost?

Your employer can fill out this form to help decide if your employer coverage is affordable and meets minimum coverage standards according to the Affordable Care Act:  Employer Coverage Tool.

In some cases, employer insurance may be affordable for the employee, but not for the rest of the family. Contact the WHP for help in that situation.

Open Enrollment Question: Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes)

4. Log-ins and password

If you had Marketplace insurance, you already have an account.  Find your Marketplace account information sheet or make sure you have the password for your email account. (If you have multiple email accounts, you can usually identify the one with the active healthcare.gov account by searching for emails from healthcare.gov.)

Want Help? We are making appointments now, so call 734-544-3030.

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Fight Repeal and Replace (Graham-Cassidy-Heller)! Support CHIP (Children's Health Insurance Program)!

Never let your guard down!  An effort to Repeal and Replace [the Affordable Care Act] has reared its ugly head again, threatening to take away healthcare from millions by ending Medicaid expansion (the Healthy Michigan Plan); raising costs for everyone; eliminating protections for pre-existing conditions; cutting coverage for low income seniors, children and the disabled; and attacking women's health and family planning.  

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The Congressional Budget Office (CBO) will not have time to fully score this bill before September 30th, 2017, and so there are not as many details about the costs and implications of this bill as there would be otherwise. However, the CBO has rated similar bills, and under those bills, 15 million people would lose Medicaid alone, and 32 million people might lose insurance. The Graham-Cassidy-Heller bill also privileges rural states over urban/suburban states, and Michigan is a clear loser. Large cuts to funding begin in 2020 but accelerate over time. Follow this twitter thread for a lot of details.

Under this bill, there would be huge premium increases for people with pre-existing conditions

Compare the bill to the ACA using the Kaiser Family Foundation comparisons web site.

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But What About MIChild?

The Children's Health Insurance Program (CHIP), which provides coverage to children who do not qualify for Medicaid but whose families cannot otherwise afford health insurance, is also under attack.  In Michigan, CHIP is the MIChild program. CHIP funding is set to expire on September 30, 2017. Although there is, in principle, bipartisan agreement on extending the CHIP program, including MIChild, this agreement is being set aside while the Senate focuses on the Graham-Cassidy-Heller bill.

This piece from the Georgetown Center for Children and Families does a good job explaining the conflict between the two efforts. As Kelly Whitener writes,

For example, it would not be possible to have a good faith negotiation on extending CHIP funding (which covers 9 million children) while there is a live debate on gutting Medicaid (which covers 37 million children). This is not simply a matter of Congress learning to multi-task – you simply cannot work toward two totally different goals simultaneously.

Without CHIP renewal, MIChild will end when the state's reserve runs out (likely, early spring of 2018). This puts the health of over 40,000 of Michigan's children at risk. 

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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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Top Posts of 2016

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Teens Who Work: Does Their Income Count?

Think of yourself as a teenager. Did you work? Did you have a summer job lifeguarding at a pool, or a year-round job bagging groceries? Did you referee kids' soccer or baseball, or babysit your neighbor's first grader?

If you did work, then you are just like millions of American teenagers, who work for spending money, to help the family pay bills, or to save money for college. 

Found online  here .

Found online here.

Lower-income families, filling out a Medicaid or Marketplace application, may wonder if the teen's income "counts."

Counting A Dependent's Income

The short answer: If the teenager's annual income is less than the required threshold for filing taxes ($6300 for earned income in 2016), then the income does not "count" as family income. If the teenager's annual earned income is more than the required threshold for filing taxes, then the income does "count" as family income. [Unearned income, such as interest from stocks or bonds, has a lower threshold to require tax filing.]
What if you have a dependent who is not a teenager, but who works? For example, what if your elderly mom lives with you and you take her as a dependent on your taxes?  What if she works 5 hours/week at a local store? The same tax filing threshold rules apply.

A Tale Of Two Families

Family 1: Maria, Juan, and Elizabeth

Maria is a single mom of Juan, age 17,  and Elizabeth, age 10. Maria works for a temporary agency and makes about $1700/month, or $20,400 annually. Using just that income, she--and her children--all qualify for Medicaid. 

Juan wants to go to college, and worked all summer scooping ice cream. He made $5,000. During the school year, though, his mom doesn't want him to work, because she wants to make sure he gets good grades. 

TEST YOURSELF: For Medicaid and the Marketplace, is the family income: 

icecreamscoop
  1. $5,000
  2. $20,400
  3. $25,400

 

If you answered #2, $20,400, you are correct. That's because Juan's ice cream income does not get added to the family income because it is less than the tax filing threshold. The entire family should be eligible for Medicaid.

**Note that Juan might still file taxes since he might get some money back in a tax refund--but it's the fact that he doesn't HAVE to file taxes that will mean that his income doesn't get added to his mom's income for the purposes of health insurance eligibility.

 

Family 2: John, Anne, Sarah and Jesse

John and Anne are married. Sarah is 16 and Jesse is 14. John cooks at a restaurant and makes about $2500/month, or $30,000/year. Anne recently went back to college and works very part-time in a grocery store, making about $500/month, or $6,000/year. Sarah wants to go to college, and she also likes to have some spending money, so she works full time in the summer, and part time during the school year, at the restaurant where her dad cooks. This year, she expects made $10,000.

TEST YOURSELF: For Medicaid and the Marketplace, is the family income: 

  1. $6,000
  2. $30,000
  3. $36,000
  4. $46,000

If you answered #4, $46,000, you are correct. That's because Sarah's income is above the tax filing threshold (she must file taxes), and so it gets added to John and Anne's income. The children--Sarah and Jesse--will still be eligible for MIChild. If John does not have an offer of employer insurance, then John and Anne will be able to go on the Marketplace

Resources

Teen Jobs and Tax Issues from Bankrate. 

How to File Your Child's First Income Tax Return from Investopedia. 

IRS Publication 929 - a very detailed explanation of dependents and income filing requirements.  

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Helping Children With Special Healthcare Needs

Children’s Special Health Care Services is a state-wide program that serves children with chronic health problems and their families. The program can save families money and at the same time make sure that sick kids get what they need! The program's aim is to provide patients and caregivers with the knowledge and resources to receive the best quality care for their individual needs. In Washtenaw County we currently have about 940 children enrolled!

How Does it Work?

The program works as secondary insurance to help cover the cost of the child’s diagnosis. Which means the family’s primary insurance – such as employer insurance or Medicaid – pays first and then CSHCS picks-up the co-pays, deductible, and out-of-pocket costs related to the qualifying diagnosis.

Here is an example:

Max is enrolled is CSHCS because he has Type 1 Diabetes. One day, he loses consciousness during gym class. His school calls an ambulance. The paramedic finds that his blood sugar was too low. CSHCS will cover the cost of the ambulance ride, the ER visit, any medicine prescribed or tests run, and hospital admission if necessary. The out of pocket medical expense for Max's family is $0

But even during a good month where Max doesn't have to go to the hospital or to see a doctor, he still needs medication and supplies to help manage his Type 1 Diabetes. Look at the charts below to see how CSHCS helps Max's family cover those costs. 

Max has type 1 diabetes, he is covered by his mom's employeers insurance who pays 80% of medical costs after a $4000 deductible.png

It's important to note that CSHCS doesn't help cover all medical costs, only the costs related to the child's qualifying diagnosis. The program will not pay for visits to the primary care physician or any other unrelated medical costs. 

Who Can Enroll?

CSHCS covers children from birth to age 21 with one or more of the qualifying diagnoses. These diagnoses are any of 2,700 physical conditions like severe Asthma, Type 1 Diabetes, Cerebral Palsy, and different types of cancer. Click here for a list of these diagnoses.

A lot of times, if a child is diagnosed with one of the diseases on the list, a nurse or social worker will recommend the child for the program and a designated pediatrician decides whether or not the child is approved. But sometimes, the program receives calls from parents who believe their child is a good fit for the program and then our public health nurses will investigate those cases further. The program may even help pay for the costs of diagnostic tests if needed.

Is CSHCS Only For Low-Income Families?

A lot of families don't know that they can enroll in CSHCS even if they have private or employer insurance! CSHCS is based on the child’s diagnosis, not income. So anyone with a child who has one or more of the qualifying diagnoses can enroll. There is a sliding annual fee which is based on the family’s income, but in certain cases--for foster children or kids already on Medicaid--the fee can be waived. For almost all current enrollees, the annually fee is significantly less than what the cost of healthcare would be without CSHCS.

More Information

For more information you can visit the Children's Special Health Care Services website

If you live in Washtenaw County you can contact one of our RNs with questions:

  • Last names starting with A through J: Colleen Warner at 734-544-3080 or by email at warnerc@ewashtenaw.org.
  • Last names starting with K through Z: Muhammad Saifudin at 734-544-9750 or by email at saifudinm@ewashtenaw.org

If you are a service provider or community partner, please contact our program supervisor, Christina Katka at 734-544-2984 or katkac@ewashtenaw.org.

If you live outside of Washtenaw County you can find contacts here.

--K. Okarski

Editor's Note: This blog post was written by Kayla Okarski, a Washtenaw County Public Health and Washtenaw Health Plan summer intern who is a senior at Grand Valley State University. Thanks Kayla for all of your work!

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Flint Water Medicaid: See If You Qualify

Map of the City of Flint. 2016 Google.

Map of the City of Flint. 2016 Google.

As a result of the Flint water crisis, the State of Michigan applied for--and got--a Medicaid waiver that allows Medicaid to serve children and pregnant women who may have been affected by lead in the water, even if their incomes are above typical Medicaid income cutoffs.

Who is eligible?

Pregnant women and children under age 21 whose income is below 400% of the FPL and were impacted by the Flint water system are now eligible for full Medicaid and targeted case management services. Children of women who were impacted while pregnant are also eligible for full Medicaid and case management services. If your income is above 400% of the poverty level but you qualify for geographic reasons, you will be able to "buy in" to Medicaid in the near future.

Income limits by household size for Flint Medicaid.

Income limits by household size for Flint Medicaid.

If you qualify for Flint Water Group MIChild, you will not have to pay the $10/month co-pay.  Young adults up to age 21 and pregnant women who qualify for Flint Water Group Healthy Michigan Plan (or any other type of Medicaid will not have to pay any co-pays or cost-sharing.

What qualifies as "impacted by the Flint water system?"  

Anyone who lived, worked, received childcare services or educational services at an address served by the Flint water system from April 1, 2014 going forward is included. There is no end date.  Children who attended schools or went to daycare centers are eligible. People who work in Flint but live in another Michigan county are eligible.  You must be a Michigan resident.  If a 19 year old took a class at UM-Flint, s/he is eligible.  If you lived in Flint in June 2014 but moved to Washtenaw County, you are eligible. 

I believe I am eligible, what do I do? 

MiBridges Application- Flint Water Question

MiBridges Application- Flint Water Question

You can apply online at michigan.gov/mibridges.  When you apply, you will be asked if you consumed water from the Flint water system.  The system will also ask you for the city, state, zip code and location type (home, work, school) where you consumed water.  You do not have to know the exact address.  At this time, you only have to attest that you consumed water from Flint Water System.  In the future it may be necessary to provide proof.  

I live in Flint and already have Medicaid, so does this matter to me?

If you currently have Medicaid (for children under 21 and pregnant women) and you live in a residence serviced by the Flint water system, you will automatically be enrolled in Flint Water Group Medicaid. This means that you will be eligible for Medicaid even if your income goes up, and that you will be eligible for additional case management services. You should receive a letter explaining the additional services.  (Remember: It is important to keep your address updated with DHHS if you move! You can do that by reporting a change online, or by faxing a notice of address change to 517-346-9888. Put your name and case number on the fax.) 

My family was denied Medicaid but I think we qualify for the Flint Water Group Medicaid. What do I do? 

If you were recently denied Medicaid but believe you are eligible for Flint Water Group Medicaid, contact the Beneficiary Help Line 1-800-642-3195 or your caseworker to report that you are part of the Flint Water Group.  Enrollment for Medicaid is open anytime, reapply anytime at michigan.gov/mibridges.  If you need help, please contact an agency who can help you

Is Flint Water Group Medicaid different from other Medicaid?

Yes.  Flint Water Group Medicaid includes all Medicaid services (medical, dental and vision) AND targeted case management services.  Targeted case management services include an assigned caseworker from Genesee Health System who will coordinate access to needed medical, social, educational and other services.  Contact your doctor, your Medicaid health plan or call the Genesee Health System at (810)257-3777 to receive the extra services.  

I am an immigrant. Can I still qualify? 

If you are an immigrant who is a naturalized citizen, a green card holder for more than five years, or a refugee or asylee, you will qualify for the Flint Water Group or other Medicaid. 

If you do not have eligible immigration status (including having a green card for less than five years, a work permit, a student visa, or no immigration documents at all), you only qualify for the emergency services Medicaid. However, if you meet the location and income criteria, you could qualify for Emergency Services Only Flint Water Group Medicaid even at a higher income level.

-M. Buhalis and R. Kraut

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Updated** Medicaid Dental: How to Use it and Where to Go...

Many Medicaid programs include dental coverage! Keeping your teeth healthy is just as important as taking care of your body. Here is a overview your dental benefit in Livingston and Washtenaw counties, as well as Jackson, Hillsdale, Monroe and Lenawee counties:

Healthy Kids: 80 Michigan Counties (including Livingston and Washtenaw) work with Delta Dental and an estimated 80% of dentists in those counties participate! This public-private partnership has continued to increase since it started in 2000, and with it many children have been able to access necessary dental services.

**MIChild: Beginning January 2016, MIChild is now a Medicaid program and all MIChild participants have Delta Dental. Medical, dental and vision benefits are now the same as Healthy Kids.

**Healthy Michigan Plan: While all HMP managed care plans have a dental benefit, only some work with Delta Dental. In Livingston and Washtenaw counties, those who have Molina and McLaren have Delta Dental, while other managed care plans use their own dental coverage. Meridian and Aetna Better Health have Dentaquest, Blue Cross Complete has HMI Dental and UnitedHealthCare has their own dental plan (call 1-800-903-5253).  When you're making an appointment, make sure to tell your dentist what managed care plan you have to avoid any confusion.

Medicaid to Supplement Medicare: As Medicare beneficiaries know all too well, it does not include a dental benefit. However, if you are eligible for Medicaid to supplement, you can access dental coverage through straight Medicaid. There are also some Medicare Advantage plans that offer dental coverage.

Finding a dentist that takes your health coverage can seem like a daunting task. Here are some helpful links to finding the right dentist for you:

**Washtenaw Community Dental Clinic opened in February 2015, and accepts all Medicaid dental plans (except Blue Cross Complete), straight Medicaid and the uninsured. Located in the Haab Building at 111 N. Huron St., Ypsilanti. Call today for an appointment, (877)313-6232.

-Haley Haddad


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MIChild is Changing, and It Generally Will Mean Better Coverage for Michigan Kids

 

MIChild is changing, effective January 1, 2016.

First--what is MIChild? MIChild is the state-run Children's Health Insurance Program for children who are over-income for Medicaid but whose families are still low-income. Whether a family has one child or ten children, the cost to the family is $10/month. 

What isn't changing?

  • MIChild will still cost $10/month per family. Payments will still be made directly to MIChild.
  • MIChild will still get your children medical, dental, and vision services. 
  • Applications to MIChild will continue to go through the DHHS MIBridges system.
  • There will still be no copays for MIChild services.
Visit  michigan.gov/mibridges , and apply for health coverage.

Visit michigan.gov/mibridges, and apply for health coverage.

What is changing?

Children will receive a (Medicaid) mihealth card instead of a MIChild card. Most children will also get a card from a health plan. Note: If you ever had a mihealth card before, and you don't still have it, you will need to call and request one. Call 1-888-367-6557.

Dental coverage has three changes: coverage will now take place through the Healthy Kids Dental program (in many cases, that will mean more access to dentists); there will be no maximum dollar limit for dental costs; and dental coverage will be limited to the Medicaid dental benefit. 

There will no longer be access to acupuncture.

Vision services will be limited to one routine eye exam every two years. (But if you need to see an eye doctor for an eye problem more frequently, that will be covered.)

Your DHHS specialist will be responsible for helping you if you need transportation to appointments. (Unless you live in Wayne, Oakland, or Macomb counties, in which case you would call 1-866-569-1902.)

MIChild enrollees will ALSO have access to additional services:

  • Help with transportation to and from covered services (if you do not have a ride)
  • Expanded hearing related services
  • Podiatrist (foot doctor) services
  • Expanded nursing facility services
  • Some school-based services (e.g. physical and speech therapy for eligible individuals), unless covered by your health plan
  • Expanded benefits for pregnant women and infants (Maternal Infant Health Program)
  • Home help services
  • Expanded well child benefits

Program Administration

The local DHHS office will now process enrollments, and you can be enrolled as early as the month after your application. Changes in income, household size, and renewals will all be processed through your local DHHS office.

Most people will need to choose a health plan for their children, and the health plan choices will be the same as the Medicaid health plans. If you want to change your health plan, call 1-888-367-6557.

Find the MDHHS Frequently Asked Questions brochure here.

MICHILD COVERAGE UPDATE 1/14/2016

Under the old MIChild rules, an application received during December would have an eligibility begin date of February, January applications would be eligible for March, etc. The new rules enacted January 1, 2016 enable the child to be enrolled in the month of application and allow retroactive coverage for 3 months or back to the date that the program became effective, which in this case is January 1, 2016.  Retroactive coverage cannot be applied to December 2015 because MIChild  rules did not allow retroactive coverage during that time frame. 

--R. Kraut

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