April, 2015
There are over 2 million Michigan Medicaid and CHIP Beneficiaries, more than ½ are children (January, 2015). www.medicaid.gov/medicaid-chip-program- Information/By-State/michigan.html
Signed into law on September 16, 2013 by Governor Rick Snyder Applications accepted beginning April 1, 2014.
March 31, 2015
Healthy Michigan Plan Eligibility Requirements Michigan residents who: Ages 19-64 Not qualified or enrolled in Medicare Not pregnant at the time of application Have an income at or below 133% of the federal poverty level (about $16,000 for a single adult) Do not qualify for or are not enrolled in other Medicaid Plans
Most Healthy Michigan Plan beneficiaries will enroll into one of the current Health Plans. Current populations that are exempt or allow for voluntary enrollment in managed care will remain as such (e.g. Native Americans).
Ambulatory services Emergency services Hospitalization Maternity care Mental health and substance abuse Prescriptions Family Planning Rehabilitative and habilitative services Laboratory services Preventive and wellness services Chronic disease management Home health
If you make between 100 and 133% of the federal poverty level, you will need to pay a monthly contribution and co-pays. Total cost sharing, including co-pays, cannot be more than 5% of the annual household income.
MI Health Account Certain individuals and services are exempt from copays: Co-pays for certain chronic conditions and related medications are waived Existing exemption frameworks are in place for services (e.g. family planning, emergency services) and populations (e.g. under 21, individuals in hospice) MI Health Account starts 6 months after enrollment in a health plan.
Application Process Encourage applicants to apply online using MiBridges: www.mibridges.michigan.gov
Websites www.healthymichiganplan.org www.michigan.gov/healthymichiganplan Email Healthymichiganplan@michigan.gov
Michigan Medicaid provides a comprehensive health care package of benefits for pregnant women who meet eligibility requirements. Apply online at www.michigan.gov/mibridges
Healthy Kids for Pregnant Women www.michigan.gov/mdch>health Care Coverage>Children & Teens>Medicaid
MI Child Coverage for citizens or documented aliens who are Michigan residents and are under age 19 who: Are not eligible for Medicaid www.michigan.gov/mdch >Health Care Coverage>Children & Teens>MIChild Have an adjusted gross income above 195% and at or below 212% FPL Do not have comprehensive health care coverage
Maternity Outpatient Medical Services (MOMS) Provides prenatal and postpartum outpatient pregnancy related services (up to 60 days after the pregnancy ends) and inpatient delivery-related services to women who are lawfully present and are not eligible for full Medicaid coverage Adjusted gross income must be at or below 195% FPL and covered by the Medicaid Emergency Services Only (ESO) program Noncitizens must meet all Medicaid eligibility requirements not related to immigration status (see the Bridges Eligibility Manual, BEM 657 for more details on eligibility or http://healthcare4mi.com )
Mobile Dental Facility Permit requirement to operate as a mobile dental provider in Michigan (MSA 15-04) Changes were implemented to the prior authorization requirement for Pediatric-Related Overnight Stays (MSA 15-03) Expansion of breast pump policy to include hospital-grade electric breast pumps, personal use electric breast pumps and manual breast pumps (MSA 14-60) Medicaid Health Plan exclusion of beneficiaries receiving metabolic formula (MSA 14-66)
o Healthy Kids dental contract with Delta Dental expanded to include Kalamazoo and Macomb counties (80 counties)(msa 14-34) o Adoption of the American Academy of Pediatric Dentistry s Dental-Specific Periodicity schedule for children up to 21 years of age (MSA 14-47) o Relocation of EPSDT information to a specific chapter in the Medicaid Provider Manual (MSA 14-30) o Autism Benefit/Services transitioned to EPSDT benefit (L-14-50)
Merger of the Department of Community Health and the Department of Human Services (Governor Rick Snyder, Executive Order, February, 2015) Promote better health outcomes, reduce health risks, and support stable and safe families while encouraging self-sufficiency.
Michigan adults, ages 21 and over, who are enrolled in both Medicare and Medicaid. Allows those enrolled to use one plan and one card to access services. Questions? www.michigan.gov/mihealthlink
myhealthbutton is a free mobile app for Medicaid or CSHCS beneficiaries which allows clients to view benefit information instantly and securely from a smartphone. MDCH-MyHealthButton@michigan.gov
The current contract expires 09-30-2015 Governor s Prosperity Regions will be used Bidders will cover all counties in a region www.michigan.gov/mdch
Information is available at www.michigan.gov/regionalprosperity
Each child should receive an oral health risk assessment by 6 months of age by a qualified pediatrician or qualified pediatric health care professional It is recommended that a child should have a dental home established by one year of age. Medicaid follows the Dental Periodicity Schedule of the American Academy of Pediatric Dentistry
About the Maternal Infant Health Program Provides home visitation support and care coordination for pregnant women and infants on Medicaid, including Healthy Michigan Plan beneficiaries Provides home visitation support and care coordination for MOMs program participants Services are intended to supplement regular prenatal/infant care
Professional Services Provided by the Maternal Infant Health Program Every MIHP provides the services of: Registered Nurse Social Worker *An Infant Mental Health Specialist or a Registered Dietician may also provide services
Where Are Maternal Infant Health Program Services Provided? Federally Qualified Health Centers Home Health Agencies Hospital Based Clinics Native American Tribes Private Providers Local and regional public health departments
An assessment visit to determine risks associated with: her health including immunization status, physical abuse, substance abuse, depression, social behaviors and resources such as transportation Interventions provided may include: encouragement to for postpartum health visit, referrals, transportation, childbirth education and parenting education and discussion of family planning options Interventions are provided over the course of 9 visits
An assessment visit to determine risks associated with: health and safety including immunization status, feeding and nutrition growth and development, family support, childcare, and family resources such as transportation Interventions provided may include: parent/family education including infant care, safe sleep, breastfeeding support, fine motor and gross motor development, social-emotional development, assist with transportation and initiate referrals (e.g. Early On, WIC) Interventions are provided over the course of 9 visits with the possibility for additional visits
The MIHP may provide transportation to pregnancy-related appointments when they are not covered by Managed Care such as WIC, mental health/substance abuse and childbirth/parenting classes.
The MIHP is an Evidence Based Practice Federal and State Government Requirements There is Standardization of Practice (Fidelity) through ongoing education of providers and use of standardized tools and forms Evidence Based Practice Improves Care Provided to Medicaid Moms and Their Infants
Quasi- Experimental MIHP Study and 2014 Annual Report A study was conducted to assess the effects of MIHP on maternal and infant healthcare utilization and health outcomes.
Prenatal Care MIHP participation increased the likelihood of receiving prenatal care and improved prenatal care adequacy Birth Outcomes Participation reduced risks of prematurity, extreme prematurity, low birth weight, and very low birth weight Maternal Postnatal Care Participation increased the likelihood of the mother receiving her postnatal visit Infant Care Participation increased the likelihood for infants to present for any well-child visits and of receiving the appropriate number of well visits during the first year of life Infant Mortality Participation reduced the risk of infant mortality
www.michigan.gov/mihp
Questions?