Michigan Department of Community Health The Healthy Michigan Plan and MAGI Update March 27, 2014

1. Michigan Department of Community HealthThe Healthy Michigan Plan and MAGI UpdateMarch 27, 2014 Jackie Prokop, RN,MHA Director, Program Policy Division

2. Overview of ACA Impact on Medicaid • Presentation overview: • The Healthy Michigan Plan • New eligibility methodology – Modified Adjusted Gross Income (MAGI)

3. Federal Law and State Law • Affordable Care Act (ACA) authorization • New eligibility category. • Funding must be appropriated by State. • House Bill 4714 • Public Act 107 of 2013 was signed into law by Governor Snyder September 16, 2013. • This is called the Healthy Michigan Plan.

4. Federal Waiver • State law requires certain cost-sharing requirements (co-pays and contributions). • Some of these requirements are not stated in federal regulation. • Need a waiver amendment to implement what is in state law. • Amended our current Adult Benefits Waiver. • Waiver Amendment was submitted 11-8-2013. Approved December 30, 2013.

5. Implementation Timeframe • Public Act 107 0f 2013 did not have an immediate effect. • Cannot implement prior to 90 days after the end of legislative session. • The Adult Benefits Waiver beneficiaries will be transitioned to the healthy Michigan Plan on April 1, 2014. • Enrollment will open for others to apply April 1, 2014.

6. Federal Funding • Federal government will pay 100% of the program cost for the first three years. • Will decrease federal match to 90% by 2020. • Current Match is about 64%

7. Impact on Low Income Citizens Provides Health Insurance Coverage for Low Income Citizens Dramatic Reduction in Uninsured in Michigan Primary Care Is Available Health Coverage Improves Health Status Improves Employability Anticipated that up to 400,000 – 500,000 people could be eligible for the Healthy Michigan Plan

8. Federal Eligibility Parameters Includes people ages 19-64 Not receiving or eligible for Medicare Not eligible for current Medicaid programs Not pregnant at the time of application Covers up to 133% of the federal poverty level (5% disregard = 138%) No asset test Must meet other federal requirements

9. Eligibility for Healthy Michigan Plan and Current Medicaid

10. Covered Services Benefit coverage must be based on federal benchmark coverage and include the 10 essential health care services. Ambulatory patient services 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. • Other, Dental, vision, home health

11. Service Delivery System • Healthy Michigan beneficiaries will enroll into the one of the current Health Plans. • Current populations that are exempt or voluntary from managed care will remain exempt or voluntary. • Will use the current Prepaid Inpatient Health Plan (PIHP) system of care.

12. MI Health Account • Required by Public Act 107 of 2013 • Cost-sharing • Average co-pays • Contribution of 2% annual income for beneficiaries with income between 100%-133% of the FPL. • Account will provide information on health care services cost and utilization. • Will show cost of services and amount of contribution in account. • Quarterly statements

13. MI Health Account • Healthy Behaviors • Health risk assessment form completed • If beneficiary engages in healthy behavior can have reduction in cost-sharing. • Goal is to have beneficiary more involved in health care decisions and improve health outcomes.

14. Modified Adjusted Gross Income (MAGI) • New eligibility determination methodology for Medicaid (excludes disabled population) • Uses a single streamlined application • Provides for no wrong door for application • Online • In person • Telephone • Standardizes the calculation of income with consistent formula • Relies on electronic data matching to the greatest extent possible • Removes asset test

15. Information Sources for the Healthy Michigan Plan For Providers: DCH Website -www.michigan.gov/healthymichiganplan • Healthy Michigan Plan policy, waiver amendment and state plan amendments posted • Healthy Michigan Handbook posted • Frequently Asked Questions posted • Digital brochures and flyers will be available by Apri1 1st For Beneficiaries: Starting April 1st Beneficiary Website - www. HealthyMichiganPlan.org • Eligibility information posted • Link to www.Michigan.gov/MiBridges • Link to www. Michigan.gov/HealthyMichiganPlan Email:-healthymichiganplan@michigan.gov

16. Apply for the Healthy Michigan Plan • Encouraging applicants to apply online using MiBridges www.mibridges.michigan.gov • DCH 1426 Paper Application is available online and at DHS Offices

17. Information Sources • New toll-free numbers for MAGI related activities. • MI healthcare helpline is 855-789-5610. • The phone application assistance helpline is 855-276-4627. • Call-line information had been updated for the Healthy Michigan Plan implementation.

18. Questions?