Medicaid expansion

Medicaid: A State By State Program

Medicaid differs state by state. The income limits for children’s Medicaid, Medicaid for low-income parents, and Medicaid for adults vary. Even some of the rules for immigrants vary. Most of the advice on our website is specific to Michigan. This blog post attempts to give you some more resources if you are located in a different state. But if the relationship between different states on Medicaid were a Facebook relationship status, it would be: “It’s Complicated.”

Find Your State—What Does Your State Offer?

Are you looking for information about your state? This map links to information about each state including eligibility, expansion, CHIP (Children’s Health Insurance Program) and enrollment. The map does not include links to enrollment sites.

State Overviews from Medicaid.gov

Covering Adults: Medicaid Expansion

The Affordable Care Act offered states the option to expand Medicaid to cover adults between the ages of 19 and 64 who are making up to 138% (133% + 5% disregard) of the Federal Poverty Levels. States voted to expand Medicaid and the federal government agreed to pay for 100% of the program from 2014 to 2016, dropping to 90% of the program after 2020. Currently 34 states including DC have expanded Medicaid, 3 states are considering expansion and 14 are not expanding. Low-income adults who previously had no healthcare could now be covered by Medicaid.

If you are from another state, find out the status of the Medicaid expansion in your state below.

Different states have given their Medicaid expansion different names. In Michigan, expanded Medicaid is called Healthy Michigan Plan. In Illinois, the program is called HealthChoice Illinois, and it is Medi-Cal in California. These plans do differ from state to state but must cover the essential health benefits set in the Affordable Care Act of 2010. Under the current administration, some states are requesting and being approved for waivers that include work requirements and other restrictions. Read more about current and pending waivers here. If you are really interested in waivers, check out the Kaiser Family Foundation’s (KFF) Waiver Tracker.

Need Help With Figuring Out Eligibility?

If you have questions about your eligibility, your child, your parent or someone else’s eligibility, call us at 734-544-3030 if you are in Michigan. If you are not in Michigan and need information about eligibility or enrolling, there are two resources.

The first is Federally Qualified Health Centers (FQHC). FQHCs are federally funded health centers that provide medical (and sometimes other) services. If you are looking for information about healthcare, an FQHC is a good place to start. Because they provide sliding fee scale services, they usually have information about Medicaid for adults, families and children, as well as patient advocates who can help you navigate the system.

FQHC Locator

The second resource for finding out about healthcare is the Marketplace’s Find Local Help (https://localhelp.healthcare.gov). This lists organizations and individuals who can help with the Marketplace and sometimes Medicaid. Choose your contacts wisely, brokers and agents are paid to sell insurance and may or may not be familiar with Medicaid programs and eligibility. Assisters are certified to enroll you on the Marketplace and should be familiar with Medicaid/CHIP eligibility in your area.

The Washtenaw Health Plan (left) is listed as an Assister; on the right, you find an Agent or Broker.

The Washtenaw Health Plan (left) is listed as an Assister; on the right, you find an Agent or Broker.

What If You Are Traveling and Need Emergency Care?

If you have Medicaid but need to go to an Emergency Room in another state, show them your Medicaid card and make sure to talk with the billing department before you leave. Most states have reciprocal agreements for emergencies for Medicaid clients—you cover mine and I’ll cover yours. Medicaid does not cover routine care in other states.

Planning A Move? Figure Out Your Health Care Options First!

If you are moving, make sure to cancel your Medicaid and apply in your new state. If you are wondering what your healthcare options are in your new state, use one of the tools above or go to this directory to find Medicaid contact information for any state.

Because different states have different rules, you may or may not be eligible for Medicaid in your new state. For instance, currently Texas has not expanded Medicaid. If your income is $1100/month (single person) in Michigan you could get Medicaid, but in Texas, you could not. Move from Texas to Michigan, and you’d be in luck.

For people who are in a state that did not expand Medicaid, if your income is below 100% of the poverty level, and especially if you are not a parent of minor children, you may need to rely on charity care programs. If you are above 100% of the poverty level, you may be able to go on the Marketplace. So when you are moving, don’t forget about the special enrollment period—it’s time-limited!

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Medicaid Work Requirements Signed--What Next?

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On Friday, June 22nd, Governor Snyder signed SB 897, the Medicaid work requirements bill. (Read about its details here. Read the full bill here.) We have been getting phone calls about what this means for individuals. For now, nothing has changed.

What happens next? The Michigan Department of Health and Human Services needs to submit a request for a waiver to the federal Centers for Medicare and Medicaid Services (CMS), and they need to approve the waiver, before any work requirements will be in place. In the meantime, if you are eligible for Medicaid, you should apply. (Figure out if you are income eligible here.)

Remember that Medicaid is open year-round, so a change in circumstances (losing a job or losing insurance, getting married, getting pregnant, etcetera) can mean you are now eligible when you were not before. If that is the case, please give us a call at 734-544-3030 or come into our offices at 555 Towner in Ypsilanti, Michigan, Monday-Friday from 9 a.m. to 4 p.m.

We will be helping people learn how to comply with Medicaid work requirements once they are in place, but for now, the Medicaid program is the same as it was yesterday. Keep Calm! Apply On!

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Four Reasons (Aside From The Work Requirement) To Ask Governor Snyder To Veto The Medicaid Work Requirements Bill

As if the Medicaid work requirements, discussed more fully in our last blog post, are not enough, there are four other problems with the Medicaid Work Requirements bill, also known as SB 897. This analysis quotes a FamiliesUSA blog post, written by Eliot Fishman, Senior Director of Health Policy. Read his full blog post here.

Read the House Fiscal Agency Legislative Analysis here. You can find a lot of the details in the House Fiscal Agency Legislative Analysis.

As Fishman notes:  

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1. The Bill Gives the Trump Administration and Washington Bureaucrats the Power to Kill the Healthy Michigan Program: As of now, with the Affordable Care Act surviving in Congress, the only people who can take Healthy Michigan coverage away or Michiganders and their state officials. But the new bill gives the Federal government one year to approve Michigan’s waiver request or the Healthy Michigan program goes away, leaving all of its enrollees with no health insurance...
2. The Bill Includes a Bizarrely Punitive Premium for Near-Poor Working People: People with incomes just over the poverty line come in for particularly harsh treatment in the bill. Anyone with an income between 100% and 138% of the poverty level for four years or more are forced to pay 5% of their income—far higher than any premium in Medicaid in any other state—or lose their coverage. This would create a strong incentive to REDUCE income to under the poverty line...
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3. The Bill Would Lock People Out of Coverage for a Year for Paperwork Discrepancies: The bill creates a broad mandate on Michigan Medicaid to take coverage away from people in the Healthy Michigan program for a year if they are found to have “misrepresented their compliance” in required monthly reporting of their work hours...
4. The Bill Creates a Crazy, Rushed Timeline for the Snyder Administration to Write and Submit a Waiver: The Snyder administration is required to submit a waiver to the Trump administration by October 1, 2018.  But federal and state law require the waiver to be submitted for public and tribal consultation starting 60 days before federal submission—so no later than the end of July. That gives Michigan Medicaid just a few weeks to lay out their plans to implement this complex mess of a bill.

You can ask Governor Snyder to veto this bill. Contact Governor Snyder here.

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Medicaid Work Requirements Passes the Senate--What Next?

Medicaid work requirements were discussed in a public hearing at the Michigan Senate Competitiveness Committee on April 18, 2018. You can watch it! The WHP's Ruth Kraut and Medicaid recipient Claire Maitre speak at 13:54 (Ruth) and 30:45 (Claire). 

The following day, April 19th, the bill was voted out of the Senate. It passed 26-11, with one Republican joining 10 Democrats in voting against the bill. The bill now moves to the House.

Problems with video?  Click here.

Here is the link to the S2 (second substitute) of SB 897, which is what was voted on. Read the bill.

Read the history of the bill here.

We've been writing about work requirements and Medicaid. Read more below.

What Can You Do Now?

Now that the bill has passed the Senate and been sent to the Legislature, no matter where you live in the State of Michigan, you can contact your Representative and tell him or her how you feel about the bill. 

Find your Michigan Representative here

Send a letter to your Representative via Michigan League for Public Policy. 

Contact Governor Snyder! Call 517-335-7858 or 517-373-3400 or click here.

Check healthcarecounts.org regularly for updates on this issue.

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Medicaid work requirements: A prescription for problems

“We’ll call you with the results on Monday.”

If you’ve ever left your doctor’s office after hearing those words, then you’re familiar with the dread. Minutes become hours, hours become days, and the worst fears tend to enter your mind no matter how hard you try to suppress them.

Waiting for that call is excruciating. But a law being proposed in Lansing would make it a lot worse for many in our state.

Michigan’s Senate Bill 897 is ethically, logically and morally wrong; it threatens the healthcare of hundreds of thousands of Michiganders. And it’s going to cost us a boatload.

The bill comes on the heels of a change at the federal level that allows states to request waivers to enforce work requirements on Medicaid recipients.

First, let’s look at what Medicaid is. Medicaid is healthcare. It was designed to help sick people get well and to help healthy people stay that way. And it does a pretty great job. Michiganders with low incomes are able to sleep at night knowing that they can receive healthcare through Medicaid and Michigan’s expanded Medicaid program, the Healthy Michigan Plan. Since its creation in 1965, that’s what Medicaid has been: A healthcare plan.

Now, let’s look at what Medicaid is not. Medicaid is not a jobs program. Jobs programs help train workers, eliminate barriers like transportation and childcare issues, and work with local governments, community members and businesses to find solutions to problems in workforce development. By all means, let’s invest in solid jobs programs!

But some in the Michigan Legislature think we need to complicate the health plan by adding layers of bureaucracy and obstacles with work requirements. Here are a few logical truths to counter the myths being used to push work requirements:

  1. Most Medicaid recipients who can work are already working. Those who don’t work are students, caregivers, retired or in poor health.
  2. Michiganders enrolled in Healthy Michigan are doing better at work and are able to find work because they have healthcare. It’s not a big stretch: Being healthy makes it easier to thrive in the workplace. But it doesn’t work the other way around. Being at work doesn’t suddenly cure health problems.
  3. Medicaid recipients, employers, doctors and state employees will be burdened with paperwork, red tape and additional hurdles. These complications will strain the state and cause many struggling Michiganders to lose coverage.
  4. It’s going to cost us. Kentucky, which recently implemented work requirements, reports that just setting up the infrastructure to track work requirements will cost nearly $187 million in the first six months alone.
  5. Work requirements are potentially illegal. Under the act that created the Medicaid program, certain parts of the Medicaid Act can be waived, but new eligibility criteria cannot be imposed—in this case, the criteria of work in order to qualify for Medicaid. Legal challenges have already begun in Kentucky that could have repercussions on any states pursuing work requirements. Michigan lawmakers should wait and see how that case unfolds.

I’m obviously urging you to take action on this issue. But I’m also asking you to start talking about it. Talk to your friends, your neighbors, your family. Help them to understand what Medicaid is and what it is not.

I also hope you’ll listen. Over the years Medicaid has helped millions of Michiganders, from those going through a rough patch to those struggling with chronic health problems or terminal illness. It is likely that someone you love or know has benefited from Medicaid. Take the time to listen to how it helped them temporarily or on a long-term basis. And encourage them to share their story to make a difference.

If you have a personal story about how Medicaid and having reliable healthcare has enabled you to work or look for work, please share it!  Click here. 

If you have a personal story about how Medicaid and having reliable healthcare has enabled you to work or look for work, please share it!  Click here. 

Healthy people are better able to work, but working people do not automatically become healthy. Let’s stop discussing unnecessary plans like this and instead focus on the real things Michigan residents need to work and provide for their families, including Medicaid and other assistance programs, job training, adult education, high-quality child care, reliable public transportation, and more.

Added April 4th, 2018 by Gilda Z. Jacobs  

By Gilda Z. Jacobs, president & CEO of the Michigan League for Public Policy since 2011

April 4, 2018 

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For These Four Working Households, Medicaid--Without Work Requirements--Matters

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The idea of work requirements for Michiganders on Medicaid is rather abstract. Unfortunately, it would have significant negative consequences. Here are some real stories of people that we have worked with in the past year. (Names have been changed.)

What unites these families is that--even though, in each case, someone in the household is working--under the proposed work requirements for Medicaid, they wouldn't qualify for Medicaid. Here are their stories.

Marsha and Will: Bad Luck and Poor Health Means Medicaid is More Important Than Ever

Marsha and WIll are a married couple in their fifties, and their kids are now all grown. In 2016, they were both working low-wage jobs in the service industry. Their combined income was around $28,000/year. They could afford their rent, and their car, and they qualified for tax credits on the Marketplace. In early 2017, WIll lost his job. He was looking for a job, but now they were living on Marsha's job at Subway, which was averaging about 28 hours/week. Paying for rent was tough, but at least they now qualified for Medicaid. After about six months of being unemployed, Will had a heart attack and was in the hospital for five days. 

Under proposed Medicaid work requirements, Marsha's work was less than 30 hours/week and Will wasn't working at all--they would not have qualified for Medicaid. When Will had his heart attack, what would have happened?

Virginia: Medicaid is Vital to Mental Health

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Virginia is a single woman in her 20s. She has a history of depression and anxiety, and had been helped by Community Mental Health. When she started working 33 hours/week, her income was too high for Medicaid, and as a result she lost her relationship with Community Mental Health. Without medications and support, her anxiety got so bad that she couldn't work at all. Then Virginia became eligible for Medicaid--and Community Mental Health--again. Now, with the support of Medicaid and CMH, she is able to work. Virginia now keeps her work hours at about 25 hours/week, in order to stay eligible for Medicaid and--therefore--CMH. 

With Medicaid work requirements, Virginia might not be able to keep her hours below 30 hours/week. And if her income goes above 30 hours/week, at $11/hour she won't be eligible for Medicaid--or CMH services.

Maria and Jose: Medicaid Keeps The Family Healthy

Maria and Jose have two children, ages 3 and 5. Jose works two jobs so that Maria can stay home with the kids--childcare costs are so high. Jose is offered (and takes!) insurance from his work, but while it would be affordable for him ($100/month), if he were to add the rest of the family it would cost $600/month. So Maria and the kids are on Medicaid, which is a good thing, because Maria and her youngest child have asthma. 

With Medicaid work requirements, Maria wouldn't be eligible for Medicaid unless she were working 30 hours/week. In order to do that, though, they would have to pay for childcare. Without the asthma medication, Maria might end up in the emergency room. 

Jasmine and Mark: Medicaid Allowed Them To Take A Chance And Start A Business

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In 2015 Jasmine and Mark decided to start their own business in Washtenaw County. Investing their life savings, they quit their jobs and started spending long hours on their business. Without income, they and their two kids got Medicaid. In the first year, they did not turn a profit. In their second year, they started making a little bit of money, but were still Medicaid eligible. By year 3, they were over income for Medicaid and went on the Marketplace.

With Medicaid work requirements, in the first two years of their business, their income did not reflect the work they were putting in. How could they prove they were working? Would they qualify for Medicaid?

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Why it could be worse (or better) to be sick in some states than others

Where you live could mean the difference between life and death.  

How did Medicaid start? 

Why doesn't the United States have Universal Health Care?  

Who lobbied against socialized medicine when most of the world adopted it?

Why is Medicaid different from one state to the next?

Vox.com made a great video to explain the history of Medicaid and how block grants, expanded Medicaid and legislation have created health care disparities from one state to another.  

What about Michigan? 

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Michigan expanded Medicaid to cover adults under 138% (133% with a 5% disregard) of the poverty level in 2014. In order for Medicaid to be expanded in Michigan, Michigan legislature insisted upon two modifications (aka waivers). The modifications involved cost sharing:  people have to pay small co-pays and premium-type payments for their Medicaid.  (Read more here: Paying for Medicaid: Co-pays and Contributions.)  

Expanded Medicaid or as it is called in Michigan, the Healthy Michigan Plan, has helped millions of people become healthier.  People have gained access to care, boosted the economy, and received mental health and substance use abuse treatment. 

If you are wondering if you are eligible for Medicaid, call 734-544-3030 or walk-in to our offices from 9am-4pm Monday - Friday. We Help People - Like You! 

 

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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. 

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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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Top Posts of 2016

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HMP Year One: a Look Back

Medicaid Expansion Year One: a Look Back

Here we are, just over one year after the implementation of Michigan’s Medicaid Expansion- the Healthy Michigan Plan! It was much quieter this morning, which provided our hard working assistors with some relief as we all remembered the long lines of people pouring out of our small lobby nearly every weekday of April 2014.

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