Provision in Medicaid work bill could end Healthy Michigan program

LANSING – Tucked into the bill that requires able-bodied Medicaid recipients to work at least 80 hours a month is a provision that could kill the state's Healthy Michigan plan altogether.

The poison pill would end the Medicaid expansion that was approved by the Legislature in 2013, which covers 680,000 Michiganders with health care, if the federal government fails to approve a waiver within 12 months.

If the state's Medicaid expansion plan deviates from previous practices, it has to apply for a waiver from the federal government to implement those changes. In Michigan's case, it will have to apply for a waiver on a provision that would limit benefits for recipients to 48 months and if they exceed that time, they'll have to start paying 5 percent of their income into their health care and prove that they are practicing healthy behaviors, such as quitting smoking or losing weight.

If the Trump administration, which has wanted to repeal Obamacare since taking office in 2017, wants to end the Medicaid expansion in Michigan, the 12-month trigger could give it the excuse to do that.

It was that provision that had Democrats especially worried and opposed to the bill, which requires that an estimated 350,000 people who are receiving Medicaid benefits work or lose their coverage.

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"The goal is to kick people off health care. In the bill, it says if they don't get the waiver, Healthy Michigan ends," said Senate Minority Leader Jim Ananich, D-Flint. "That's 680,000 people losing health care. That's what it's about."

Sen. Mike Shirkey, R-Clarklake, the sponsor of the bill, said he expects the waiver to be granted, but that recipients would have some time before the program ended if the federal government denies the waiver request.

The state "would have to give notice to enrollees and the program stops in four months," he said.

The movement toward requiring work for Medicaid coverage is growing across the nation with three states already requiring work for benefits and the administration of President Donald Trump reviewing requests from seven other states. The administration told Medicaid administrators earlier this year that it would support such requests and Trump signed an executive order last week asking for work requirements for recipients of federal benefits, such as food stamps and Medicaid.

The bill, which received final passage Thursday in the Senate, is a compromise from what was initially proposed, which included a 29-hour workweek requirement and a controversial provision that would allow counties that had unemployment rates of 8.5% or more to be exempt from the work requirements. That would primarily benefit rural counties, but not urban cities such as Detroit, Flint and Saginaw that are in counties that have lower overall unemployment rates.

That provision was stripped out of the bill, in part, because it would cost the state Department of Health and Human Services too much to administer. But it also would have affected minority communities much harder than the rest of the population.

People who are exempt from the work requirements include pregnant women; people receiving disability benefits; full-time students; the medically frail; caretakers of a family member under age 6 or a dependent with a disability; a recipient who met a good cause temporary exemption; a recipient with a medical condition that resulted in a work limitation; a recipient who had been incarcerated within the last six months; a recipient of unemployment benefits, or a recipient under 21 who had previously been in foster care.

Shirkey estimated that about 350,000 of the 680,000 Healthy Michigan program recipients would be required to work under the bill.

Michigan has about 2.4 million people who get health care coverage through Medicaid. A majority are elderly, disabled or children, but in 2013, the Legislature passed the Healthy Michigan law to expand Medicaid to low-income Michiganders and 680,000 people signed up.

Gov. Rick Snyder said Thursday that he supported the compromise legislation and expects to sign it, despite an outpouring of calls for him to veto the bill from groups that advocate for poor people.

Contact Kathleen Gray: 313-223-4430, kgray99@freepress.com or on Twitter @michpoligal