medicaid

Medicaid Work Requirements Are Coming…What Does It Mean?

Medicaid work requirements were written into state law in June of 2018 and were approved by the federal government over a year ago. Now the Michigan Department of Health and Human Services (MDHHS) is preparing to implement work requirements, and IF things continue, people who have the Healthy Michigan Plan may lose their health care if they do not meet the work requirements.

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People who may be subject to Medicaid work requirements:

  • Enrolled in the Healthy Michigan Plan (HMP)

  • Current Michigan resident

  • Age 19-62

  • Not disabled, pregnant, or qualifying for another exemption (listed below)

What are the changes?

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  • Requirement to work or participate in other qualifying activities for at least 80 hours per month.

  • HMP beneficiaries must report to MDDHS on a monthly basis and are allowed 3 months of non-compliance (not reporting, or reporting but not participating in qualifying activities) within 12 months.

  • Loss of eligibility for non-compliance. After 3 months of non-compliance, beneficiaries will lose their healthcare coverage (HMP).

What counts as work or a qualifying activity?

  • Employment or self-employment

  • Education directly related to employment (school, college, etc.)

  • Participation in a substance use disorder treatment program

  • Community service with a 501(c)(3) or 501(c)(4) for 3 months only every 12 months

Who qualifies for an exemption?

  • Caretaker of a family member under 6 years old

  • Beneficiaries receiving temporary or permanent long-term disability benefits

  • Full-time students

  • Pregnant women

  • Individuals who have a medical professional’s order stating they are medically frail or have a medical condition that limits their ability to work

  • Beneficiaries who have been incarcerated in the last 6 months

  • Beneficiaries receiving Michigan unemployment benefits

  • Individuals who are receiving SNAP (food assistance) or TANF (cash assistance) benefits.

What is the timeline for work requirements to begin?

  • September 2019

    DHHS is sending Exemption Forms and Letters to HMP members who need to tell DHHS they qualify for an exemption. If you qualify for an exemption, fill out the form and FAX it to 517-432-6079. Do not mail it.

  • October 2019

    DHHS will send letters to people who are listed as having an exemption (see above). A separate letter will also be mailed to HMP members who are 62 or older because they are also exempt.

  • January 2020

    HMP members who have not qualified for an exemption will need to start reporting their work to MDHHS. When there is more information about how to report, there will be a new blog post. Until then, stay tuned…

Unless…

State advocates are hoping to stop Medicaid work requirements with a lawsuit. And they NEED PLAINTIFFS! They are looking for current Healthy Michigan Plan members who will be adversely affected by the new requirements.

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Examples of people who would be good plaintiffs include:

  • single working parents with children between the ages of 6-11;

  • people whose hours per week are highly variable or dependent on factors outside their control;

  • people who may not be medically limited but have jobs that are less than 3 hours/day. This might include school lunch supervisors or school bus drivers, part-time home healthcare workers or restaurant workers who may have reduced hours when business is slow.

  • People with sporadic hours like substitute teachers, recently incarcerated people who are looking for a job, and seasonal job workers are also good candidates.

If you have a good candidate, please have them contact Mario Azzi at the Center for Civil Justice: 800-724-7441 or mazzi@ccj-mi.org OR Lisa Ruby at Michigan Poverty Law Program 734-998-6100 ext. 617 or lruby@mplp.org. Click here for a flyer to print.

If you have any questions or concerns about Medicaid work requirements, ask us in the comments below or you can always call the WHP office at 734-544-3030. We are also open for walk-ins 9am-4pm Monday through Friday at 555 Towner, Ypsilanti, MI.

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Preparing For Open Enrollment - Employer, Marketplace and Medicaid

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Don’t be frightened! Health care isn’t scary!

Medicaid Enrollment is Always Open.

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You can always apply for Medicaid. Anytime during the year you become eligible, you can apply for Medicaid. No qualifying events, no special documents. Check your income here and apply here. As always if you have questions, call us at 734-544-3030.

Employer Open Enrollment

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If you are offered health insurance through your job, chances are your open enrollment period is in the fall with a January 1, 2019 start date. Some employers (schools, universities, businesses with fiscal years based on other calendars) may have open enrollment during other times of the year.

Evaluate your options every year.

Each year your employer negotiates new benefit packages with health, dental and vision insurance companies. Your open enrollment may also include retirement options, disability and life insurance. When it comes time to evaluate your options make sure to look at each plan. If you don’t understand the details of a benefit, contact your HR department to explain it to you. Here are some tips for thinking about your particular family and your how you use your health insurance.

  1. How much health care do you expect to use?

  2. What is my deductible? What is my maximum out of pocket?

  3. Is my employer insurance affordable? Do I have another option?

You may be wondering if you can sign up on the Marketplace, read more about that option, Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes).

Marketplace Open Enrollment Nov. 1 - Dec. 15

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The Open Enrollment Period for the Marketplace (aka Obamacare, healthcare.gov, ACA) is November 1 to December 15. During open enrollment anyone who is eligible can sign up for health care coverage that will start on January 1, 2019. In order to sign up on the Marketplace ask yourself these 3 questions:

  1. Am I eligible for Medicaid? If yes, you are not eligible to enroll with tax subsidies on the Marketplace. If you are a family, children may be eligible for Medicaid/MIChild and parents may be eligible for the Marketplace.

  2. Does my employer offer affordable insurance? If your employer insurance is less than 9.69% of your income for the lowest priced, ACA-compliant employee only plan, you are not eligible to enroll with tax credits on the Marketplace. Read more here Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes).

  3. Do you have income and are you filing taxes? You must have income and file taxes to receive tax credits and enroll in health care on the Marketplace.

Information needed for a Marketplace application

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Did you answer yes to all 3 questions? The next step is to gather the documents and information you will need to complete a Marketplace application and select your health care plan. You will need the following:

  • Names and social security numbers for everyone in your tax household. Your tax household includes anyone you will claim on your tax return.

  • Earned income information -recent paystubs for everyone who is working or self-employment records (Schedule C from the previous year’s return).

  • Unearned income information - pension, retirement, real estate income, social security (RSDI or SSI) income or capital gains.

  • 2017 Tax return including Schedule C, if applicable.

  • List of doctors

  • List of prescriptions

  • Marketplace Account information - user id and password.

    • If you don’t have an account and need to create one you will need an active email account that you can access immediately. You must be able to access the email to access a verification email.

The next step is to estimate your income for 2019. For some people this is easy, but for anyone whose income varies during the year, it can be tricky. (We have written many posts about income, click here to browse all the income blogs.)

Now go to the Marketplace website, healthcare.gov, complete an application and select your 2019 health care coverage. You can preview 2019 plans here.

If you have questions, if you need assistance with the application or if you need help with the whole thing, please call the Washtenaw Health Plan and make an appointment. Michigan residents, we can also answer questions over the phone. Call us at 734-544-3030. The sooner you call the better! If you are not in southeast Michigan, use this resource to find local help for healthcare.

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Washtenaw Health Plan

734-544-3030

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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 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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Ten Reasons To Oppose Medicaid Work Requirements

Printable pdf of this blog post here.

You may have heard that there are some proposals in the Michigan legislature to require individuals on Medicaid to work in order to continue to qualify for Medicaid  (Proposed in March 2018: Senate Bill 897 and House Bill 5716). The Washtenaw Health Plan and Washtenaw County are opposed to any efforts to impose work requirements on Medicaid recipients. Here's why: 

1. Most people on Medicaid are already working.

Those who are not working, are most likely to be found taking care of young children, elderly relatives, to be living in high unemployment areas, or to be in poor health themselves. The vast majority of individuals in Medicaid are in households with at least one working person (Kaiser Family Foundation, 2016). 

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In December 2017, a team of University of Michigan researchers did extensive research on individuals in the Michigan Medicaid expansion, called the Healthy Michigan Plan, population.

  • Nearly half the individuals are working (48.8%)
  • 5% are students
  • Nearly 5% are home taking care of children
  • 11% reported being unable to work because of their health
  • Over one fourth are out of work, many of them because they are in fair or poor health. Three-quarters of those who were out of work reported having a chronic health condition.

NOTE: This study was the first peer-reviewed study from the formal evaluation of Michigan's expansion, called the Healthy Michigan Plan. The evaluation, funded by a contract with the Michigan Department of Health and Human Services, was required under Michigan's federal waiver. 

As Renuka Tipirneni, lead author of the study notes, "'Is it worth the cost to screen and track enrollees when only a small minority isn't working who are potentially able to work?"

2. The Medicaid expansion has helped improve individuals' health.

Health improvements mean it is more likely that they will be able to work--now or in the future. 

According to the UM IHPI study, "In all, nearly half of the newly covered Michiganders said their physical health improved in the first year of coverage, and nearly 40 percent said their mental or dental health got better. Those who said their health improved also had the most chance of experiencing an effect on their work life. As a group, they were four times more likely to say that getting Medicaid coverage helped them do a better job at work. And those who felt their health had improved, but were out of work, were three times as likely to say that their coverage helped them look for a job."

3. Work requirements can worsen (or externalize) other problems. 

For instance, a person with epilepsy who loses access to seizure medications could have a seizure while driving and have a car accident. The cost, then, is to the individual (who is injured by the car accident and seizure), to the costs to the insurance system, and potentially to other individuals involved in the car accident.

4. Work requirements cost the system more.

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Work requirements drive people to more expensive care. Rather than a person getting preventive care, and a prescription, from a primary care doctor for an easily treated problem like high blood pressure, they are more likely to end up in the emergency room, where they know they will not be turned away. Rather than getting a free flu vaccine, they are more likely to get the flu--ending up infecting others, requiring time off work, and perhaps risking a hospitalization. 

5. Work requirements place a huge administrative burden on Department of Health and Human Services (DHHS) staff.  

DHHS staff already struggle under enormous caseloads. The administrative burden of this additional work is significant. The true number of people who could work but aren't is small. Yet requiring people to show that they are working, or cannot work, requires a lot of time on the part of DHHS staff.

Paperwork photo by Tom Ventura

Paperwork photo by Tom Ventura

6. Work requirements place a huge administrative burden on individuals with Medicaid.

In addition, they are likely to affect many others. For instance, if one person in a family does not return proof they are working, others in the family may be wrongfully cut off. This policy is another bureaucratic obstacle intended to keep poor people from getting healthcare.

7. We are in the midst of an opioid epidemic and a surge in suicides.

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Mental health and substance use disorder services are essential; suicide is preventable. Work requirements make it difficult for individuals getting mental health or substance use treatment to continue to get treatment. In 2015, the State of Michigan's Prescription Drug and Opioid Abuse Task Force report recommended " exploring ways for the State to increase access to care, including wraparound services and MAT [Medication-Assisted Therapy], as indicated by national and state guidelines for treatment. (p. 20)" Work requirements would surely reduce access to care. 

8. Work requirements put physicians and nurses in an untenable position.

Physicians take the Hippocratic oath, to do no harm, but if people are cut off of Medicaid and physicians are unable to get paid for patient visits, their organizations will find it financially untenable to take care of these patients. That is one reason that the American College of Physicians, the American Academy of Family Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, the American Psychiatric Association and the American Academy of Pediatrics have taken a position against Medicaid work requirements. Read their statement here.

9. Work requirements threaten the health of people with disabilities.

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As the IHPI study indicates, many individuals who have Medicaid and are not working are doing so because they are in poor or fair health. In the experience of staff at the Washtenaw Health Plan, in many cases the access to health care allows people to either a) get better, and start working or b) get the necessary evidence from competent physicians to show that they are disabled. Without Medicaid, many individuals would not be able to collect the medical evidence to prove that they are disabled. In 2016, the Kaiser Family Foundation found that 36% of people on Medicaid who are not working are disabled.

10. The Washtenaw Health Plan and the Washtenaw County Health Department believe that healthcare is a human right.

We oppose efforts to reduce access to coverage, and believe in healthcare for all. The Washtenaw County Board of Commissioners agrees with us. Read their resolution here

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