35,000 parents and Kinship Caregivers protected from losing Medicaid.
McKuhen v. Olszewski, Gladwin Cir. Ct. 2003. On behalf of a low-income parent who needed ongoing treatment for cancer, CCJ brought a successful class action to enforce Michigan Social Welfare Act requiring Medicaid coverage of medically needy parents and caretaker relatives. For more on CCJ's current healthcare work, click here.
Millions of dollars worth of medical bills paid or forgiven in Saginaw County.
After Saginaw County eliminated funding for its RCH program, CCJ successfully sued the Saginaw County Board of Commissioners and Social Services Board to require that they establish eligibility guidelines for an RCH program, fund the program, and tell potentially eligible people about the program’s existence, the eligibility rules, and the application process. As the result of the initial litigation and a later motion to hold the defendants in contempt, Saginaw County developed and implemented policies and procedures that resulted in the payment or forgiveness of millions of dollars worth of medical bills for inpatient hospitalization. CCJ continues to monitor compliance with the Court’s order regarding Saginaw County’s RCH program.
Similar policies and procedures implemented in Genesee County.
As the result of advocacy by CCJ, Genesee County has adopted policies and procedures similar to Saginaw County’s. The CCJ Health Eligibility Law Program continues to monitor the availability of RCH in Genesee County.
The health care reform law passed by Congress and signed by President Barack Obama in March 2010 will help strengthen and improve Michigan’s Medicaid program. The law is called the Patient Protection and Affordable Care Act (PPACA ). A few of the most important parts of the law are listed below:
Under the new health care reform law, states cannot eliminate Medicaid coverage for any people who were eligible for Medicaid when health care reform was passed in March 2010. States also cannot make any changes in laws, policies or rules that would make a person who currently qualifies for Medicaid ineligible for Medicaid. This includes changes in income or asset limits, and changes in how income or assets are counted or budgeted.
This is particularly good news for low-income parents, kinship caregivers, and those 19-20 years old who almost lost Medicaid in recent years when the Michigan Senate voted to cut them off from Medicaid as a way to reduce state spending. CCJ and other advocates worked hard to educate lawmakers about the importance of covering low-income parents and young adults. They remained Medicaid-eligible (as long as their income was below very strict limits) when the PPACA passed.
Unfortunately, health care reform does not require Michigan to provide all of the same services covered by Medicaid in the past; therefore, the state could also cut what it pays for Medicaid-covered services. State lawmakers may try to reduce state spending by cutting payment rates and eliminating “optional” benefits such as dental vision. CCJ and other advocacy organizations will continue to urge legislators to protect access to the full range of necessary medical care for Michigan Medicaid recipients.
In 2014 and 2015, the states will be required to pay the higher Medicare rate for primary care received by Medicaid patients. The cost of this required increase in payment rates will be covered by the federal government.
On January 1, 2014, most adults with adjusted gross income below 138 percent of the federal poverty level (FPL), will be eligible for Medicaid under the health care reform law. The State of Michigan estimates that about 400,000 adults will be eligible for Medicaid as a result of this change. The cost of providing Medicaid to these newly eligible people will be paid in full by the federal government in 2014, and be gradually reduced to a 90 percent federal contribution in 2020 and subsequent years.
This expansion will cover many childless adults who are not considered disabled or elderly including those aged 19 to 20 who are not in high school and do not have incomes above the current Medicaid income limit of about 45 percent FPL. It will also cover adults aged 21 to 64, who currently are not covered by Medicaid regardless of income and parents and other relatives raising dependent children with incomes above the current Medicaid income limit of about 45 percent FPL.
Unfortunately, the expansion does not cover seniors (aged 65 or older), and people who receive Medicare. Michigan could expand its Medicaid eligibility to cover seniors and people with disabilities up to the same income level, but it will not receive the higher federal matching rate contribution to pay for an expansion of those groups.
Under health care reform, people will be able to use the "Health Insurance Exchange” to find out if they qualify for Medicaid or for government subsidies to buy private insurance. Rules and procedures for determining Medicaid eligibility will be much simpler and will require less work for the state and for most people applying for or receiving Medicaid.
Michigan could begin expanding Medicaid eligibility, but the higher federal match for the costs of covering new groups is not available until 2014.
Michigan could also choose to expand family planning coverage to men and women with incomeS below 185 percent FPL who do not have full Medicaid coverage. Michigan currently provides family planning services to women aged 19 to 44 who have income below 185 percent FPL under a waiver from the federal government which expired in 2011. Unfortunately, under current law the coverage is not provided to men or women aged 45 or older or to women who also have a Medicaid deductible case, even if they have not met their deductible. For more information about Plan First! and links to the application form, go to http://www.michigan.gov/mdch/0,1607,7-132--146295--,00.html.
Michigan could also allow providers, health departments, federally qualified health centers and others to give immediate, presumptive eligibility to applicants who appear eligible for Plan First! so they do not have delays in accessing family planning services, which could result in unwanted pregnancy. Such presumptive eligibility is already available to pregnant women so that prenatal care can start as soon as possible.
CCJ works with the MIJobs Coalition work group to improve the Medicaid deductible/spend down process. The MIJobs Coalition is a group of advocates and agency staff members working to expand and improve employment opportunities for people with disabilities.
CCJ advocates for reforms that would make Medicaid deductibles more reasonable for all low-income people in Michigan, including those with disabilities. CCJ and its allies want to ensure that individuals who meet their deductibles receive Medicaid coverage promptly before it's too late. The current process for establishing eligibility using a deductible should be streamlined and policies for calculating deductible amounts should be made more just.
Currently, when people with disabilities have a Medicaid deductible, it's often so high (several hundred dollars), that it takes individuals months to get Medicaid which results in high emergency and hospitalization bills. Medicaid with a deductible often provides no health coverage at all because many providers will not extend credit to low-income patients and those patients can't afford to pay their deductible.
Even for people with monthly medical expenses that are higher than their deductible, the process for showing they have met the deductible is too slow and complicated. By the time the person learns they are eligible for Medicaid, their eligibility has ended.
Because of the way that deductibles are set in Michigan, some Medicaid recipients who are elderly or have disabilities go from full Medicaid coverage without a deductible to Medicaid with a deductible of several hundred dollars, even though their income has only increased slightly.
Other states have taken action to make their "deductible" Medicaid process easier and have ensured that deductibles are more reasonable. Michigan should follow their lead.
Please share your story with CCJ if you have had problems with Medicaid's high deductibles or spend-down.
For more information about this issue, please see:
"An Introduction to Medicaid" and "Understanding Deductible Medicaid In Michigan" (rev. 01/08) Revised Medicaid Article – Jan 2008.
Memo on how Michigan could improve its spend-down eligibility systems. (10/04) Oct 2004 Memo – Spend-down options.
Pamphlet on Medicaid and other health programs for "People with Low Income and High Medical Expenses" (rev. 2006).
Instructions for "Using Medicaid with a Deductible" (Spend-Down Medicaid) (rev. April 2008) Deductible MA rev. Apr 2008.
MIChild is Michigan’s "Children’s Health Insurance Program" (SCHIP) for children with budgeted family incomes above the Medicaid limits but below 200 percent of the federal poverty level. MIChild operates on both state and federal funding and is governed by state and federal law. Individuals may apply for MIChild using the short form MIChild/Healthy Kids Medicaid application or by submitting the DHS Application form.
Medicare provides federally funded medical care to most seniors (aged 65 or older) and people with disabilities who have received Social Security Disability benefits for two years or more. Medicare eligibility is not based on income.
Medicare consists of several parts, including Part A (hospital coverage), Part B (includes coverage for office visits, medical tests, and other out-patient care), and Part D (prescription medication coverage). Enrollment in Parts B and D is optional, except for persons on Medicaid, who automatically are enrolled in Part D. Coverage under Parts B and D generally requires the payment of monthly premiums, which are deducted from the recipient's Social Security benefits. Individuals with questions about their eligibility for Medicare can contact the Social Security Administration at (800) 772-1213.
Low-income Medicare recipients may qualify for help with their Medicare Part B and Part D premiums, co-payments, and deductibles through Medicaid or the Medicare Savings Programs. To apply for Medicaid and Medicare cost-sharing, contact your local Michigan Department of Human Services office. See the section on Medicaid for Seniors and Persons with Disabilities (in Health/Medical) for more information about Medicaid and Medicare Savings Programs.
Low-income Medicare recipients also may qualify for help with Part D premiums, deductibles, and co-payments under the Low-Income Subsidy Program. To apply, contact the Social Security Administration at (800) 772-1213.
The Michigan Medicare/Medicaid Assistance Program (MMAP) helps individuals with questions about their Medicare benefits and eligibility. You can reach MMAP at (800) 803-7174.
CCJ provides advocacy to ensure that low-income people with Medicare receive the benefits and coverage they are entitled to under the Medicaid program, the Low-Income Subsidy Program, and the Medicare Savings Program.