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.