Michigan: Medicaid expansion waiver approved (again), with some strings attached

Well, this is mostly good news, anyway. A week or so I reported that Michigan's version of the ACA's Medicaid expansion provision (called simply "Healthy Michigan") was at risk of having the plug pulled because a) it has to be re-approved by CMS and b) the revised version of the waiver includes some pretty draconian extra requirements.

The problem was that if CMS didn't approve the waiver, the entire program would be shut down, kicking some 600,000 Michiganders off their healthcare coverage next April.

Well, as Amy Lynn Smith reports via Eclectablog, CMS did end up approving the waiver after all, ensuring that the Healthy Michigan program continues for another few years:

CMS has approved the second waiver and the Healthy Michigan Plan will continue without any disruption.

Michigan Governor Rick Snyder had this to say in a statement:

The Healthy Michigan Plan has provided Michiganders with the opportunity to improve their health and wellness by enrolling in health care coverage. I’m proud of this program, our residents, and Michigan’s continued leadership in health care innovation. I appreciate the work of the Centers for Medicaid and Medicare Services [sic] and thank it for its partnership and approval of our unique approach to keep Michigan moving forward.

To be fair, Gov. Snyder should also thank the mostly Democratic legislators and health reform advocates who fought hard to pass Medicaid expansion in Michigan.

The Healthy Michigan Plan has been heralded as a model that other Republican-led states can use to find a compromise to make Medicaid expansion palatable to legislators who are often opposed to the expansion on strictly ideological grounds — mostly, an intense dislike of President Obama and the Affordable Care Act (ACA), or Obamacare.

Details of the second waiver are as follows: Starting April 1, 2018, Healthy Michigan Plan participants with incomes between 100 and 133 percent of the federal poverty level must work with their physician on strategies to lose weight, quit smoking or adopt other healthy behaviors. If they don’t, they must obtain health insurance through the Healthcare.gov marketplace.

I'm not entirely sure whether the final approved waiver wording is the same as that reported last week; this "healthy behavior" thing doesn't sound that bad at all, frankly. A Detroit Free Press story has more details:

Eligible participants must contribute up to 2% of their income to the health savings account, which will be administered by the state and can be used for out-of-pocket expenses. The exact portion is based on the person's or household's modified adjusted gross income, or MAGI, as well as copays the enrollee would experience in the first six month of the program.

Cost-sharing -- both the contributions to the health savings account and any copays -- would not exceed 5% of the enrollee's MAGI for the first four years and might increase after that to 7% for individuals who are deemed not medically frail.

U.S. Sen. Debbie Stabenow said news of the federal waiver was incredible.

"We thank them (CMS) for being able to thread the needle here," she said. "Families will have a wonderful Christmas present knowing their health insurance is going to continue.”

Hmmm...the original story made it sound like the 7% threshold was guaranteed as opposed to only possible.

Anyway, overall this is still a pretty good thing, though I really think CMS should have held the line at 5%.