Michigan Medicaid rules change soon. Can cool envelopes help avoid confusion?

Medicaid letter

More than 270,000 Healthy Michigan recipients are receiving letters like this one this week, informing them of changes that could cost them coverage if they don’t act.

Michigan Health Watch is made possible by generous financial support from the Michigan Health Endowment Fund, the Michigan Association of Health Plans, and the Michigan Health and Hospital Association. The monthly mental health special report is made possible by generous financial support of the Ethel & James Flinn Foundation. Please visit the Michigan Health Watch 'About' page for more information.

Michigan is turning to communications specialists to help get the word out about changes to Medicaid that could cause hundreds of thousands of recipients to lose coverage if they don’t get jobs or look for work.

Last week, a campaign began to send 273,637 newly designed, brightly colored letters to mailboxes throughout the state. In contrast to the black-and-white letters sent in February full of legalese and qualifiers, the new version demands attention with varied font sizes and vivid graphics.

Even the envelope is yellow.

“We can do better in speaking simply and clearly,” said Robert Gordon, director of the Michigan Department of Health and Human Services.

The letters inform some of the 650,000 Michiganders who get health coverage through Healthy Michigan, the expanded Medicaid program made possible by the Affordable Care Act, of new work requirements.

The first batch of letters is going to those whom the state believes do not qualify for an exemption to the work requirements. Another batch of letters will go out this fall to beneficiaries the state believes are disabled or have another exemption, informing them they don’t need to take action.

The rules, passed last year by the Republican-led Legislature, require beneficiaries up to 62 years old to prove they are spending 80 hours per month working, attending school or job training to receive government insurance benefits. Some exemptions will apply, including for medical conditions, pregnancy and disability. 

Michigan is one of 16 states trying to implement such work requirements, according to the Kaiser Family Foundation, which is tracking the progress in those states. Michigan officials hope to avoid a debacle like one in Arkansas, which last year was the first to put work requirements to the test. 

More than 18,000 Arkansans lost benefits even though most met the requirements or would have been exempted from them. About half the recipients didn’t report to the state because they had no internet or were confused about the requirements, according to a report this summer in the New England Journal of Medicine.

The problems were so widespread that a federal judge struck down Arkansas’ new rules, finding that they failed to meet the core objective of Medicaid — getting medical coverage to the poor.  Judges elsewhere blocked similar rules in Kentucky and New Hampshire.

Meanwhile, Indiana’s program — though it started in January — has been rolled out incrementally. Though the Indiana rule is similar to those in Michigan, Arkansas and Kentucky, beneficiaries weren’t required to report until this summer. Plus, at first, beneficiaries are required to work just 20 hours a month, and they lose coverage only if they fall short of the requirement at least five months of the year.

Based on the experience in Arkansas, 61,000 to 183,000 Healthy Michigan Plan recipients could lose their Medicaid benefits over the next year, according to a report released in February by the Los Angeles-based law firm Manatt, Phelps & Phillips LLP.

Julie Burke

Julie Burke, an outreach worker with Baldwin-based Family Health Care, helps residents in rural Lake County get health coverage. She worries that many will lose benefits under the new work requirements.

The cost of redesigning the new letters is about $20,000 and the final tally will include production costs and postage. Printing of the letters and envelopes, in addition to postage costs, will top $800,000, according to Bob Wheaton, a health department spokesman.

Continued outreach, which also could include advertising, depends in large part on $10 million in funding in Gov. Gretchen Whitmer’s proposed budget, Gordon said. The letters are intended to not only grab attention and not get tossed into the trash, but convey respect, he added.

“People are really busy, they have other things to do than wade through overly complicated legal talk,” he said.


Robert Gordon, director of the Michigan Department of Health and Human Services, says simplifying communications is common sense and a matter of respect. (Courtesy photo)

The effort follows other initiatives in the past few years to simplify its forms. Last year, the state radically overhauled its form for general assistance like food stamps, trimming the 42-page document to 18 pages and making it significantly easier to complete. The project cost $830,000.

The Medicaid form is earning raves from advocates such as Alison Hirschel, director of the Michigan Elder Justice Initiative, who said even experienced attorneys have had trouble sorting through health benefits.

The new letter is “outstanding” and “the best communication I’ve seen from them,” she said.

The color and graphics on the letter — even the font size — ensure the critical messages are easy to read and understand, said Amber Bellazaire, a health policy analyst with the Michigan League of Public Policy, a left-leaning policy group that has opposed work requirements for Medicaid benefits but is working with legislators and state officials to ease their rollout.

Lawmakers are considering offering more time to report work activities for the previous month and exempting recipient from filing if MDHHS can verify on its own that person was working. 

Among other plans before the rollout, the state is planning a call center and training for “navigators” that can help people fulfill reporting requirements.

“None of these changes will matter if people don’t open their mail,” Bellazaire said.


Within easy reach of Robert Gordon, who oversees Michigan’s human services programs, is the rolled-up paper copy of the old 18,409-word form for public assistance — an example of bureaucracy run amok. (Bridge photo by Robin Erb)

It’s still unclear how many of the roughly 650,000 beneficiaries ultimately will be eligible for exemptions. The nonpartisan state Senate Fiscal Agency has said it could be “a significant portion.”

Gordon is clear: However the work is simplified, state staff and community workers —  whether located in health clinics or social services organizations — are going to struggle to make sure beneficiaries know about the deadlines and can adequately report their hours or justify their exemption, he said.

It’s both a challenge in terms of human capabilities and time as well as within outdated government systems, including old computer systems.

“We are doing everything humanly possible to effectively implement this law, but there are going to be problems inevitably because it is a very complex law, and we have these very complex and highly imperfect systems.”

Facts matter. Trust matters. Journalism matters.

If you learned something from the story you're reading please consider supporting our work. Your donation allows us to keep our Michigan-focused reporting and analysis free and accessible to all. All donations are voluntary, but for as little as $1 you can become a member of Bridge Club and support freedom of the press in Michigan during a crucial election year.

Pay with VISA Pay with MasterCard Pay with American Express Donate now

Comment Form

Add new comment

Dear Reader: We value your thoughts and criticism on the articles, but insist on civility. Criticizing comments or ideas is welcome, but Bridge won’t tolerate comments that are false or defamatory or that demean, personally attack, spread hate or harmful stereotypes. Violating these standards could result in a ban.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.


Mon, 09/09/2019 - 9:23am

I think the last paragraph sums up the situation well. A better but probably not feasible approach would be to have a face to face meeting with everyone impacted by this.

Mon, 09/09/2019 - 9:46am

Yes, this should happen.

Wife used to be in charge of hiring people. When they heard the hours and salary a lot said, no I don't want to do that because I'd make so much I'd lose my medical benefits.

This plan is a step in the right direction. People must work, but if they work and meet other requirements, they will still receive medicaid. Sounds like a step up to me, and not perpetual government assistance.

Jonah 4
Mon, 09/09/2019 - 10:30am

I disagree with the policy passed by the Republicans to require able bodied Medicaid recipients to work or attend training, etc. However, given the House and Senate's inability to come up with a good, no gimmicks budget plan the past nine years to fix the crumbling State infrastructure and to bring education in this state from its dismal low to the top, they clearly are not earning their salaries and benefits. Given that, their salaries and benefits should be terminated till they do the jobs they are currently being paid to do but do not.

Marlene Augst
Mon, 09/09/2019 - 1:00pm

Nothing about your comment makes any sense.

Mon, 09/09/2019 - 1:57pm

Road & Bridges infrastructure is been held up since 2011-2012 by Mitch McConell see senate bill S.1867 2011-2012 /112 th Congress medicaid mailing using ...taxpayers money for Insurance Companies to privatizing medicare/medcaid. dental care and all benefits have been "given to seniors fo over 10-15 years.just another waist of taxpayer Care and more confusing the seniors.

Mon, 09/09/2019 - 11:24am

I bet they didn't have any problems reading the forms that were needed to sign them up for free healthcare to begin with!

Robin Kapanka
Mon, 09/09/2019 - 12:27pm

It would be a big help to investigate these people claiming children with an unknown father that is actually in their lives with a good job to boot while the parent works under the table and has everything she desires including a new garage, pool, deck, different newer looking cars every couple years and all the kids that are adults even had cars in parents name. (4 adult kids & I saw this with my own eyes). How do people get away with this crap? I can't even make a mortage payment but they live high off the hog. Pisses me off royaly!

Marlene Augst
Mon, 09/09/2019 - 12:58pm

It's about time, there is NO MORAL obligation whatsoever for taxpayers to provide ABLE BODIED adults with ANYTHING. It amazes me how taxpayers are forced to provide for their own insurance, then provide for Medicare and Medicaid, and then subsidize the Obamacare while still providing funds for PP. When does it end?

Mon, 09/09/2019 - 9:43pm

It will be interesting to see how this works out, some of these "able bodied adults" have no job skills but do have mental, drug or alcohol problems which make them unemployable even for the most menial jobs around. They could end up lost in the process and out on the street with no place to go.

Tue, 09/10/2019 - 12:31pm

Say it again louder for the libertarian sociopaths content to let the poor and indigent die in the street

Chuck U. Farley
Tue, 09/24/2019 - 6:35pm

This new law is cruel. Simply cruel. I'm a white middle-aged divorced male. I work five or six days per week, but limited hours (3-6) because of physical limitations and the limitations of my job. Some months I end up with slightly fewer than 80 hours. I've been at this job for nearly a decade, and I love my job. I do not intend to quit to find a cruddier job just to get a few extra hours to satisfy the requirements of this law, I cannot squeeze more hours out of my job than the clients grant, I don't NEED job training, and I do not have the physical ability or time to perform community service after working my job 5 or 6 days per week. My employer does not provide insurance. My body's a wreck, but I do NOT want to be on disability insurance at this time. I want to work; I just can't always guarantee I can work 80 hours per month. Sometimes it's more. Sometimes it's less.

And yet my reward for working as much as I can with my physical issues and my employer's limitations is to be booted off SNAP and Healthy Michigan because I fell 5 hours short three months out of the year, in the slow season.

But then, with Republicans, the cruelty is the point, isn't it?

I pray Governor Whitmer and our current legislators do something about this cruel law. Either you want to expand Medicare to help us, or you want us to die. That's what it boils down to. I can't afford to buy into the insurance marketplace. I CAN'T work any more hours than I do. I can't give in and go through the disability process, nor do I want to, nor should the State be pushing people like myself to do so in order to keep our insurance.

I don't give a fudge how pretty and informative the letter is. I'm appalled at the cost of making it so pretty. Instead of spending the money to HELP people keep their insurance, you're spending it to make it clear to us that we're being kicked out. Thanks for nothing.