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Medicaid Generally
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Medicaid Generally
Michigan's Budget Problems
Citizenship Documentation Rules
Medicaid Reimbursement for Bills You Paid
Problems Paying Medicaid Co-payments
Medicaid Hearing Delays
Recent Issue Alerts
Analysis, Pamphlets, etc.
Achievements
Useful Links, etc
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Michigan’s Medicaid program provides health care coverage to low income individuals in dozens of categories, including children, pregnant women, young adults under age 21, parents or caretaker relatives (kinship caregivers), persons with disabilities, and seniors age 65 or older. CCJ provides advocacy to maintain and improve access to health care under the Medicaid program.

For general information about Medicaid: please see "An Introduction to Medicaid” and “Understanding Deductible Medicaid in Michigan”.

The pages below address some of the current Medicaid issues that CCJ is working on, which are listed on the right side of the page, and provide links to additional information and resources. Click on the menu to your right to skip to specific pages.


Medicaid at Risk -- Michigan's Budget Problems

Every year, the Michigan legislature is faced with the problem of having too little money to pay for all existing programs and services in the coming year.

This means the Medicaid program is at risk for being cut back. In the past, the legislature has considered cutting Medicaid to a group of 19- and 20-year olds who are not parents, pregnant, or disabled. In the past, some legislators also have proposed cutting off Medicaid to low income working parents and kinship caregivers who do not receive Family Independence Program (FIP) cash assistance but still receive Medicaid.

CCJ and other advocates are fighting against cuts in Medicaid. For information about Medicaid for 19- and 20-year olds in Michigan, click here.

Please share your story with CCJ if you or your family depend on Medicaid and would suffer if Medicaid was cut.

For more information about Michigan's budget problems, see the Michigan League for Human Services analyses at their website, milhs.org.


Getting Medicaid May Be More Difficult -- Citizenship and Identity Documentation Requirements for U.S. Citizens

Because of changes in federal law, Medicaid applicants who say they are U.S. citizens must provide papers that prove their identity and that they are citizens. Many people have problems doing this. The law limits which documents the Medicaid agency will accept as proof. Some people do not have the right documents. Many people have difficulty getting copies of the required documents because they don’t know where to get them or don’t have money to pay the required fees.

The Michigan Department of Human Services (DHS) can use its computer system to check the state’s vital statistics records to prove citizenship for most people born in Michigan. DHS does not use this computer match process unless someone applying for Medicaid asks DHS for help with proving citizenship.

CCJ is working with others to advocate for change in the federal law. CCJ also is advocating for changes in state policy and procedures to make it easier for individuals to meet the new requirements.

Please share your story with CCJ or contact our Saginaw office if you have had problems with this policy.

For more information about this issue:

Issue Alert 01/01/08 http://www.mplp.org/Issues/mplpissue.2008-01-08.0691077831/

Analysis: “Thousands More Children, Pregnant Women, and Families are Uninsured in Michigan Due to New Federal Documentation Requirements” (03/02/08)

Flyer: “Proof of U.S. Citizenship and Identity (I.D.) to qualify for Medicaid and Cash Assistance (FIP or SDA) (Family Independence Program or State Disability Assistance)”


Problems Getting Medicaid Payment for Medical Bills You Paid? The Right to Reimbursement When You Win Medicaid because of a Hearing Request

When an application for Medicaid is denied, the person who has been denied can appeal the denial by asking for a hearing. During the appeal process, the person (or their family or friends) might pay for medical care, such as prescriptions or doctor visits. If the person wins their Medicaid after requesting a hearing, Medicaid is supposed to pay for the medical care the person received during the time they were eligible for Medicaid. If the medical bill already has been paid by the person (or the person's family or friends), then the person should ask the doctor, pharmacy, or other medical provider to bill Medicaid and pay the person back for what he or she has paid.

If the doctor, pharmacy, or other provider won’t do that, then Medicaid must reimburse the person for any medical bills they paid during the appeal. The person who wins at a hearing also can get Medicaid reimbursement for amounts they paid for medical bills from the 3 months before they applied for Medicaid, if they win Medicaid for those months. Only the amounts paid on bills for Medicaid-covered services are reimbursed.

CCJ won a lawsuit to make sure the Michigan Medicaid program would reimburse persons who win Medicaid on appeal. Recently, some advocates have reported that the Medicaid program is not telling persons who win Medicaid after a hearing request about their right to direct reimbursement.

An application for SSI (Supplemental Security Income) is considered a Medicaid application. Persons who win SSI and Medicaid after requesting a hearing because their SSI application is denied also should receive notice of thier right to reimbursement and should be reimbursed if the medical provider will not bill Medicaid and refund the money already paid.

Please share your story with CCJ or contact our Saginaw office with CCJ if you (or a client of yours) did not get notice about the right to reimbursement or had a problem getting reimbursement under this policy.

For more information about this issue:

Problems Getting Care or Services Due to Medicaid Co-payments?

In Michigan, some people who have Medicaid are charged small co-payments for prescription medications and other medical services. Under federal law, the state Medicaid agency must make sure that medical providers do not deny services to a Medicaid recipient who is not able to pay the co-payment. In 2006, as a result of a lawsuit filed by CCJ, a federal court determined that Michigan Medicaid policy on pharmacy co-payments violated this federal law.

Following appeals by both sides in the lawsuit, an agreement was reached that allowed the State to continue using its policy (with some modifications) for a limited period of time. That period has now ended.

The protection in federal law is for Medicaid only – not for Medicare Part D prescription drug copayments or for copayments under the County Plan A, Adult Benefits Waiver (ABW), or Adult Medical Program (AMP) programs.

Please share your story with CCJ or contact our Saginaw office if you have had problems getting prescriptions filled, doctor visits, or other care because of co-payments.

For more information about this issue:

Waiting a Long Time for a Medicaid Hearing or Decision?

When a person requests a hearing because Medicaid has been denied, stopped, or reduced, the Medicaid agency must hold a hearing, issue a decision, and implement the decision within 90 days from the date the hearing is requested.

CCJ is asking a federal court to enforce a court order that requires the Medicaid agency to meet the 90 day standard.

Please share your story with CCJ or contact our Saginaw office if you have had problems with not getting a hearing decision within 90 days of your request for a Medicaid hearing.


Recent Issue Alerts

Analysis, Reports, Pamphlets and Other Information

Achievements

Stopping Medicaid Cuts

Together with other advocates, CCJ has helped stop efforts to cut vulnerable groups, such as young adults and caretaker relatives, from the Medicaid program in Michigan.

Policy Changes

Time for Providing Verification Extended

When the Michigan Medicaid agency issued a policy that allowed only one extension of time for Medicaid applicants who need more time to provide verification of eligibility factors (such as income, citizenship, assets, disability, etc.), CCJ and other advocates successfully advocated for a policy that would allow more time. Policy now allows up to three extensions of time. See the issue alert discussing current policy: http://www.mplp.org/Issues/mplpissue.2008-07-08.9949304300/

Work-related penalties against Medicaid coverage eliminated

CCJ and other advocates successfully advocated to stop Medicaid terminations as a penalty when when families are penalized for failing to meet work-related requirements of the Family Independence Program (FIP) program. This ensures parents have continued access to health care services, including family planning services, while they are without cash assistance. See the issue alert discussing current policy:
http://www.michiganlegalaid.org/MPLP/Issues/mplpissue.2007-04-18.1778749732.

Litigation

CCJ has successfully litigated a number of cases enforcing the rights of low income individuals under federal Medicaid law and state law, including:

  • Transportation Assistance - Medicaid recipients’ right to notice and an opportunity to be heard when Medicaid transportation assistance to access Medicaid covered services is denied. Boatman v. Hammons, 164 F. 3d 286 (6th Cir. 1999). http://www.ca6.uscourts.gov/opinions.pdf/98a0370p-06.pdf
  • Eligibility Rules for Medicaid applicants and recipients - CCJ enforced laws requiring state agencies to take into account the financial needs of all children in the household considered when determining Medicaid eligibility for their parents or siblings. The case resulted in expanded eligibility and lowered spenddowns (now called deductibles) for many pregnant women, families, and children. Bunker v. Haveman, W.D. Mi., 1999.
  • Medicaid Eligibility for Non-parent kinship caregivers - CCJ enforced laws ensuring that state agencies treated kinship caregivers the same as parents when determining the caregivers’ financial eligibility for Medicaid under the caretaker relative” category of Medicaid. The case led to expanded eligibility and lowered spenddowns (now called deductibles) for kinship caregivers throughout Michigan. Markva v. Haveman, 168 F. Supp. 2d 695 (E.D. Mi. 2001); 317 F.3d 547 (6th Cir. 2003) http://www.ca6.uscourts.gov/opinions.pdf/03a0030p-06.pdf
  • The right to an assessment of continued Medicaid Eligibility - When Michigan threatened to eliminate the Caretaker Relative category of Medicaid, CCJ ensured that that those losing Medicaid received their right to a pretermination review of eligibility under other categories. Markva v. Haveman, E.D. Mi. 2003. (The elimination of this Medicaid Category of ultimately stopped due to a court order that CCJ obtained in McKuhen v Olszewski).
  • Preservation of Medicaid to 35,000 adults – CCJ prevented efforts to eliminate a Medicaid category that provided coverage to over 35,000 low-income parents’ and caretaker relatives. CCJ enforced the state’s duty to provide such coverage under the Michign Social Welfare Act. McKuhen v. Olszewski, Gladwin County Circuit Court 2003.
  • Medicaid reimbursement for bills paid when hearing requested -- CCJ filed litigation to ensure that ensure that the Medicaid agencies reimburses Medicaid recipients medical expenses incurred during retroactive eligibility period and during appeal, if Medicaid is initially denied but granted after a hearing request is filed. Such reimbursement includes direct reimbursement for bills paid by the recipient, family, or friends. Schott v. Olszewski, 401 F.3d 682 (6th Cir 2005). http://www.ca6.uscourts.gov/opinions.pdf/05a0132p-06.pdf

Useful Links and Resources

Michigan Department of Human Services Policy Manuals http://www.mfia.state.mi.us/olmweb/ex/html/

Local Michigan Department of Human Services offices http://michigan.gov/dhs/0,1607,7-124-5461---,00.html

Michigan Department of Community Health "Online" Application for MIChild and Healthy Kids https://healthcare4mi.com/michild-web/

Michigan Medicaid Provider Manual http://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf

 

Michigan Department of Human Services Application form for Medicaid and Medicare Savings Program http://www.michigan.gov/documents/dhs/DHS_Information_Booklet_and_Assistance_Application_242170_7.pdf
Last Updated on Tuesday, 28 April 2009 11:08