States with Pending CMMS Work Requirement Applications:
Medicaid Work Requirement Exemptions and Criteria for Extending Coverage
Healthy Michigan enrollees (non-disabled Obamacare recipients) with incomes below the poverty line will not be affected by the work requirement rule.
Other categories of exemptions from Medicaid work requirements:
To remain enrolled in the Healthy Michigan Plan (HMP) once you have reached or exceeded of the Federal Poverty Limit (FPL) you may continue benefits if:
Healthy Michigan (HMP) enrollees who have reached income and lifetime benefit levels will be offered one (1) of two (2) options to retain coverage:
The Marketplace Option
The Marketplace Option requires that you purchase coverage through the Federal Healthcare Exchange. Participants who select this option will be required to change (opt-out) of their eligibility status from the Healthy Michigan Plan (HMP) in order to be eligible for the Federal Advance Premium Tax Credit and cost-sharing subsidies.
It is important to remember that the “individual mandate” provision of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare imposes a tax penalty on individuals who are without health insurance each year.
The current tax penalty, effective January 1, 2019 is $0.
However, persons who were uninsured for more than two (2) months in 2018 may be subject to a $695 fine plus inflation, or up to 2.5% of their household income.
You may be exempt from the Obamacare tax penalty if:
Open enrollment for 2019 was from November 1, 2018 to December 15, 2018.
Special enrollment periods are considered for a change in life event or family status. Contact the Michigan Department of Insurance and Financial Services (DIFS) for more information. A link is provided below.
The Cost-Sharing Option
Recipients may choose to continue their Healthy Michigan Plan (HMP) coverage by paying a “cost-sharing” premium of 5% of their income.
Effective 4/1/2018, Healthy Michigan Plan (HMP) recipients who are not medically frail and who have been enrolled at least twelve (12) months will be required to complete a “health risk assessment” or to purchase a qualified plan through the Marketplace.
Medicaid Work Requirement Healthy Lifestyle Limitation
Healthy Michigan (HMP) recipients who have reached income levels between 100 – 133% of the Federal Poverty Level (FPL) and who have been enrolled for 48 months will be mandated to complete a “Healthy Behavior Assessment.”
There will be an intentional effort to make the healthy behaviors incrementally more challenging in additional to the 5% premium contribution payment.
That is, you may be required to quit smoking or engaging in other activities deemed high-risk behaviors that contribute to poor health.
Recipients who do not comply with these two (2) conditions may have their benefits suspended.
Social and Fiscal Implications of the Medicaid Work Requirement Rule
The New York Times (2010) reported a projection by the Congressional Budget Office (CBO) predicting that there would be 54 million uninsured people by the year 2019.
Estimates regarding the fiscal impact of the Michigan workforce engagement rule suggest a 5 to 15% caseload reduction and $5 to $20 million dollars annual savings in the state budget.
There are approximately 670,000 Healthy Michigan Plan (HMP) enrollees, with an estimated 130,000 (about 20%) exemptions, and 540,000 non-exempt.
Of the 540,000 non-exempt participants, an estimated 5 to 15% will lose their health coverage for various reasons due to the new Medicaid work requirements.
These estimates do not speak to the increase in administrative costs and technology upgrades that will be required to implement the program. Nor does it provide insight into the increased demand on support services such as child care, transportation, and workforce development programs due to the loss of coverage.
The American Journal of Public Health suggests that the lack of insurance kills 45,000 people a year: “More Americans die of lack of health insurance than terrorism, homicide, drunk driving, and HIV combined.”
According to the American Journal of Medicine:
“…18% of those filing bankruptcy in 2007 cited illness and medical bills as having contributed to their financial failure.”
Was this post helpful? Leave a comment and share your thoughts. If you need case management services or assistance, please contact us by completing the confidential Contact Form. Also, consider donating to continue this important work and expand our reach to the broader community.
Healthy Michigan Medicaid Work Requirement Bill
State Assistance Programs Enforce Work Requirements for Government Benefits
The Working Poor: On Welfare with A Job
Medicaid.gov State Waiver’s List
Nationwide Snapshot of State Proposals to Implement Work Requirements
Feds Approve Michigan’s Medicaid Work Requirement, beginning 2020 (Detroit Free Press)
Feds Approve Michigan’s Medicaid Work Requirement (Detroit Free Press)
Feds Approve Michigan’s Medicaid Work Requirement, beginning 2020 (Lansing State Journal)
Medicaid Healthy Michigan Plan (Lansing State Journal)
4 Things to Know About Michigan’s Medicaid Work Requirements
Michigan Senate Bill 897
DIFS – Shopping for Health Coverage
Op Ed: Medicare For All: Yes We Can
Welcome to The Community Advocate Network. My name is Deborah Mitchell, I am a graduate in Social Work and Registered Social Work Technician. My human service background began in 2007 which includes medical case management and service navigation for the indigent population, outpatient mental health counseling with substance use and abuse disorders, supportive employment and job development for mental health consumers, and structured living domicile management.