Michigan’s New Presumptive Eligibility Application

By Natasha Robinson, MPCA Program Specialist

Many of the workers across the state helping individuals and families access affordable coverage are aware of the changes taking place to Michigan’s medical assistance programs application — A major application has been modified, and several others are now obsolete and will no longer be accepted. Let’s take a deeper dive into what’s happening, based on what we’ve learned!

The website, www.HealthCare4MI.com, houses Michigan’s presumptive eligibility Medicaid application as it did previously. However, the electronic and paper applications look different and have been updated to screen consumers for all types of affordable health care coverage options, not just MIChild, Healthy Kids, PLAN FIRST!, and MOMS as before. Organizations previously trained and certified as Qualified Agencies must train and retest in the new system in order to assist with presumptive eligibility applications. Presumptive eligibility provides immediate access to needed health care services while putting people on a path to ongoing coverage. In Michigan, children under the age of 19 and pregnant women of any age can apply for presumptive eligibility at agencies such as Health Centers and hospitals that are trained and certified by the Michigan Department of Community Health (MDCH).

Obtaining training on this site is going to be important for all outreach and enrollment assisters, including Navigators and Certified Application Counselors, because it is expected this site will house the Healthy Michigan Plan (www.michigan.gov/healthymichiganplan) application in the near future. It was announced during the training that the site contractor, Maximus, would have the application live by April. In addition to an application for presumptive eligibility, the website also now features a full application for health care coverage. Health care coverage refers to Medicaid, the Children’s Health Insurance Program (CHIP), private health insurance plans that offer comprehensive coverage, and a tax credit that can help pay premiums for health coverage. The full application does allow Marketplace Navigators and Certified Application Counselors to input their ID numbers if they assist a consumer through this application.

MDCH will host several trainings over the next week for organizations desiring to become Qualified Agencies. As noted above, organizations that were previously trained and certified as Qualified Agencies must train and retest in the new system in order to assist with a presumptive eligibility application, which links directly at www.healthcare4mi.com/pe. The full application at www.healthcare4mi.com may be accessed and completed by anyone. Any Medicaid enrolled provider can become a Qualified Agency. It should be noted however, that an agency’s participation in the Michigan Presumptive Eligibility Program is optional. Participating agencies will have their enrollment statistics tracked after being issued by MDCH.

Upcoming Trainings for the New Presumptive Application Process for Michigan’s Application for Health Coverage (healthcare4mi.com)

Email Laurthelhayes@maximus.com to register

February 3, 10 am–12 pm ET
February 5, 1–3 pm ET
February 7, 10 am–12 pm ET
February 10, 2–4 pm ET

PowerPoint Slides

HealthCare4MI.com: Presumptive Application Agency Training

Presumptive Eligibility Training (MDCH)

Health Care for Pregnant Women

A Summary of What Has Changed

-The application reflects new modified adjusted gross income (MAGI) standards.  MAGI allows for a standard deduction across the board. Additionally, the MSA-1582, Plan First! and DCH-0373, Healthy Kids/MIChild applications have been removed. Individuals can apply for the programs through the new application.

-The Michigan Medicaid program recently released a policy bulletin proposing to discontinue Plan First! enrollment March 31, 2014; cease program benefits on June 30, 2014; and to not request renewal of the Family Planning Waiver. The rationale for phasing out Plan First! as explained in the bulletin is that the majority of the program’s beneficiaries will be eligible for either Healthy Michigan or for subsidized insurance through the Health Insurance Marketplace. Click here to read more on our blog.

-Presumptive eligibility is per individual, so each person desiring PE will have to use a new application. The application asks about 12 brief questions and offers an instant decision.

-The presumptive eligibility application does not go automatically to evaluate for full, ongoing coverage. Those desiring coverage beyond the PE period must complete the full application for coverage and submit it.

-Presumptive eligibility begins the date the PE determination is made and ends on the last day of the month following the month in which the determination is made, or when full coverage is approved or denied after a full application is processed.

-Trainers identified a best practice that assisters should use: Complete a presumptive eligibility application for children and pregnant women, and immediately afterward, complete the full application. This gives them the best chance of having ongoing coverage beyond the presumptive eligibility period.

-Applications are first assessed by Medicaid, then MIChild, then the Marketplace to determine what individuals are eligible for.

– Consumers may apply by phone or seek assistance while applying online or by paper at 1-855-276-4627, Monday through Friday from 8 am to 7 pm. The DCH-1426 Application for Health Coverage paper version can be found here: Word    PDF.

-MDCH intends to eventually have a “Train the Trainer” program for this website, so stay tuned.

-You must register for a training, participate in a training, take the exam (which is emailed after the training), and fax it back to MDCH in order to receive an Agency ID number. MDCH will assign one Agency ID number per address and it can be shared among trained assisters within an organization.

-MIBridges (michigan.gov/mibridges) still accepts applications for medical assistance, food assistance, cash assistance, child care assistance, and emergency services, and should still be used as needed. The system has some updates as well and we’re waiting to hear on any updates that community partners should know. As we know more, we’ll share!


The New HealthCare4MI.com


The Old HealthCare4MI.com


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