Have an opinion on Michigan’s Medicaid work rules? Weigh in quickly.

The Michigan Department of Health and Human Services is accepting public feedback on proposed work requirements for the state’s Medicaid expansion recipients. The deadline to respond is Aug. 12, though the state said comments will continue to be accepted after the formal deadline ends.

Michigan health officials say they want to hear from you about the state’s plan to require Medicaid expansion recipients to work to continue receiving health benefits.

Before the state asks the federal government this fall to approve its controversial plan, which Gov. Rick Snyder signed into law in June, it needs to collect public feedback. The deadline to submit questions or comments is Sunday, Aug. 12, though Michigan Department of Health and Human Services staffers say they’ll continue to take feedback even after the formal comment period ends.

When the Republican-sponsored bill was introduced in the Legislature this spring, it immediately elicited criticism from advocates for low-income Michiganders that the bill would harm some of the state’s most vulnerable residents.

Though they have been imposed as conditions for receiving other forms of welfare assistance, work requirements had not been permitted under Medicaid until the Trump administration this year loosened guidelines, allowing states to apply to adopt them.

Four states — Indiana, Kentucky, Arkansas and New Hampshire — have had waivers to create Medicaid work requirements approved by the federal Centers for Medicare and Medicaid Services. But a federal judge recently blocked Kentucky’s proposal from taking effect and sent it back for more review. That case is being watched across the country.

Michigan held two public hearings last week in Lansing and Detroit. DHHS spokesman Bob Wheaton said about 45 people attended in total; the hour-long meetings were held on weekday afternoons. (The Lansing event was recorded and can be viewed here.)

How to submit comments

Comments on a state plan to impose work requirements on Medicaid expansion recipients can be sent via the U.S. Postal Service or by email by Sunday, Aug. 12. Details about the proposal and how to be heard can be found here.

You can mail comments to:

MDHHS 

Medical Services Administration 

Bureau of Medicaid Policy and Health System Innovation 

Attention: Medicaid Policy 

P.O. Box 30479 

Lansing, MI 48909-7979

Or you can email comments to healthymichiganplan@michigan.gov. Include “Demonstration Extension Application Amendment” in the subject line.

The Michigan League for Public Policy, which advocates for vulnerable Michigan residents, also created a feedback form.

 

In all, 245 comments have been submitted thus far, Wheaton said. Department staff will send all written comments to the federal Centers for Medicare and Medicaid Services, which decides the waiver request, and will make them available online once the waiver is submitted by Oct. 1.

People will continue to be able to send in questions or comments after Sunday’s deadline passes, he said.

Sen. Mike Shirkey, a Republican from Clarklake in Jackson County who sponsored the work bill, and business groups maintain the requirements are needed to help fill a talent pipeline for employers having trouble finding workers. Requiring work in exchange for government assistance is a “hand up” rather than a “handout,” its backers say, and will help people move up the economic ladder.

GOP legislators and business groups, including the Michigan Chamber of Commerce, have expressed concern that the state’s Healthy Michigan Plan would negatively impact the state budget, as enrollment exceeded initial expectations.

Critics of the idea, including Democratic lawmakers and advocacy groups like the Michigan League for Public Policy, contend that Medicaid was never designed to be a workforce development program.

These critics say it’s unclear how many of the state’s roughly 660,000 Healthy Michigan Plan recipients could be subject to the work rules — a DHHS official said at a recent public hearing that department staff are still working to identify the number. Critics add that many recipients already work or would run into child care and transportation barriers trying to comply with the work mandate.

An earlier version of the bill included an exemption for people who live in high-unemployment counties, though the provision was pulled after criticism that it would cover mostly white, rural residents and not poor, heavily minority residents living in high-unemployment cities.

If the federal government approves Michigan’s request, the law as signed would require able-bodied adults enrolled in the Healthy Michigan Plan to work for an average of 80 hours per month — roughly 20 hours per week — to keep benefits; other activities allowed under the rules include job training, education, internships, community service and an active job search. Recipients who fail to meet the requirements for more than three months in a year would lose benefits for at least a month until they’re again in compliance.

The new changes also would require Healthy Michigan Plan enrollees earning between 100 percent and 133 percent of the federal poverty level, and who have participated in the program for at least 48 months, to pay 5 percent of their income toward their benefits. That’s up from 2 percent today.

The work law also adds triggers that would end the Healthy Michigan program altogether, depending on whether the federal government signs off on the waiver the state would need to impose the work requirements, prompting concerns that the entire Medicaid expansion population could be at risk of losing benefits.

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Comments

Linda K. Strohl
Thu, 08/09/2018 - 8:59am

Home health care agencies are struggling already to meet surging demand for their services and immigration policy changes have made this situation worse. Many disabled and seniors who have unpaid caregivers on Medicaid would suffer in multiple ways: they would be unable to receive the at-home care they need by family members and spouses; more seniors would have to wait for services due to scarcity of home health workers, and an outcome would be costly institutionalization. There must be an exemption for caregivers who perform important tasks for disabled and senior members of our state.

Anna
Thu, 08/09/2018 - 9:56am

I wish they would add a Healthy MI 'buy in' option as an alternative to the work option. I'm 55, retired early after laid off my long term job of 20 years. Minor carpal tunnel prevents me from doing more computer work. My biggest retirement concern was affordable health insurance, so I was happy to get on the Healthy MI Plan. I'd be happy to pay a low monthly premium rather than the work requirement. I cannot afford an individual plan. ACA plans won't cover folks that make less than about 15k per year, they refer them to Medicaid... so I would be stuck in the no coverage gap if I didn't have it. If the offered low-premium Medicaid (and Medicare) options it would help lots of folks in my situation.

Julie Monteiro ...
Thu, 08/09/2018 - 9:59am

Dear Michigan Department of Health and Human Services,

Michigan must provide Medicaid to individuals and families in need, without prejudice, to ensure that we have a healthy population. The proposed changes to add work restrictions are reprehensible, as they will will harm those who most need the benefits. Cancelling coverage altogether if recipients do not work for 3 months in a calendar year would create perverse incentives - for example, for individuals to not fill temporary assignments (for fear of not finding another short-term position) or to not take time off of work when sick or to care for family members. Increasing co-pays to 5% of income for those at or just above the poverty threshold is an unfair financial burden and harms those who need government assistance. Provisions that would trigger an end the Healthy Michigan program would cause tremendous harm to Michigan's citizens and the general health of our population. Please overturn this bill in its entirety and, instead, uphold our Healthy Michigan program as a robust government service that provides healthcare coverage to Michiganders in need.

Thank you for taking public comments on proposed changes to Michigan's Medicaid program.

Sherry A Wells
Thu, 08/09/2018 - 10:05am

Thank you, Bridge, for making me aware of this. The email I just sent to "Healthy Michigan" was:
I was a welfare recipient as a child of divorce and as the 3 years' married mother of a 3-month old whose husband left and never paid a penny of support. Back in 1970, I was able to finish my remaining 9 months of a degree while on ADC (not allowed since) and get a job as an ADC caseworker! I am certain that the taxes I paid on the next year's income easily repaid every penny of the welfare.
As a caseworker, I found more recipients trying to work when they physically should not have than the maybe one person trying to "milk the system." One woman wanted a factory job, but no, the system wanted to train women for cutting hair or LPN, neither of which could ever get anyone with even one child out of poverty. And the system has not been improved and now the ax is out again.
Instead of requiring, how about inviting? How about having the Chamber of Commerce to list specifically all of the jobs it says are going begging and to work with organizations to recruit (that "invitation" again) from the handful of "able-bodied" remaining after exclusions and to provide the necessary counseling, training, transportation and child care to enable that result.
Article I, section 8 of the U. S. Constitution gave Congress the power to "lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common defense and general Welfare of the United States." When "welfare" had a positive meaning and included health and safety.

JB
Thu, 08/09/2018 - 10:22am

I agree with this idea! Coupled with exemptions for work based on medical need. Tying in the most in demand jobs in the area, can these workers fulfill the need for these job openings?

Karen
Fri, 08/10/2018 - 8:33am

Let's not confuse purpose of medicaid, to provide healthcare to disabled and low income people, with a jobs program. Medicare saves the state money by enabling preventive care and care for persons with chronic illnesses. It's not about work. Most people on medicaid who are able do work. How could this plan work when economy is not robust, when jobs aren't available? Cost of childcare and transportation issues already compromise work options for low-income workers. Let's have a program to solve those problems. It's not medicare.

Kevin Farley
Sat, 08/11/2018 - 11:33am

I'm concerned by who will determine disability. I have found with many state appointed physicians their lack of concern and who every is telling them what to do is appalling. They don't take into count many mental conditions as well as physical. I know there are people out their that take advantage of the system and I feel the amount of inspectors needs to be increased. In Michigan there are so few inspectors to check everything. Not only do people suffer but businesses do too.

Chuck Jordan
Sun, 08/12/2018 - 11:03am

The idea is a good one. The problem is in application. If a person can work, she/he should. But who will make that determination? What will happen when the costs for taking care of a child and transportation are more than the job pays? Training and education for these folks could be a positive. What will really happen?

CARL VER BEEK
Mon, 08/13/2018 - 10:52am

This law is well intentioned, but misses the mark for reform.
It is unclear whether the administrative cost will exceed the savings.
A better approach would be to follow the process used by Oregon for over 25 years. Prioritize the benefits to fit the legislative appropriation. This assures a balanced budget and stops the cost shift from the underpayment by Medicaid to those with an insurance plan. Who gave the hospitals the power to tax? They just pass on their "losses" to the insurance industry, who pass it on to those who buy insurance.