Jackie Prokop, PhD, RN Director, Medicaid Program Policy Division Michigan Department of Health and Human Services Medicaid and CHIP Overview June 11, 2018 Jackie Prokop, PhD, RN Director, Medicaid Program Policy Division

Program Coverage

Medicaid Program Michigan Medicaid is an entitlement program that started as a result of Title XIX of the Social Security Act in 1965. The Michigan Medicaid program is a cooperative venture jointly funded by the Centers for Medicare and Medicaid Services (CMS), and the State of Michigan. Administered by the states for individuals and families with low-incomes and limited resources.

Medicaid vs CHIP Program Funding Medicaid is an entitlement and does not have a cap on enrollment or on funding. Children's Health Insurance Program (CHIP) is administered under a program allotment. This is called Title XXI.

Medicaid Covered Populations Title XIX Pregnant Women Children under age 21 Low-income elderly Aged, Blind, Disabled Parents or Caretaker Relatives Emergency Services Only – non-citizens “Spend down” Healthy Michigan Plan covers adults 133% of the federal poverty level (FPL) Other special populations

Medicaid Eligibility for Children Newborns Healthy kids infants under age 1 Healthy kids infants over age 1 Healthy kids pregnant women MIChild – Medicaid Expansion Other Healthy kids Foster care Low-income family Ward of the state Disabled children Children’s waiver Flint Waiver Children with serious emotional disturbances Does not include CSHCS, WIC

Eligibility for Michigan Medicaid

Federal Poverty Level (FPL) for 2018 2018 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA PERSONS IN FAMILY/HOUSEHOLD POVERTY GUIDELINE For families/households with more than 8 persons, add $4,320 for each additional person. 1 $12,140 2 $16,460 3 $20,780 4 $25,100 5 $29,420 6 $33,740

Citizenship and Residency Must meet U.S. citizenship requirements Used to be self declared, now with the Deficit Reduction Act of 2005, must prove citizenship Match federal files Must meet Michigan Residency Self-attestation

Modified Adjusted Gross Income (MAGI) New eligibility determination methodology for Medicaid (excludes disabled population) Uses a single streamlined application Provides for no wrong door for application Online In person Telephone Standardizes the calculation of income with consistent formula Relies on electronic data matching to the greatest extent possible Removes asset test

Medicaid Consumers and Costs 51% of the consumers are children though the aged and disabled population is growing. population age 85 and older in Michigan has increased 47%, while the population ages 0-64 has decreased 4%. Children: 42% of the consumers 20% of total Medicaid spending Aged and Disabled: 17% of the consumers 47% of total Medicaid spending 5

Medicaid Delivery System Data from FY15, if asked. Raw Data: T:\Presentations\Budget Hearings\FY16 Medicaid\FY15 Medicaid delivery system (from Dennis) Chart: T:\Presentations\Budget Hearings\FY16 Medicaid\Other FY16 Charts

Quick Facts Pay for roughly 50% of all pregnancies in Michigan. Provide coverage to roughly 45-50% of all kids in the state (this includes Medicaid and MIChild). Case load is roughly 2.3 million people in the state being covered by Medicaid.

Medicaid Cost Sharing No deductibles (unless it is a spend down beneficiary) No premiums Except Healthy Michigan Plan, Freedom to Work, MIChild Co-pays - $1 to $3 co-pay for office visits or pharmacy and a $50 hospital co-pay Children, pregnant women, most Native Americans exempt. Co-pays for family planning services, services provided in a Federally Qualified Health Center, Rural Health Center, and Tribal Health Center, and certain programs are exempt.

CHIP Program - MIChild Covers all children up to 212% of the FPL who are not Medicaid eligible Premiums $10 per family (Native Americans exempt) Roughly 40,000 enrolled Michigan has a 3% uninsured rate for children under 18 years of age. Lowest rate of all of the states.

Healthy Kids Dental Program Provide Dental care through our fee-for- service program for adults. Provide dental care through Delta Dental in all counties in Michigan. Contract was bid in Summer 2017 and Blue Cross Blue Shield of Michigan and Delta Dental of Michigan, Inc. were selected to serve as statewide dental plans Covers children up to 21 years of age.

Maternity Outpatient Medical Services (MOMS) Program for pregnant women who are not eligible for Medicaid or their Medicaid eligibility pending. Up to 195% of the FPL Women are not U.S. citizens. Children born are citizens and are Medicaid eligible at birth. Migrant workers residing in Michigan. CHIP funds to care for unborn child.

Flint Waiver Approximately 27,500 individuals living across the state are now enrolled in the Flint Waiver This waiver, which was approved in 2016, broadened Medicaid access and coverage for children and pregnant women affected by the Flint water crisis 400% of the FPL Case managers are available to assist waiver enrollees with a variety of activities known to combat the effects of lead exposure, including coordinating care, identifying lead hazard in the family’s home, and linking families with necessary resources and supports. Expand the health resources available to residents by adding a new targeted case management benefit to the coverage package for eligible individuals. 14

Lead Abatement Health Services Initiative The Children’s Health Insurance Program (CHIP) Health Services Initiative, which began in 2017, expands lead abatement activities in Flint and other targeted areas within the State Approximately $24 million available annually to abate lead hazards from the homes of Medicaid and CHIP eligible individuals (children under age 19 and pregnant women) Work is now ongoing in the cities of Flint (priority community), Detroit, Battle Creek, Grand Rapids, and Huron, Lapeer, Sanilac, and Tuscola counties To date, these funds have supported: Lead investigations of 341 units Abatement of lead hazards in 160 units Lead training and certification for 113 individuals Replacement of approximately 1,000 lead service lines in Flint The federal match is 98.35 percent for FY18 $30,000 GF/GP 15

Questions? Jackie Prokop, PhD, RN Director, Program Policy Division Prokopj@michigan.gov 517-284-1219