Michigan, CMS Still Talking on Medicaid Waiver

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By Nora Macaluso

Nov. 9 — Michigan and federal CMS officials are still in talks about the state's request for a waiver that would allow the state to continue to expand its “Healthy Michigan” program for low-income adults as an alternative to traditional Medicaid expansion, the head of the state's health department said.

The two “stumbling blocks” involve cost-sharing provisions included in Healthy Michigan, Nick Lyon, director of the Michigan Department of Health and Human Services, said at a health policy conference at Michigan State University.

The plan requires copayments from some enrollees, and includes an amendment requiring those with incomes of 100 percent to 133 percent of the federal poverty level who have had Healthy Michigan coverage for 48 cumulative months to either purchase private insurance or contribute as much as 7 percent of their income to an account to pay for covered benefits (171 HCDR, 9/3/15). “We're really trying to push back towards the factors that drive health,” encouraging plan participants to adopt healthy behaviors through giving them “skin in the game,” Lyon said.

The Centers for Medicare & Medicaid Services has a “hard red line they don't like to cross” when it comes to cost sharing, Lyon said. “I continue to push that what we're doing is not a hard cutoff,” he said, as those who pass the 48-month mark have the opportunity to buy coverage elsewhere or contribute to Medicaid coverage, he said. “One common goal we all have is we want to maintain coverage for the 580,000 people receiving these benefits,” he said.

“We're making significant progress” with the CMS, Lyon said. “I'm quite comfortable with where we are today.”

Assuming a waiver is received by the Dec. 31 deadline, the next hurdle for the plan is funding, Lyon said. The state is facing budgetary pressures, and “we've got to keep continuing to push that the investment [in Healthy Michigan] is worth it,” he said.

To contact the reporter on this story: Nora Macaluso in Lansing, Mich., at nmacaluso@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com