Publications

Projected impacts of Medicaid work requirements: An overview of current state proposals

As of January 2019, 14 states have submitted proposals to the federal government requesting permission to establish work requirements in their Medicaid programs. To date, the U.S. Centers for Medicare and Medicaid Services (CMS) has approved Medicaid work requirements for seven states, and two states (Arkansas and Indiana) have begun implementing these requirements for Medicaid beneficiaries.

In June 2018, Michigan enacted work requirements for many enrollees in the Healthy Michigan Plan (HMP), Michigan’s expanded Medicaid program for low-income adults.

Beginning in January 2020, HMP enrollees under age 63 will be required to report 80 hours of work per month or obtain an exemption (see CHRT’s previous fact sheet, Proposed Medicaid Work Requirements in Michigan).

The Michigan House Fiscal Agency initially estimated that approximately 80 percent of enrollees would be subject to the requirements, while 20 percent would qualify for an exemption.  More recently, an independent analysis by Manatt Health projected that 39 percent of HMP enrollees would be automatically exempt (based on age, pregnancy, medically frail, or incarceration status; or because they are already meeting SNAP/TANF work requirements), while 61 percent would be required to report work hours or obtain an exemption. This analysis estimated that 9 to 27 percent of all HMP enrollees could lose coverage over a one-year period.

Read Projected Impacts of Medicaid Work Requirements in Michigan.

 

Proposed work requirements for Medicaid in Michigan: June 7, 2018

At the start of 2018, the U.S. Centers for Medicare and Medicaid Services (CMS) announced a major shift in federal policy that would allow states to request permission to establish, and test the impact of, work and community engagement requirements for able-bodied adults receiving Medicaid health insurance coverage. In the last five months, work requirement proposals have been approved in four states; formal applications have been submitted by seven more, and a number of others are preparing proposals.

Read Full Brief Here

In April, the Michigan State Senate took the first step toward establishing work requirements by passing Senate Bill 897. The Michigan House of Representatives passed an updated version of the bill on June 6. And on the morning of June 7, the Michigan Senate approved the revisions and sent the bill to the Governor’s office for signature.

Setting the stage for the 2019 Health Insurance Marketplace

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healthThe Centers for Medicare and Medicaid Services is rolling back regulations around rate increases, essential health benefits, health insurance navigators, and more, for insurers offering Qualified Health Plan coverage on the Health Insurance Marketplace in 2019.

In a new fact sheet, CHRT compares the current rules and regulations to the changes that go into effect in 2019—with a special focus on Michigan. Here are just a few highlights:

  • Rate increases under 15 percent will no longer require review;
  • Simple choice standardized plans will be eliminated; and
  • Consumer cost-sharing limits will increase by 7 percent.

These changes will impact Michigan consumers as soon as November 1, 2018, when the next Marketplace Open Enrollment Period begins.

Read Full Brief Here.

Proposed work requirements for Medicaid in Michigan: April 20, 2018

At the start of 2018, the U.S. Centers for Medicare and Medicaid Services announced a major shift in federal policy that would allow states to request permission to establish, and test the impact of, work and community engagement requirements for able-bodied adults receiving Medicaid health insurance coverage. In the last three months, work requirement proposals have been approved in three states; formal applications have been submitted by seven more; and a number of others are preparing proposals.

Read Full Brief Here

In early March, Michigan state senators took the first step toward preparing a work requirement proposal of their own by introducing Senate Bill 897. The bill passed the Michigan State Senate on April 19. In this fact sheet, we compare the characteristics and projected impact of Michigan’s Medicaid work requirement proposal against the characteristics and projected impact of approved work requirement proposals in Kentucky, Indiana, and Arkansas.

Issue Brief: Bipartisan Budget Act adds $3B for substance abuse, mental health, more

The Bipartisan Budget Act was signed into law on February 9, 2018. While the main purpose of the legislation is to temporarily fund the federal government through March 23, 2018, it also includes an agreement to raise the caps on domestic and military spending for the next two years.

The legislation includes many health care policies, as well. The major policies are described in Health Care Policies in the Bipartisan Budget Act (H.R. 1892).

 

Health Care Provisions in the Tax Cuts and Jobs Act (H.R. 1)

The Tax Cuts and Jobs Act passed the U.S. House of Representatives on November 16, 2017, and an amended version passed the U.S. Senate on December 2, 2017. Congress reconciled the differences between the two bills in a compromise conference report.

While the purpose of the legislation is to reduce tax rates for businesses and individuals, it includes several major health care policy changes. These provisions are described in the brief, Health Care Provisions in the Tax Cuts and Jobs Act.

Editor’s Note: CHRT updated this fact sheet Jan. 12, 2018 to include more recent Medicare beneficiary numbers, updated information on PAYGO, and reflect that the conference report is now law.

Health Insurance Marketplace in Michigan 2018: Rate Analysis

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In 2017, the federal government took several regulatory and administrative actions that affect the health insurance marketplaces created under the Affordable Care Act (ACA). At the same time that Congress considered legislative proposals to repeal and replace the ACA, the U.S. Department of Health and Human Services (HHS) promulgated new regulations that changed annual open enrollment dates and announced the end of cost-sharing reduction payments to insurers. These developments, in addition to several other factors, have impacted Marketplace carrier participation and plan pricing in Michigan.

Key Findings

  • Michigan continues to have a robust Marketplace. Eight insurers are participating in Michigan’s health insurance marketplace in 2018, a decrease of two insurers from 2017.
  • Michigan consumers can select from a variety of Marketplace plans. There are 12 to 52 plans offered in each of Michigan’s 83 counties.
  • Across all counties, the average premium increase for the lowest cost and second-lowest cost silver plans is 33 percent and 34 percent, respectively. Premiums for the lowest cost bronze plan increased by 16 percent, and premiums for the lowest cost gold plan increased by 6 percent.
  • Premium tax credits are linked to the cost of the local second-lowest cost silver plan. All else equal, individuals who are eligible for premium tax credits could receive a larger tax credit in 2018 due to premium increases for the second-lowest cost silver plan. In 23 counties, larger tax credit amounts will eliminate the cost difference between renewing the 2017 lowest cost silver plan and actively enrolling in the 2018 lowest cost silver plan.
  • The federal government reduced the open enrollment period to 45 days, from 92 days in 2017.
  • Federal financial support for Michigan Navigators to help with open enrollment has been reduced by 72 percent, from $2,228,692 in 2017 to $627,958 in 2018.

For more, read Rate Analysis: 2018 Health Insurance Marketplace.

Select Affordable Care Act replacement plans and implications

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Read Full Brief Here

No single strategy to replace the Affordable Care Act (ACA) has yet emerged. However, there are several ideas that seem to have considerable support among those in health care leadership roles in President Trump’s Administration and Congress.

This brief, Select Affordable Care Act Replacement Plans and Implications, summarizes the key features of the most developed full repeal and replacement plans offered to date.

You can also see CHRT’s companion piece, ACA Repeal and Replacement: Proposals and Action, for a one-page summary of the plans and tentative process.

ACA Repeal and Replacement: Proposals and Action

Beginning last month, both U.S. President Donald Trump and the U.S. Congress began taking steps to repeal the Affordable Care Act (ACA). However, a single replacement strategy has not yet emerged.

In a new one-page fact sheet, CHRT summarizes the most developed ACA repeal and replacement proposals offered to date and outlines the tentative replacement process.

You can also review CHRT’s companion piece, Select Affordable Care Act Replacement Plans and Implications, for a detailed table summarizing the key features and implications of the most developed full ACA repeal and replacement plans offered to date.

Rate Analysis: Michigan’s 2017 Health Insurance Marketplace

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While the results of the 2016 presidential election have sparked recent debates about options to repeal and replace the Affordable Care Act, the health insurance marketplaces created under the law continue to operate as usual. So although the future of the law remains unknown, consumers who enroll in Marketplace coverage can likely expect their coverage to remain uninterrupted for the 2017 plan year.

Read Full Brief Here

The changing dynamics of the health insurance marketplace are important for 2017 enrollees to understand. Under current federal policy, enrollees who do not actively apply and enroll in 2017 coverage are auto-renewed into their 2016 plan, if it continues to be offered. Beginning with the 2017 open enrollment period, individuals who were enrolled in a plan offered by an issuer that is no longer participating in the marketplace will automatically be enrolled into a plan offered in their area by a different carrier if they do not actively choose another plan.

In addition, changes to benchmark plans directly affect premium tax credit amounts, so many enrollees will need to balance potentially higher costs for renewing their 2016 plan with other important considerations, such as the breadth of available provider networks.