LANSING – 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. Burwellwhether 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.
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,” 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.
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.
This story was published by Gongwer News Service. To
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