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Expanded Mich. Medicaid could become model program

Michigan’s expanded Medicaid program — a unique version of the longtime federal health plan for poor people — asks beneficiaries to chip in on their medical costs.

Robin Erb, Livingston Daily, Mar 24, 2014

>But the Healthy Michigan plan, which will go live April 1, offers incentives for healthy behaviors, too. Shedding pounds, kicking a smoking habit or even getting a flu shot, for example, could shave dollars off those costs.

Details still are being worked out when it comes to the incentives and penalties that some say will add personal responsibility to a program that’s enrolling many low-income people who weren’t eligible before - and eventually could cover an estimated 470,000 Michiganders.

The way the head of the Michigan Department of Community Health sees it, better behavior will help cut expenses in the long run.

The goal is simple, said James Haveman, the department’s director: “Keep people out of the emergency room.”

That might be a model for nearly two dozen other states trying to decide whether to expand their Medicaid programs under the 2010 Affordable Care Act.

Legislatures in those states balked at the federal version of expanded Medicaid. But if they can find a compromise that’s more palatable -one that incorporates cost-sharing, for example - they might rethink their positions, said Matt Salo, executive director of the National Association of Medicaid Directors.

The U.S. Supreme Court ruling in 2012 that said that states could not be forced to extend Medicaid to more people handed states leverage last year in passing their own versions of expanded Medicaid.

“Until recently, the options were simply, ‘Expand or don’t,’ ” he said.

Twenty-five states and the District of Columbia expanded their Medicaid programs Jan. 1.

Only Michigan, Arkansas and Iowa have won federal approval now for their unique versions of the program. Arkansas, for example, allows Medicaid beneficiaries to shop for insurance policies along with other consumers in the online marketplace.

In Michigan, the insistence on cost-sharing and incentives for healthy behaviors is “not only unique but also (follows) best practices,” said Jackie Garner, a senior official in the Midwest region of the U.S. Centers for Medicare and Medicaid Services.

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“If other states decide to expand, they’ll be able to look at Michigan as a really good example of the way it can done,” she said.

In fact, the federal health law was built, in part, on the belief that regular care and preventive care can help shave costs in the long run. The health-reform law - signed by President Barack Obama four years ago - allows states to expand Medicaid with most of the medical costs covered by federal dollars.

It makes sense that the Medicaid program wants to parallel some health plans’ wellness practices to bring down costs, Garner said.

“Promoting health and wellness, rather than just fixing a health problem, is perhaps not as unique as it once was, but we still have a long way to go in our culture,” Garner said.

Now, as the March 31 deadline looms for people to purchase private health insurance on the federal marketplace, consumer advocates are retooling for another campaign: Helping Michiganders who can’t afford private insurance to understand an unprecedented public health initiative that extends health coverage to nearly anyone with income up to 133 percent of the federal poverty level.

“We figure these coming months for us are going to be crazy,” said Jamie Jackson, a coordinator of outreach for Advantage Health Centers, a clinic that serves metro Detroit’s uninsured people.

Consumers who were denied Medicaid in the past mistakenly believe they won’t be eligible. Or they don’t understand that assets -something that disqualified someone from receiving Medicaid coverage in the past - won’t be used to determine eligibility for Healthy Michigan.

The new program is based on income only.

It wasn’t until Thursday that the confusion began to clear, when Gov. Rick Snyder announced that the state would begin to accept Medicaid applications at 12:01 a.m. April 1.

That means Advantage staff will call at least 750 people that they determined would most likely be eligible for Healthy Michigan to let them know they can start enrolling.

The staff at ACCESS social services agency in Dearborn has a long list of potential enrollees, too.

Until now, said Madiha Tariq, outreach coordinator, there had been little information about the plan, how it will work, or even when applications would be taken.

“There were no pieces to sort through, nothing we could explain to clients,” she said. Thursday’s announcement means staff will begin to focus on the details of Healthy Michigan so they can explain them.

“Our job doesn’t end March 31,” she said.

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