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Healthcare.gov & Medicaid Expansion – Quick Michigan Facts

January 15, 2014

By Scott Lyon, Senior Vice President

Earlier this week the Department of Health and Human Services issued its third issue brief regarding national and state level enrollment related information for the Health Insurance Marketplace.  This information is cumulative and covers the period October 1, 2013 – December 28, 2013.

Here in Michigan we have had 75,511 individuals enroll via the Marketplace and an additional 4,196 applications are pending.  22,221 more individuals have applied and through that process they have qualified for Medicaid. Unfortunately, what we do not know from the data released is how many of the 75,511 were previously uninsured, how many previously had an individual policy that was terminated, or how many came from a sole-proprietor/one subscriber plan that no longer meets the ACA requirements.  Fully 84% of the individuals applying for coverage via the Marketplace are eligible to receive some level of subsidy.  Nationally, 79% are eligible for a subsidy.  Of those applying, 45% are male and 55% are female, which tracks closely to the national average of 44% male and 55% female.

While gender is an important actuarial consideration, age is one of the most critical factors to the long-term viability of the health insurance risk pools.  The following table provides data on Health Insurance Marketplace applications by age here in Michigan and nationally.

Age

Michigan

National

Under 18

5%

6%

18-34

25%

24%

35-44

13%

15%

45-64

57%

55%

What type of plans are Michigan citizens selecting compares to those chosen nationally? 

Plan Type

Michigan

National

Bronze

12%

20%

Silver

70%

60%

Gold

14%

13%

Platinum

3%

7%

Catastrophic

1%

1%

With three additional months of open enrollment, it is a little too early to start drawing any conclusions regarding the relative success or failure of this grand experiment.  That said, experts suggest that in order for the risk pool to balance out, the number of 18 – 34 year old enrollees needs to be closer to 40%.  This is something to keep an eye on for the next couple of months as this will be an early indicator of where things are headed longer term.

Medicaid Expansion

First, Medicaid expansion in Michigan is better known as the Healthy Michigan Plan.  By way of background, the Michigan legislature passed, and Governor Snyder signed into law, Public Act 107 of 2013 on September 13 of last year.  Because PA 107 of 2013 did not get the votes needed for immediate effect, the Healthy Michigan Plan will begin around April 1, 2014.  Further, because the Healthy Michigan Plan requires certain co-payments and deductibles, a Federal Waiver was required.  This waiver was submitted to the Secretary of Health and Human Services on November 8, 2013 and in what some would describe as lightning speed for a federal bureaucracy like HHS, it was approved on December 30, 2013.

For an individual to qualify for the Healthy Michigan Plan, they must meet the following requirements:

  • Be between 19 – 64 years of age
  • Not be enrolled in, or eligible for, Medicare
  • Not be eligible for our current Medicaid Program
  • Not be pregnant at the time of enrollment
  • Have an income below 138% of the federal poverty level (roughly $15,000/year)

It is expected that an additional 400,000 to 500,000 Michigan citizens will qualify for Medicaid under this program, bringing the total Medicaid population in Michigan to somewhere around 1.886 million – fully 25% of the Michigan population under the age of 65.

Healthy Michigan beneficiaries will enroll in one of the current Medicaid Health Plans and they will use the current prepaid Inpatient Health Plan system of care.  Much like plans offered to individuals and small business, the Healthy Michigan Plan will cover the 10 Essential Health Care Services required by the Affordable care Act.

At the time of enrollment, the Healthy Michigan Plan requires a MI Health Account be established through which beneficiaries will contribute 2% of annual income (for individuals with income between 100% and 133% of the federal poverty level).  Additionally, a health risk assessment (HRA) must be completed; if the beneficiary engages in healthy behaviors, a reduction in required cost sharing amounts occurs.  The HRA will also provide the beneficiaries with information on health care costs incurred and utilization.  The goal of the MI Health Account is to have beneficiaries more involved in their health care decisions and improve overall health outcomes.

If you have customers with employees who may qualify for the Healthy Michigan Plan, there are some new resources that you can direct them to for additional information and enrollment:

www.michigan.gov/healthymichigan
MI healthcare helpline at 855-789-5610

Phone application assistance line at 855-276-4627

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