An Overview of Medicaid

Medicaid (also called Medical Assistance, or MA) is health insurance for people with low income. In Michigan, there is traditional Medicaid (TM) and the Healthy Michigan Plan (HMP). HMP started in 2014 as part of the Affordable Care Act. Once you are enrolled, TM and HMP work just like other health insurance.

Changes Are Coming to Medicaid in 2023 and 2024: Take Action to Keep Coverage

If you already get Medicaid, some important changes will begin in 2023 and continue for about a year. Read the article Medicaid Continuous Coverage Will Stop in 2023-2024 to learn about what you can do to keep your health insurance coverage.

Who Is Eligible?

In order to be eligible for TM or HMP, you must meet certain requirements. Some requirements have to do with how much income you have. Others have to do with nonfinancial things like your citizenship and Michigan residence. You could also be eligible based on age, disability, or blindness. The Michigan Department of Health and Human Services (MDHHS) will review your application to decide if you are eligible.

There are a few common requirements for both HMP and TM. You must be a Michigan resident and have income below a certain level to qualify for either program. However, TM has an asset limit while HMP does not. Also, TM has many categories, or sub-programs, within it. Someone must fit into one of those categories to get TM. There are no categories with HMP.

It is typically easier to qualify for HMP than TM. However, there are some groups of people who are not eligible for HMP. These groups of people are not eligible for HMP:

• Minor children
• Pregnant women
• People 65 or older
• People getting Medicare

These groups of people fall into categories for TM. So if they meet the other eligibility requirements, they will get TM.

TM Categories

The TM categories are divided into two groups: Group 1 and Group 2. These categories have different income requirements. To qualify for Group 1 programs, you need to be at or below a certain net income level. Net income is countable income minus allowed deductions.

Group 2 programs also have a net income limit. However, you can be eligible for Group 2 programs even if your income is over the limit. This is because Group 2 programs also use the medical bills you pay to determine your eligibility. Group 2 programs can sometimes have a deductible (spend-down). A deductible is an amount of your health care costs you are responsible for before your benefits start. For example, if you have a $100 deductible, you are responsible for the first $100 of your health care costs before your benefits start.

To learn about the TM categories in Michigan, visit “Health Care Programs Eligibility” on the MDHHS website.

Supplemental Security Income (SSI) Related Medicaid  

You are automatically eligible for TM if you get SSI if both of these are true:

• You are a Michigan resident
• You cooperate with third-party resource liability requirements

A third-party resource is a person, entity, or program that is or could be liable to pay for part or all of your medical expenses.

Even if you don’t get SSI, you may still be eligible for either HMP or TM based on your age, or being disabled or blind. To learn more about this, you can speak with someone at the Michigan Medicare/Medicaid Assistance Program (MMAP). MMAP is a free, state-wide counseling service designed to help people with questions about health care.

Your local legal services office may also be able to help you for free. Use the Guide to Legal Help to find a legal services office near you. Even if they are not able to represent you, they could still offer you advice and other help.

Another place where you could find help is from a local Federally Qualified Health Center (FQHC). FQHCs are community-based health care providers that get funding from Health Resources & Services Administration (HRSA). They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

Income and Asset Limits

HMP and each TM category have income limits. Some TM categories also have asset limits. The limits vary depending on the program. HMP programs do not have asset limits.

Income

Income is money you get. MDHHS will look at the money you get from things like:

• Wages from your job, including self-employment
• Child support
• Disability benefits
• Unemployment

MDHHS sometimes doesn’t count all the money you get as income. For example, if you get SSI, that won’t be counted.

Assets

Assets are things you own. Some examples are cash, personal property, and real property. Real property is land and the things on it. Personal property includes investments, retirement accounts, life insurance policies, and trusts. There is no asset limit for TM categories for eligible children, pregnant women, and some families with minor children. Most other TM categories have asset limits. HMP does not have asset limits.

To learn more about income and asset limits, read Income and Asset Limits for Medicaid.

Other Eligibility Requirements

Along with income and asset limits, you must meet other requirements to be eligible for TM or HMP. Depending on your situation, you must:

• Be a Michigan resident
• Have a Social Security number or work with MDHHS to get one
• Be a U.S. citizen or an immigrant with a specific status
• Report certain information to MDHHS
• Apply for any state or federal benefits for which you could be eligible

Michigan Resident

Being a Michigan resident means you live in Michigan. You are allowed to leave the state as long as you intend to come back. For example, if you leave Michigan to spend part of the winter in a warmer place, you are a Michigan resident if you intend to come back.

If you are homeless, you may still be eligible for TM or HMP. Not having a permanent address does not affect your status as a Michigan resident. You will not be denied TM or HMP solely because you are homeless. To learn more, you can speak with someone at the MMAP. Your local legal services office may also be able to help you. Use the Guide to Legal Help to find a legal services office near you. Even if they are not able to represent you, they could still offer you advice and other help.

You can also contact a local FQHC. They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

Citizenship and Immigration Requirements

You must be a U.S. citizen or have a specific immigration status to get TM or HMP. Being a “qualified alien” could mean you have the specific immigration status that makes you eligible for TM or HMP. Some examples of qualified aliens are lawfully admitted permanent residents (LPRs, or green card holders), asylees, and refugees.

To learn more about immigration statuses and TM and HMP, you can speak with someone at MMAP. You can use the Guide to Legal Help to find immigration lawyers and legal services lawyers who may be able to help answer your questions.

You can also contact a local FQHC. They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

You do not have to be a U.S. citizen or have a specific immigration status to get emergency medical services.

Report Information to MDHHS

You need to report information to MDHHS to get and continue to get TM or HMP. Some examples of information you may need to report are:

• Your income and assets
• The paternity of your children and information about child support
• Third-party resources

There is a good cause exemption for the child support cooperation requirement if you are a survivor of domestic violence.

A third-party resource is a person, entity, or program that is or could be liable to pay for part or all of your medical expenses.

Freedom to Work: Working and Getting Medicaid

The Freedom to Work law allows people with disabilities to get TM while working. To be eligible, you must meet all of the following requirements:

• Be disabled according to Social Security Administration standards
• Be working
• Be between the ages of 16 and 64
• Meet the “Other Eligibility Requirements” listed above

There is an income and asset limit. If you earn a substantial income from work, you may have to pay a premium (monthly payment) on your coverage. The premium amount increases the more money you make.

To learn more, you can speak with someone at MMAP. Your local legal services office may also be able to help you. Use the Guide to Legal Help to find a legal services office near you.

You can also contact a local FQHC. They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

Disabled Adult Children

Some disabled adult children (DAC) are eligible for TM if they meet certain requirements. In order to be eligible, they must:

• Be at least 18 years old
• Have received SSI in the past but stopped getting it because they became eligible for DAC Retirement, Survivors, and Disability Insurance (RSDI) benefits
• Be eligible for SSI if not for the RSDI benefits

To learn more, you can speak with someone at MMAP. Your local legal services office may also be able to help you. Use the Guide to Legal Help to find a legal services office near you.

You can also contact a local FQHC. They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

How Do I Apply?

To apply for TM or HMP, submit an application to MDHHS. The fastest way to apply is online through the MI Bridges Portal. If you apply online, you will have proof of your application. You can also apply in person at your local MDHHS office. Your local MDHHS office has to give you a paper application form if you ask for it. You can also print an application form and fill it out before going to MDHHS.

You can have a friend or family member help you complete the application. If you have trouble reading or writing, MDHHS must help you, but you need to let them know that you need help. Some MDHHS offices have computer stations where you can apply online through the MI Bridges Portal with help from an employee.

When you apply, you will be asked to prove important parts of your application. This means you may have to show documents such as your birth certificate, Social Security card, state ID card, driver license, or passport. You may also need documents that show your income and expenses. This could include pay stubs and bank statements. These documents must be less than 30 days old.

When you submit your application, you are swearing that all of the information you gave is true and complete to the best of your knowledge. If you don’t understand a question, it is better to ask for help than to guess.

If you speak limited English, MDHHS must provide you with an interpreter. Be sure to tell MDHHS that you need an interpreter or need help understanding documents in English. You have a right to bring your own interpreter if you prefer. The application is also available in Spanish and Arabic. You can also apply online and have someone help you.

In most cases, MDHHS has 45 days to make a decision after you apply. If MDHHS needs to make a disability determination as part of your application, it has 90 days to make a decision. If you are pregnant when you apply, MDHHS has 15 days to make a decision.

Getting HMP/TM

If you are approved for TM or HMP, you will get an eligibility letter explaining your coverage and an enrollment card. If you have questions about your coverage, you can call member services using the number on your letter or the back of your enrollment card.

If you’re not sure whether your doctor and pharmacist accept your insurance plan, you can call their office to find out. You can also look on your program’s website for a list of providers. 

Mistakes in Billing

In order to avoid issues with billing, make sure your providers accept your coverage before visiting their office or getting a product or medication from them. Be sure to update them if any information changes.

Reporting Changes

Report any changes in your household size, income, or assets to MDHHS. You must report the changes within 10 days of the change. If you do not, your benefits could be reduced or stopped. The easiest and most reliable way to report changes is online using MI Bridges. You can also call MI Bridges at 888-642-7434 or use DHS Form-2240 to report changes.

It is best to report changes in writing and keep copies of the e-mail, fax, or letter as proof you reported the changes on time. If you report a change and there is negative action you do not agree with (for example, you lose your coverage or your deductible increases), you have the right to request a hearing. You can use the Do-It-Yourself MDHHS Hearing Request tool to complete your request. Make a copy of the form to keep for your records.

Request a Hearing After Denial or Termination or Decrease in Benefits

If MDHHS takes an action or makes a decision you do not agree with, you can request a hearing. You can use the Do-It-Yourself MDHHS Hearing Request tool to complete your request. Make a copy of the form to keep for your records.

You can fax, mail, or drop off your request in person. If you fax your request, keep the fax confirmation for your records. If you choose to mail your request, you may want to send it by certified mail to have proof of when you sent it. Be sure to direct it to the “Hearing Coordinator”, not your caseworker. 

If you drop off your request, sign the log book in the office lobby (if available). If you have a camera phone, take a picture of your signature in the log book for your records. You could also ask the person who takes the form to stamp your copy as proof of when you dropped it off.

You should request a hearing before the effective action date listed on the notice. The effective action date for Medicaid is always at the beginning of the month. If the person does this, federal law requires their coverage to continue.

An old MDHHS policy required Medicaid hearing requests to be received by MDHHS within 10 days of the notice date. MDHHS changed this policy but has not fixed its computer system. This means people getting Medicaid continue to get notices that require their hearing requests be received in 10 days. If you have had an issue related to this, contact your local legal services office for help. Use the Guide to Legal Help to get their contact information.

If You Win

If you win, MDHHS will pay any bill you got from a provider (such as a doctor or therapist) when you didn’t have coverage. If you paid for any medical expense out-of-pocket, you could be reimbursed for that. Asking for this could be complex. You may want to speak with a lawyer who can help you ask for reimbursements. Use the Guide to Legal Help to find lawyers or a legal services office near you.