Michigan Medicaid Madness?

Last fall, Michigan approved Medicaid expansion with a few minor local modifications that the federal government approved.  The vote passed the Michigan Senate with a coalition of all Democrats and a minority of Republicans.  Under Michigan law, a law can only go into immediate effect if there is a supermajority.  The Medicaid expansion passed with a bare majority, so it is not going live until April 1st.  I have not paid too much attention to Michigan Medicaid expansion as I thought this would be the typical pattern of the second round of expansion states — a coalition of almost all Democrats plus the caucus of Republicans who can count to eleven or greater with their pants on to take effectively free money. 

However, commenter Red Apple Smokes made a comment and a follow-up e-mail that led me to get interested in Michigan Medicaid:

I’m currently trying to get signed up for health insurance before the end of the month deadline (my fault for waiting until the last minute), and I was under the impression that Michigan expanded its Medicaid program. Maybe it was wishful thinking on my part, but I thought that a person that was currently unemployed and who made less than $8,000 last year would be eligible. From what I’m seeing, this isn’t the case.

Two interesting things.  People like Red Apple Smokes are why there will be a massive surge at a deadline.  They have enough other things to manage and coordinate that other things which don’t have immediate impact get pushed back until they cannot get pushed back any further.  That is a minor point.  The more important point is that Michigan is doing something odd from a mechanical point about running their Medicaid enrollment.

The odd thing that is happening is Michigan has not released their application process for newly eligible Medicaid membership to the public yet.  Right now, they are still displaying the very stingy and hard to qualify for legacy Medicaid on their portion of Healthcare.gov.  Red Apple Smoke easily qualifies for Medicaid expansion but does not qualify for Legacy Medicaid.

Michigan Live on 3/20/14:

Michigan will start taking applications for its expanded Medicaid program on April 1.

State officials as recently as this week said it might not be ready until later in the month, but on Thursday announced that all systems are go for the program that’s expected to cover 320,000 Michiganders in the first year.

This decision is odd for a couple of reasons that we’ll talk about below the fold:

The biggest oddity is that neglecting to utilize Healthcare.gov as an early identifier and redirector to Michigan Medicaid expansion.  Even if Michigan Medicaid managed care organizations were incapable to taking new applications and new membership, it would have been extraordinary useful to generate a current, curated and clean contact list of people who would have qualified for expansion as they went online from October to today and entered their income.  People like Red Apple Smokes should have been told that they did not qualify for Exchange subsidies but they did qualify for Medicaid, and would receive a follow-up as soon as the application process was ready.  Instead, people in Red Apple Smoke’s shoes who don’t have as many knowledge resources to draw upon will think that they are ineligible as they make too much for legacy Medicaid but not enough for Exchange subsidies. 

The second oddity is a health insurance plumbing situation.  Michigan is planning to make coverage retroactive to the first of the month of application.  That is fairly common for Medicaid so it is not too odd.  Speaking as an insurance company plumber, retroactivity is time consuming, expensive and error prone in the best of situations.  Opening a brand new program with an expected surge of initial enrollment is not the best of situations.  There will be tens of thousands of people entering the system, and all of them will be retroactively eligible.  Things will get fucked up.  I guarantee it as a statistical near certainty.  Opening up enrollment in early March would have eased the pains and reduced the scope of retroactive changes that need to be made. 

I’m hoping that Michigan’s state regulators and managed care organizations (private insurance companies that run Medicaid HMOs for the state government) used the seven months to test the everliving shit out of the new processes needed for expansion, but this project plan guarantees that some people who are eligible and proactive in seeking health insurance through healthcare.gov are left out thinking that they are ineligible for any government assistance on or off the Exchange, and it also dramatically increases the probability and scope of an administrative mess for the first couple of months.

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18 replies
  1. 1
    Original Lee says:

    Based on what has been relayed to me by a friend who has been trying to get her son signed up, FUBAR is a partially accurate description. She is very disgusted with the whole process. Being a Tea Party person, she blames Obama for it all, especially the bit where the insurance company pulled out the entire annual premium from her son’s checking account, after she spent 3 months on the phone trying to get him signed up. He is currently unemployed, so I should think he’s eligible for a subsidy. I would not be surprised if the Michigan GOP deliberately set things up to be as opaque and expensive as possible.

  2. 2
    Rommie says:

    It’s profoundly cynical to think this is Working As Intended, but I live in Michigan, and yeah, it’s WAI. The R’s here think they know who will get the blame for FUBAR.

  3. 3
    aimai says:

    If we ever get back control of the house and senate we really need to strip Medicaid from the states and make it a national program with a single set of eligibility rules at the national level, and give people an absolute right to it.

  4. 4
    Richard Mayhew says:

    @aimai: that would be my preference for several reasons. Solving the “Mississippi” problem is the greatest. Making sure that states don’t have to be pro-cyclical spending cutters during a major demand collapse would be another. My major change would be to establish a federal baseline with the allowance that states can add to that baseline as they see fit (allow Massachusetts to have a much more robust safety net than what the 218th Dem could vote for in Congress).

  5. 5
    Elizabelle says:

    @aimai:

    Absolutely re national standards.

    And I would not mind hearing that people were respectfully picketing Chief Justice Roberts’ (R-Robber Barons) home from a legally approved distance.

    He gave and took away with his Supreme Court ruling, and it’s very possible he knew JUST what he was doing with his Medicaid decision.

  6. 6
    Elizabelle says:

    @Richard Mayhew:

    plus the caucus of Republicans who can count to eleven or greater with their pants on

    Well done, Richard! Glad I finished my coffee before reading this post in depth.

  7. 7
    ken says:

    Michigan is having this problem solely because Michigan Democrats couldn’t be bothered to vote in 2010. Alot of these problems would disappear if people understood a little about the census and it effect on their lives when it comes to the government. Ever article should end with “get your friends who voted for Obama to vote D in 2014”

  8. 8
    JPL says:

    Richard, Thank you for covering the MI medicaid fiasco. There are probably others besides Red Apple that needed help in finding a solution to health care coverage. I live in GA and as you probably have heard, not only did they choose to forgo medicaid expansion, they make signing up for the extensions more difficult. There will be no help.

  9. 9
    Kirbster says:

    I wish Red Apple luck in running the gauntlet in MI. I submitted my application for a subsidy/tax credit in MA on December 7th that is still “pending.” The Bay State’s solution to unprocessed applicants is to put us all on Medicaid until they get their act together or June 30th, whichever comes first. It’s a stupid, expensive solution to a problem that shouldn’t have occurred, but that’s what happens when the we can’t decide whether we’re “United” or “States” and have to reinvent the wheel fifty different ways.

  10. 10
    Red Apple Smokes says:

    I’d like to thank the Balloon Juice community and Richard in particular for their help with this issue. I was aware that coverage would not start until April, which when coupled with uncertainty as to whether I would still be in the state, is a big part of the reason that I had delayed signing up. Honestly, my heart sank into my stomach when I was online yesterday and thought that I was going to be left out in the cold. My initial reaction was to be furious with John Roberts as well as the Michigan GOP. Unfortunately, I don’t expect that reaction to be common since I’m the type of guy that wouldn’t vote for a Republican at gunpoint. Again, thank you to everyone that took the time to provide me some assistance; that’s just one of the reasons I think this is one of the best communities out there.

  11. 11
    Tim F. says:

    Hmm. The ACA open enrollment deadline is March 31. Michigan Republicans made their Medicaid expansion available starting the next day.

    That only sounds strange if you do not assume these people are practically epileptic with hateful spite.

  12. 12
    Elizabelle says:

    @Tim F.:

    Churchlady voice:

    “How con-veen-E-ent!”

  13. 13
    chauncey1186 says:

    As a member of a county coalition of service organizations/Navigators that has been working tirelessly since last fall to get folks enrolled in Healthcare.gov here in West Michigan, I can tell you the medicaid expansion here has been a nightmare! Not only does the April 1st start date for the new medicaid enrollment cause undue confusion for folks who may now be eligible for HealthyMichigan, but by order of the the “powers that be” at the state, DHS (Department of Human Services) has been operating under a virtual “gag-order” NOT to share any information with those of us in the field. Top that off with Governor Snyder claiming ALL credit for the expansion (the ACA is barely mentioned ANYWHERE, either on the state site, Michigan Benefits Access portal, or marketing materials), and frustration quickly turns to fury! Did I mention that pretty much ZERO help from the state was given during the ACA open enrollment? In fact, DHS was specifically told NOT to participate in coalition activities. Now Snyder is spending boatloads of money to promote HealthyMichigan AND is expecting local coalitions to help. Could there be an election coming up? snark off!

  14. 14
    Tim F. says:

    I just keep reminding myself, at least Snyder approved it…at least Snyder approved it…

    Really. The hate and spite that motivates these people just amazes me.

  15. 15
    Temporarily Max McGee (soon enough to be Andy K again) says:

    @Original Lee:

    I’m in Michigan, I signed up through the exchange, my premiums were fully subsidized, and not a buck came out of my checking account. Hell, I didn’t have to enter my banking info at all. I’ll lay a buck that your friend went straight to the insurer rather than through the exchange- which means that her son’s premium was higher, too, than it would have been had she gone through the exchange.

  16. 16
    mclaren says:

    Once again, Richard Mayhew is lying to you. He presents Michigan’s messed up rollout as thought it were bad implementation when in fact the reality is that Michigan (like all other states) is working hard to make sure that as many potential Medicaid enrollees as possible get the mistaken impression that they’re not eligible.

    States are going broke from Medicaid costs. It is in the individual state’s interest to make certain that as few people as possible sign up for Medicaid. Every sick American who incorrectly thinks they’re not eligible for Medicaid and winds up dying is another sick American that the state in question won’t have to pay for.

    Individual states are in the position of the GOP, to use Alan Grayson’s words: their plan is “if you get sick, you should die quickly.” Richard Mayhew doesn’t want to tell us this harsh bottom line because Mayhew doesn’t want to admit that the current broken American health care system rewards doctors and hospitals and medical devicemakers perversely for pushing their basic health costs as high as possible, and Mayhew also doesn’t want to admit that the current broken American health care system rewards individual states for denying as many of its citizens Medicaid coverage as possible.

    There is no upside to lower overall health care costs for doctors or hospitals or medical devicemakers, so basic medical costs rise infinitely, without limit. There is upside for individual states to increasing Medicaid coverage, because it simply means more red ink for the states.

    These problems can only be fixed with a national solution. “The market” will only make things worse because all the incentives in a money-based for-profit health care market reward lower expenditures (making sure poor people can’t or won’t sign up for Medicaid) and higher prices (doctors hospitals and medical devicemakers become rich beyond their wildest dreams as they increase prices without limit).

    Richard Mayhew as usual doesn’t want to admit these basic facts. Instead, Mayhew prefers to tell fairy tales and “peculiar” rollouts and “odd choices.” These choices are not peculiar. They’re exactly what you’d expect when a state faces going broke because of its Medicaid costs, and when doctors/hospitals/medical devicemakers face buying a new vacation home in Maui if they can keep medical prices high.

  17. 17
    Thoroughly Pizzled says:

    It’s shameful. We didn’t even know what day Healthy Michigan enrollment was going to start until last week. Some Navigators have been collecting people’s information so they can type it all in once the application opens, but it’s going to be a shitshow.

    Healthy Michigan does cover vision and dental for adults, so it’s got that going for it.

  18. 18
    StringOnAStick says:

    MI has a serious problem with crazy rethuglicans and entrenched racism, both of which are why ACA/Medicaid expansion have been resisted at every turn; anything to avoid giving aid to blah people. I suppose it was only going to happen when Snyder realized (1) there are a lot of poor white people in MI, and (2) with proper propaganda, he could get credit for getting them a Medicaid expansion.

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