Michigan: Snyder finally gets around to actually asking feds to help clean up his mess

Last month, Michigan Governor Rick Snyder stated that he was planning on asking the Obama administration to expand Medicaid to cover...

... all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.

...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.

Specifically, the initiative, which is expected to be sent to the Obama administration in the next week, seeks expanding Medicaid eligibility to those affected regardless of income level. The request would also include the expansion of Medicaid coverage for people already enrolled in other forms of insurance.

The idea, state officials said, is to spread comprehensive benefits to children who may have come into contact with lead in the water regardless of their ability to pay. Generally, lead affects children more than it does adults. Children tend to show signs of severe lead toxicity at lower levels than adults, according to the federal Centers for Disease Control.

As I noted at the time, 42% of Flint's entire population is below 100% of the Federal Poverty Line, while the average income is just $14.4K. Since Medicaid already covers various groups of children and pregnant women up to between 160 - 212% FPL and the ACA's Medicaid expansion provision already covers everyone else up to 138% FPL as it is, the odds are that a good 60% of the city's population already qualifies for Medicaid anyway.

I estimated that Snyder's move (if and when he actually got around to it) might be good for perhaps 8,000 additional kids being covered...which isn't bad, but isn't nearly as dramatic an increase as it first appeared either.

Well, yesterday, 3 weeks later, Snyder finally got around to actually putting in his request:

On January 16, 2016, President Obama declared an emergency in the State of Michigan and ordered federal aid to supplement state and local response efforts due to the emergency conditions in the area affected by contaminated water. On February 16, 2016Michigan submitted a request to extend coverage to two optional coverage groups in Medicaid through the section 1115 demonstration: pregnant women and children through age 20, up to and including 400 percent of the federal poverty level, who are currently served by the Flint water system or were served by the Flint water system between April 2014 and the date on which the Flint water system is deemed safe by the appropriate authorities.  Individuals receive care through Medicaid managed care plans, receive all state plan benefits and lead abatement in the home.  The state requests a five year demonstration be authorized.

Hmmmm...ok. The 400% FPL cut-off wasn't originally part of the deal (the earlier story specifically noted "regardless of income level" ), and I don't imagine Flint has that many families above 400% FPL anyway...but that's besides the point. As far as I'm concerned, every single kid in Flint should receive free coverage...with Snyder himself and his corporatist buddies footing the bill. Then again, a Detroit News article about the formal request claims the number of children/pregnant women would be 15,000, nearly double my 8,000 estimate, so at least there's that.

However, the News article closes with a rather confusingly-worded caveat about the income level cut-off:

According to a release from Snyder’s office, the expanded coverage would go to those up to the age of of 21 who “are being served or who were served by Flint’s water system between April 2014 and a future date when the water system is deemed safe. Pregnant women and their future children will also be made eligible.”

All incomes will be covered by the program, but individuals with an annual income of $47,520, or households of four with an income of $97,200, will have the option of buying into the program.

Um...does that mean that anyone under 400% will be covered for free, while those over 400% would have to pay a fee of some sort? The actual filing itself isn't any clearer; here's the relevant wording:

1. Eligible Individuals: Eligible individuals include residents of Michigan who meet one of the following criteria:

  • Those individuals up to age 21 who are served by the Flint water system or were served by the Flint water system between April 2014 and the date on which the Flint water system is deemed safe by the appropriate authorities. This would include any children born to the pregnant women described below.
  • Those individuals who are served by the Flint water system and are pregnant between the date of approval of this waiver request and the date on which the Flint water system is deemed safe by the appropriate authorities.

2. Income and Asset Standards: An income standard of 400 percent FPL would be applied, using MAGI-based methodologies. No asset test would be applied. Individuals up to age 21 and pregnant women with household income above 400 percent FPL could buy in to unsubsidized coverage under the program.

Huh. Um...ok.

(sigh) Anyway, there you have it. Hopefully CMS will grant the request, although again, this is Snyder's screw-up; he should be the one paying the cost. For the record, the average cost of Medicaid/CHIP for children is around $1,900 per year in Michigan...but that generally doesn't include the cost of treating the effects of lead poisoning. For adults (pregnant women in this case) it's over $3,000 apiece.

Assuming an average of, say, $4,000 apiece for 15,000 kids/women, that'd be something like $60 million per year that the Snyder administration is asking the feds to pony up (or, assuming the standard federal/state split is used, $41 million from the feds and another $19 million from the state of Michigan).