Dec. 31—A Michigan Medicaid eligibility expansion, which includes the use of income-related premiums, recently received federal approval.

The Centers for Medicare & Medicaid Services (CMS) approved on Dec. 30 Michigan's plan to add about 400,000 residents to its Medicaid program, as authorized by the Affordable Care Act (ACA).

The “Healthy Michigan” plan was billed by Republican Gov. Rick Snyder as a way to not only expand access to all residents with incomes of up to 133 percent of the federal poverty level (FPL), but also to reform the program through custom features, such as the use of premiums for beneficiaries earning more than 100 percent of the FPL. Beneficiaries can reduce their premiums by undertaking healthy lifestyle changes.

Michigan was the 25th state (plus the District of Columbia) to agree to expand its Medicaid program after the Supreme Court eliminated penalties for states that do not undertake the ACA expansion.

A recent survey of the Medicaid directors in 23 expanding states that was published in Health Affairs found most states expect 50 to 75 percent of newly eligible uninsured adults will sign up for coverage. An estimated 13 million were projected to gain Medicaid coverage by 2020 under the ACA, according to the Congressional Budget Office.

Another finding from the directors’ survey was that most expected the ACA to bring in a “moderate” or “large” number of previously eligible individuals into Medicaid due to the “woodwork effect.” 

Additionally, 90 percent of directors concluded that the ACA’s 2013 to 2014 increase in Medicaid primary care payment rates to Medicare levels will produce no impact or only a “small increase in the number of providers” accepting Medicaid in their states. The increase aimed, in part, to help reduce the use of emergency departments by Medicaid beneficiaries.

Another recent study found Medicaid and Medicare patients more likely than privately insured patients to report their emergency department visit stemmed not from a need for immediate care, but because of trouble accessing care elsewhere. The findings were based on a review of the 2011 National Health Interview Survey used by 4,606 patients seeking emergency care.

Publication Date: Tuesday, December 31, 2013