Hospitals in Michigan got welcome news when GOP Gov. Rick Snyder recently announced a faster-than-anticipated enrollment push into the state's Medicaid expansion program.
Aided by outreach from hospitals and many community-based organizations, enrollment surpassed the Healthy Michigan Plan's first-year target of 322,000 in only a few months.
But it hasn't all been smooth sailing. Waters were rough from the start when Snyder joined a small group of Republican governors in opting to expand Medicaid coverage under the Affordable Care Act. To do so, he battled the GOP-controlled state House and Senate. Enrollment for his Medicaid waiver plan, signed into law last September, didn't begin until April 1: the day after 2014 enrollment ended for Michigan's federally facilitated health insurance exchange.
According to a state official, Michigan got partial files from the federal government prior to April 1 on 85,000-some individuals looking at exchange plans who seemed eligible for traditional Medicaid—a managed-care program covering about 1.9 million state residents—or for the Healthy Michigan Plan.
On April 1, the state began proactive outreach to these individuals. But it wasn't enough.
In late June, CMS notified Michigan and five other states that they had to tell federal regulators by July 14 how they intended to fix their Medicaid backlogs.
At this point, Michigan is in compliance with six of seven components but continues working with CMS on "bi-directional account transfers" that will enable the state to finish processing Medicaid files, spokeswoman Angela Minicuci of the Michigan Dept. of Community Health, told Healthcare Dive.
Minicuci said July 15 that the state's outreach effort is providing coverage to individuals—with many of them enrolling into the Healthy Michigan Plan—"while we work through technology issues with the federal government." The extent of the state's current backlog on Medicaid applications is unclear.
The bottom line, according to the governor's office, is that the Healthy Michigan Plan is ahead of expectations in extending coverage to nearly a half-million low-income state residents: 323,022 were enrolled as of July 10. The plan has some beneficiary cost-sharing and federal- and state-mandated essential health benefits, including ambulatory services, emergency services and hospitalization.
Some Michigan hospitals told Healthcare Dive it's been worth the wait—and the effort—to get more people in their communities covered by health insurance plans in 2014.
Making a difference in Flint, Mich.
"We probably have seen an uptick in folks with the ability to pay for their healthcare," either through the Healthy Michigan Plan, health insurance exchange plans, or a local taxpayer-funded program for indigent care, said Andy Kruse, Genesys Health System's vice president of mission integration.
"I think in general our finance folks [are saying] that there is a leveling off or a decline in uncompensated care," Kruse said.
Anchored by a 410-bed regional medical center in Grand Blanc, Mich., Genesys, a part of Ascension Health, serves six counties around Flint, Mich., about 60 miles northwest of Detroit. Kruse describes Flint as a community hit hard by the economic downturn, with hourly jobs at General Motors dropping from about 80,000 a few decades ago to roughly 6,500 now. The city has three major hospitals, he said.
Genesys usually reports $35 million to $40 million a year in uncompensated care, including charity care and Medicare and Medicaid shortfalls, Kruse said. Medicaid accounts for about 11% of business.
Kruse explained that the Healthy Michigan Plan covers eligible people earning up to 133% of the federal poverty level, and a local countywide program, Genesee Health Plan, covers up to 175% of FPL for primary-care services, paying physicians at 110% of Medicaid's rate. But an estimated 7,000 to 9,000 county residents won't qualify for either program, he said.
Yet the Healthy Michigan Plan is helping to fill in coverage gaps, Kruse said. "I think it's huge," he said. "It was a wonderful move on the part of our state to expand the Medicaid program. It wasn't an easy road. It was fought tooth-and-nail...and all early indications are [that expanded coverage is beginning to work]."
Covering previously uninsured in Muskegon, Mich.
"We have seen some significant [coverage] numbers, through both the health exchange products and Healthy Michigan. We've seen large numbers of people previously uninsured who now have coverage," said Michael Grant, regional director of patient financial services for Mercy Health. The regional health system in western Michigan, along Lake Michigan's shoreline, is part of CHE Trinity Health. Its network includes five hospitals, 58 physician offices, and 1,300-plus medical staff physicians.
Mercy Health is a regional delivery system serving two markets, Grant explained. In Grand Rapids, 38.5% of individuals enrolling into exchange products or the Healthy Michigan Plan lacked health insurance in 2013, he said, while 52.4% of individuals in Muskegon weren't insured last year. That compares to a national figure of about 20%. Most are going into the Healthy Michigan Plan, he added.
"We are seeing a decrease in [patients] needing financial support...and we as an organization are reallocating charity dollars to people still lacking coverage," Grant said. These include undocumented migrant workers in the region sent to Mercy Health through federally qualified health centers, he said.
Mercy Health is proactive with community outreach and enrollment efforts, Grant said. "If an individual comes into one of our facilities or physician offices, we screen to find coverage through Healthy Michigan or an exchange product or other programs like the VA [Veterans Affairs]," he said.
Supporting universal healthcare coverage
Laura Appel, vice president of federal policy and advocacy at the Michigan Health & Hospital Association, said the state's 130-some hospitals "have supported achieving universal healthcare coverage for decades." Hospitals' efforts to inform people about the Healthy Michigan Plan helped to meet—and exceed—the state's 2014 enrollment target, she said.
"Ultimately, we want to help an estimated 477,000 Michigan residents get healthcare coverage, so our work to enroll more people in the Healthy Michigan Plan will continue," Appel said. "The Healthy Michigan Plan will [cover] people who previously didn’t have health insurance and, if and when beneficiaries need care through a hospital, Michigan’s network of hospitals, health systems and academic medical centers will be ready to provide the care, education and resources people need."
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