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Michigan and the ACA’s Medicaid expansion

622k enrolled in Healthy Michigan Plan; Governor urges feds to keep Medicaid expansion

michigan Medicaid guide

Republican Governor Rick Snyder pushed for an alternative approach to Medicaid expansion in Michigan and ultimately gained bi-partisan support for the plan, which is called Healthy Michigan. Sign up for the program began April 1, 2014, and by January 2017, more than 622,000 people had enrolled in Healthy Michigan coverage. Enrollment increased rapidly in 2014 and 2015, and then continued to increase slowly in 2016.

By October 2016, total enrollment in Medicaid/CHIP in Michigan had reached 2,284,448, which was a 20 percent increase over the enrollment total at the end of 2013. This total includes people who were already eligible for Medicaid based on the pre-ACA (Affordable Care Act) guidelines.

Governor urges lawmakers to leave Healthy Michigan intact

Under the Trump Administration, and with continuing Republican majorities in Congress, the future of the ACA is up in the air (you can see more in our blog section). Lawmakers began the process of repealing (via defunding) the ACA in early January 2017, but repealing and replacing the law could take up to four years.

Snyder is urging lawmakers to leave Healthy Michigan intact, calling it a “successful” program, and a “good role model” for other states. University of Michigan researchers report that Medicaid expansion in Michigan has resulted in about 30,000 new jobs, and a $2.3 billion increase in personal income in the state in 2016. The researchers also determined that Michigan saved $235 million in 2016 as a result of Medicaid expansion, thanks to federal Medicaid funds covering some prison health care costs that were previously covered by the state.

Michigan’s eligibility guidelines

You qualify for Medicaid in Michigan if your household income is below the following limits:

  • 195 percent of the federal poverty level for infants under 1 year old
  • 160 percent of FPL for children 1-18 years old; children with slightly higher household income — up to 212 percent of FPL, qualify for the Children’s Health Insurance Program, which is called MICHILD in Michigan
  • 195 percent of FPL for pregnant women
  • 133 percent of FPL for parents and other adults (the eligibility calculation includes a built-in 5 percent income disregard. So eligibility actually extends up to 138 percent of FPL).

While these are the main groups covered by Medicaid, other people — such as those who are blind or disabled — may also qualify. See the Department of Community Health website for more information on covered groups and eligibility guidelines.

Use the annual income chart from to see FPL shown as dollar amounts.

Enrolling in Medicaid

Here is how you can apply for Medicaid:

  • Apply online using MI Bridges, or enroll through
  • Fill out a paper application (the form is DCH-1426) and turn it in at a local office, by fax, or by mail. The mailing address is Health Insurance Affordability Program; Michigan Department of Community Health; P.O. Box 30273; Lansing, MI 48909. Find the location or fax number for a local office.
  • Get help with your application by calling the application help line at 1-855-276-4627.

Michigan expands, reforms Medicaid

At the end of 2013, Michigan received federal approval to expand and reform its Medicaid program. Within the state, the expansion program is known as Healthy Michigan.

The state needed special approval — in the form of two federal waivers — for new cost-sharing requirements. Enrollees with incomes between 100 to 138 percent of the federal poverty level must contribute up to 2 percent of their income to health savings accounts that are administered by the state.

Enrollment for the Healthy Michigan expansion started April 1, 2014, with estimates that 320,000 people would sign up in the first year and up to 470,000 ultimately. As of Jan. 5, 2015, nearly 497,000 people had enrolled in Healthy Michigan. And by January 2017, enrollment had reached 622,264.

The path to Medicaid expansion

It took nearly eight months to authorize the Healthy Michigan plan. Republican Gov. Rick Snyder announced his support in February 2013, saying it was good move for public health and state finances. Snyder had support from numerous health care and advocacy groups, but was opposed by some Republicans in the state legislature.

Ultimately, the state Senate passed Medicaid expansion in late August 2013 after an eight-hour session. The House followed suit a few days later, passing it in early September, and Snyder signed it into law on Sept. 16, 2013. University of Michigan Medical School researchers believe the state’s bi-partisan solution could be a model for other states that have yet to expand Medicaid.

While the Senate passed Medicaid expansion, it also prevented it from taking effect immediately and delaying the start of Healthy Michigan enrollment until April 1, 2014. The Department of Community Health said each day’s delay would cost the state $7 million in federal funding.

While the delay had a negative financial impact, it is also being credited as a factor in the successful rollout of the program. Michigan was able to use the first three months of 2014 to plan and to build awareness, leading to rapid uptake of the program once enrollment began.

Second waiver keeps Healthy Michigan alive

In December 2015, CMS approved Michigan’s second waiver, albeit an adjusted form of the waiver that the state had submitted. The legislation Michigan had passed called for changes to Medicaid eligibility after an enrollee had been in the program for 48 cumulative months. Michigan’s plan was to have individuals at that point either switch to a QHP through the exchange (subsidized with Medicaid funds), or remain in the Healthy Michigan Plan but with cost-sharing of up to 7 percent of income (with an opportunity to reduce the cost-sharing by participating in various healthy behaviors).

Some of this (the 7 percent of income cost-sharing, and the 48-month time limit) presented problems for CMS, but the waiver had to be approved in order to keep the Healthy Michigan program active past April 2016, as the stipulations had been built into the state law.

So CMS worked with Michigan officials to reach a compromise. Assuming Medicaid expansion remains in effect under the Trump Administration, the current guidelines state that as of April 1, 2018 (four years after Healthy Michigan took effect), all Healthy Michigan enrollees with income above the poverty level (ie, between 100 percent and 138 percent of the poverty level) will have to either switch to a QHP subsidized with Medicaid funds, or work with their doctors to fulfill the healthy behavior requirements to remain on the Healthy Michigan Plan.

This change will apply regardless of how long each enrollee has been in the program. And there’s no longer a mention of cost-sharing amounting to 7 percent of income, but there is still an opportunity for enrollees to reduce their cost-sharing via healthy behaviors. It should be noted, however, that about 80 percent of Healthy Michigan enrollees have income below the poverty level, and the second waiver makes no changes to their coverage under the program.

Michigan Medicaid

How to apply

Apply online using MI Bridges. Fill out form DCH-1426. Call the application help line at 1-855-276-4627.

Who is eligible

Children up to 1 year with household income up to 195% of FPL. Children ages 1-18 with household income up to 160% of FPL; children with household income up to 212% of FPL qualify for MICHILD (low-cost health insurance for kids). Pregnant women with household income up to 195% of FPL. Adults with household income up to 133% of FPL (138% with the built-in income disregard). Select other groups: see details

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