Medicaid Expansion In Michigan: The Second CMS Waiver

Health Affairs Blog post by Marianne Udow-Phillips, Joshua Fangmeier, Leah Corneail, and Richard Hirth

In the summer of 2013, when the State of Michigan Legislature debated whether or not to expand Medicaid, there was considerable discussion about a number of issues, including the role of the private sector and whether to include a “time limit” on Medicaid benefits. The Legislature ultimately passed the Healthy Michigan Plan (the state’s Medicaid expansion) by one vote in September 2013. We discussed Michigan’s path to Medicaid expansion in a previous Health Affairs Blog post.

Section 1115 Waiver Requests

As part of the legislation, the state required the Michigan Department of Health and Human Services to submit two 1115 waiver applications. The first waiver, submitted on November 8, 2013, included a number of provisions, notably, the establishment of a cost-sharing structure connected to a health savings account for most recipients.

Under this first waiver, an individual’s maximum cost-sharing would be 5 percent of family income but could be lower based upon an individual’s participation in certain healthy behavior programs established by participating Medicaid health plans. The State of Michigan submitted its second waiver request in September 2015 to the Centers for Medicare and Medicaid Services (CMS) in order to continue the Healthy Michigan Plan beyond April 30, 2016.