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State of Michigan Official "Stakes Are High for the Healthy Michigan Plan Second Waiver"

Thursday, June 25, 2015  
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As Michigan prepares to submit its new proposed waiver for the Healthy Michigan plan to the federal government, the stakes for the waiver are high, a Health and Human Services official said Wednesday, and could include the program ending if a waiver is not approved by December 31.

But since the proposed waiver also calls for persons now on the Healthy Michigan plan to acquire coverage through the federal exchange, it is unclear what the state may do if the U.S. Supreme Court rules that tax subsidies cannot be granted to persons who get their insurance through a federal exchange, Jackie Prokop, program policy division director for the Department of Health and Human Services, told reporters following a hearing on the upcoming waiver request.

The 2013 statute that authorized the Healthy Michigan program requires that a new waiver from the federal government either allow a person to get insurance from the exchange or increase the cost a person could pay as part of their Healthy Michigan coverage.

Ms. Prokop told reporters it was hard to speculate on what the results might be if the U.S. Supreme Court throws out the subsidies.

The court could rule as early as Thursday on the issue in King v. Burwell whether tax subsidies apply to persons getting health insurance through the federal exchange under the federal Patient Protection and Affordable Care Act. Nearly 300,000 people now get insurance through the federal exchange, and, according to the Department of Insurance and Financial Services, get tax subsidies of $273 a year.

The Healthy Michigan plan required an initial waiver from the federal Center for Medicare and Medicaid Services to go into effect after the Legislature enacted the measure in 2013. A second waiver must now be approved for the program, which has nearly 600,000 Michigan residents enrolled, to continue.

Ms. Prokop said at the hearing if the federal CMS does not approve the waiver by December 31, then the Healthy Michigan plan will end on April 1, 2016. "We do have a big vested interest in this waiver," Ms. Prokop said.

The state has to submit its waiver request by September 1. The state has already put out a paper on the overall dimensions of the waiver - which were specified by the act - and has had a telephone conference with federal officials.

Ms. Prokop praised the federal officials, saying they understood what the law required. "They know what's at stake here," she said.

And the hearing was held to generate questions and concerns from different individuals on the proposed waiver so the state could better prepare its waiver request.

The waiver would affect a person whose income was between 100 percent and 133 percent of the federal poverty level and who had coverage under the Healthy Michigan Medicaid expansion for a cumulative total of 48 months. Under those guidelines, the changes would not take effect until April 2018.

The law requires the state to seek a waiver to allow those persons to either get coverage on the federal exchange or to pay up to 7 percent of the costs, which include co-pays, of the program.

Currently, the program can charge up to 3.5 percent of the program's personal cost, but if a person engages in healthy behaviors after a health assessment, that total can be cut.

Even at 3.5 percent, the state needed to get a waiver, since the federal government limits the cost sharing element to 2 percent.

Speaking to reporters afterwards, Ms. Prokop said the federal government has not said anything at this point about changing the request, or seeking the Legislature to change the act, to modify any of those conditions. In fact, she said, the conversations at this point seem optimistic.


Source: Gongwer 

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