children

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

Person at computer.png

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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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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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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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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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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What is WIC?

What is WIC?

WIC, as it is commonly called, is the Women, Infants and Children Supplemental Nutrition Program.  WIC provides nutrition support for moms, pregnant women, infants and children up to age 5 and is a great way to supplement your food budget!

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