Category Archives: Access

Understanding ACA Enrollment Data

By Phillip Bergquist, Director of Health Center Operations, Michigan Primary Care Association

Sarah Kliff said it best in her post for the Washington Post’s Wonkblog— “counting the number of people who have signed up for Obamacare turns out to be vexingly difficult. After four months of open enrollment, now seems like an excellent time to break down what we do and don’t know about the exact number of people gaining coverage through the Affordable Care Act.”

Kliff’s post refers extensively to the monthly updates on health insurance enrollment published by the U.S. Department of Health and Human Services’ Assistant Secretary for Planning and Evaluation. The reports provide enrollee demographics, intel on plan selection and information on Marketplace financial assistance, in addition to Medicaid/CHIP eligibility assessments.

Building on Wonkblog’s analysis of national enrollment data, I wanted to share some of the most recent indicators for the the State of Michigan infused with a little editorial context.

  • 112,013 Michigan residents have selected a plan in the Marketplace.
    • Michigan’s enrollment total exceeded HHS projections for the state by just over 12,000 enrollees. However, we still have a lot of work ahead to reach the 161,000 enrollee target set for the end of March.
  • 15.5% of the eligible population in Michigan has enrolled.
    • Michigan has the tenth highest percentage in the country and the second highest amongst states using
  • There are still significant gaps between them number of individuals who applied and were eligible to enroll and those who actually selected a plan.
    • 255,055 Michigan residents were found eligible to enroll in a Marketplace plan; 147,654 were found eligible to enroll with financial assistance. Since 112,013 actually selected a plan, there appears to be a need for stronger follow-up on applications to capture those who submitted but haven’t yet enrolled.
  • The percentage of young adults (age 18-34) enrolling through the Marketplace in Michigan increased slightly from 25% cumulatively in January to 26% in February.
    • Michigan’s young adult enrollment is slightly higher than the average for all states (24%) but lower than we would hope as over one-third of premium tax credit eligible individuals in Michigan fall into this age group.
  • 88% of Michigan’s enrollees selected a Silver medal level plan or higher.
    • This is again higher than the average for all states (81%) and a good indicator of positive plan selection decisions. Consumers appear to be choosing higher value plans over those that are simply cheapest.
  • 86% of Michigan’s enrollees received financial assistance through the Marketplace.
    • Nearly 80% of those who received financial assistance selected a silver plan, which shows most enrollees are maximizing the potential impact of cost-sharing reductions.
  • 34,032 Michiganders were assessed eligible for current Medicaid or CHIP coverage.
    • Admittedly, this number is very low right now. It will climb dramatically when the Healthy Michigan Plan is implemented later this spring.

With only 41 days left in the Marketplace open enrollment period, we won’t have to wait long to see how the amazing outreach and education efforts  in communities across the state impact coverage enrollment. We’ll be sure to continue to dig into the enrollment data to better understand our collective impact in the months to come.


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,, 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 ( 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 The full application at 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 (

Email 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 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 ( 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


The Old

Family Health Center of Battle Creek Targeting May for Opening of Women’s Health Facility

Developer rendition of Family Health Center of Battle Creek's new Women's Health Facility

Developer rendition of Family Health Center of Battle Creek’s new Women’s Health Facility

First floor plans for Family Health Center of Battle Creek's new Women's Health Facility

First floor plans for Family Health Center of Battle Creek’s new Women’s Health Facility

Basement floor plans for FHC's new Women's Health Facility

Basement floor plans for FHC’s new Women’s Health Facility

Family Health Center of Battle Creek (FHC) has some big news; and by big news, we are talking about 45,400 square feet of big news. FHC is in the final construction stage of its new $10 million Women’s Health Facility in the Park Hill section of Battle Creek, and is expecting to begin seeing patients at the new site starting in May 2014.

The new facility will house FHC’s expanded obstetrics (OB) services to meet the needs of underserved women in Calhoun County, regardless of insurance status or income level. FHC will offer an array of services at the Women’s Health Facility, including group OB visits and care delivered by certified midwives, nurse care coordinators, and behavioral health counselors.

“Family Health Center’s goal is to achieve 100% access to health care services with zero health disparities,” said Dr. AJ Jones, President and CEO of Family Health Center of Battle Creek. “We look forward to serving the women of Calhoun County in the state-of-the-art facility currently under construction.”

As the largest provider of OB services in Calhoun County, the new facility will increase FHC’s capacity to provide services to the more than 1,900 pregnant women served by FHC’s Women’s Health Services, of which more than 78% are uninsured or covered by Medicaid. Over half of all deliveries at Bronson Battle Creek Hospital in 2013 were provided by FHC. With the number of patients expected to continue increasing, Family Health Center of Battle Creek is solidly positioned for continued growth over many years.

Taking a community-based approach to planning for the new facility and expanding OB services, Family Health Center of Battle Creek enlisted the direct input from local women, health champions from the African American community, and many partner organizations including the Maternal and Infant Health Commission of Calhoun County, Summit Pointe (a local mental health agency), and Bronson Battle Creek Hospital.

Planning and construction for the new facility was funded by grants from the W.K. Kellogg Foundation and the U.S. Health Services and Resources Administration, as well as through funding made directly available by Family Health Center of Battle Creek. Michigan Primary Care Association’s Health Center Capital Development Program, with support from the Kresge Foundation, provided for pre-development services and presentation materials.

FHC North Ave 02

Family Health Center of Battle Creek’s original North Avenue Women’s Center which opened in 1986.

Starting in 1986 as the North Avenue Women’s Health Center and growing from there, Family Health Center of Battle Creek has made great strides in increasing access to health care for women in Calhoun County and surrounding areas. This new state-of-the-art facility sets the stage for the same growth over the next 25 years.

For more information about the services that Family Health Center of Battle Creek provides, call 269-965-8866, or visit

Michigan Health Centers in Solid Footing for Provider Recruitment in 2014


With attention surrounding access to care often focusing on provider recruitment efforts, it can be easy to overlook the many levels of work that bolster those efforts in numerous ways. One such effort is the federal Health Professional Shortage Designation (HPSA) process, administered by the Health Resources and Services Administration (HRSA). This involves a closely integrated partnership among Michigan Health Centers, Michigan Primary Care Association, the Michigan Department of Community Health, and HRSA.

Working fervently up to the end of the calendar year to lock in federal Automatic-Facility HPSA designation scores, HRSA re-scored nine Michigan Health Centers from all regions of the state in the final weeks of 2013. The Automatic-Facility HPSA score is calculated by taking many factors into consideration, and while they vary slightly across the health disciplines, each use the common criteria of population-to-provider ratio, percent of population with incomes below 100% of the federal poverty level, and the travel time or distance to the nearest source of care. For primary care, the additional criteria used for determination is infant mortality or low birth weight rate. For dental care, the additional criteria is the percent of population with access to fluoridated water, and for mental care, the additional criteria used in determination of score is the youth or elderly ratio, as well as substance abuse and alcohol abuse prevalence.

The re-scoring process resulted in positive increases for each of the organizations. Having a federal Automatic-Facility HPSA designation allows a Health Center to apply for approval to have one or more delivery sites participate in student loan repayment programs through the National Health Service Corps (NHSC) and/or NURSE Corps sponsored by HRSA.

For these nine Michigan Health Centers, the average score increases for primary, dental, and mental health care were 7, 9, and 4, respectively. These increased scores mean increased competitiveness for NHSC and NURSE Corps site approval. Along the same lines, six of the nine Michigan Health Centers are considered in Tier 1 ( a score of 14 or higher) for placement in the dental and mental health disciplines, making them eligible for the max contribution level for the NHSC and NURSE Corps loan repayment program for practitioners committing to two years of service.

Additionally, eight of the nine Health Centers saw a score increase of five or greater in primary care. For dental care, five of the nine received score increases of greater than 10, while two other Health Centers received a five-point score increase. In the mental health discipline, despite overall slighter score increases, two Health Centers received increases greater than five, while the remaining Health Centers saw increases ranging from one to four points.

With the National Health Service Corps and NURSE Corps loan repayment program application cycles now open for Fiscal Year 2014, news of the score increases comes at a perfect time. The NHSC application cycle is open through March 20, and the NURSE Corp application cycle through February 27.

For more information on the National Health Service Corp, please click here. For more information on the NURSE Corps, please click here.

Baldwin Family Health Care Hosts Open House to Showcase Renovations to Child and Adolescent Health Center in White Cloud School


Kathy Sather, CEO of Baldwin Family Health Care, and Barry Seabrook, Superintendent of White Cloud Schools, cut the ribbon at the newly renovated Child and Adolescent Health Center in White Cloud.

Is your child in need of health care but you’re always running short on time to get him/her to the doctor’s office? If you live in Northern Michigan’s White Cloud school district, Baldwin Family Health Care and White Cloud Schools may have the answer you are looking for: a School-based Health Center.

Kathy Sather, CEO of Baldwin Family Health Care, and Barry Seabrook, Superintendent of White Cloud Schools, enjoy the open house showcasing the Child and Adolescent Health Center at White Cloud Middle School.

Kathy Sather, CEO of Baldwin Family Health Care, and Barry Seabrook, Superintendent of White Cloud Schools, enjoy the open house showcasing the Child and Adolescent Health Center at White Cloud Middle School.

Baldwin Family Health Care and White Cloud Schools hosted a public open house on Wednesday, December 11, 2013, to showcase the newly renovated Health Center located at White Cloud Middle School. This School-based Health Center has been operating since 2009 and was recently expanded to double the space available for health care services. The renovation project was made possible through a federal grant awarded to Baldwin Family Health Care in 2012.

The renovated space includes two medical exam rooms, a behavioral health office, a small area for lab work, an educational room, and office space for staff. Optometry services, like vision exams and the opportunity to purchase reduced price eyeglasses, will also be available on a scheduled basis through a collaborative outreach program with the Michigan College of Optometry at Ferris State University.

The Health Center now also offers dental services with the addition of a dental operatory. This provides students the opportunity to receive dental exams, fluoride varnishes, and restorative care right at school.

White Cloud Child and Adolescent Health Center dental operatory

White Cloud Child and Adolescent Health Center dental operatory

“Some schools have a mobile dentist that visits the school, but they can’t offer the comprehensive, continuous care that students will receive with us. We can offer both preventive and restorative services, and because we utilize electronic records, information is easily transferable to any of our Health Centers,” said Kathy Sather, CEO, Baldwin Family Health Care. “We look forward to working with the children, coaching them on healthy habits, and teaching them about the importance of preventive care and to not put off seeking care when it’s needed.”

Baldwin Family Health Care provides comprehensive, high-quality primary and preventive health care services for residents of Lake, Missaukee, Newaygo, and Wexford counties. With most of its service area rural and isolated, Family Health Care sought the funding to improve students’ access to health care services and reduce missed days of school. Having the Health Center located within the school is a major convenience for both students and parents, allowing students to get the care they need without having to travel long distances, thus reducing time out of the classroom.

Exam room at the newly renovated White Cloud Child and Adolescent Health Center

Exam room at the newly renovated Child and Adolescent Health Center located at the White Cloud Middle School

For more information on Baldwin Family Health Care, please visit

For more information on School-based Health Centers, please visit the School-Community Health Alliance of Michigan at

Identifying Fraud: Communication from the Health Insurance Marketplace Processing Center

Since October 1, 2013, consumers, assisters, and even Health Insurance Marketplace Call Center representatives have used the Marketplace paper application as a way to capture information while the Centers for Medicare and Medicaid Services (CMS) continues improving Recently, the Michigan Department of Insurance and Financial Services responded to concerns of fraud related to phone calls from people claiming to be Health Insurance Marketplace representatives.

Legitimate Phone Calls
The U.S. Department of Health and Human Services has contracted with a third-party firm named Serco to process Marketplace paper applications. All applications that are mailed to the processing center in London, Kentucky, are reviewed, and those which are incomplete or present a complex family structure are set aside for follow-up. Serco began contacting applicants by phone three weeks ago to complete or clarify application information.

If you are contacted by Serco about your Marketplace paper application, your caller ID may read one of the following:

• Health Insurance MP

• 606-260-4191 (Kentucky)

• 636-698-6320 (Missouri)

• 479-877-3203 (Arkansas)

• 580-354-7707 (Oklahoma)

The Serco employee will state that he/she is calling from the Health Insurance Marketplace regarding your recent health insurance application and give you his/her name and agent ID number. You should write this down and keep this for future reference. The employee will use three pieces of information to verify that you are the correct person to speak with about your application, including requesting the last four digits of your social security number.

If you would prefer to not provide certain information over the phone, you can tell the Serco employee this at any time during the call. CMS will then mail you a letter explaining the next steps for processing your application and your options for providing the needed information.

Serco will make three attempts within seven days to contact you, leaving voicemails each time they are unsuccessful. If unsuccessful, a notice will be mailed to you that contains next steps for processing your application. There is no phone number you can call to contact Serco.

It is important to know that the Marketplace will be unable to determine eligibility if an application is incomplete.

Fraudulent Phone Calls
Consumers have reported cases of fraud in which people posing as Marketplace representatives have contacted them via phone to sell private unsubsidized plans. You should never give your personal health information to someone who calls or comes to your home uninvited, even if that person says they are from the Marketplace. While the Health Insurance Marketplace may ask for your income or salary, it will never ask you for information about your personal health or financial institution. If you have been contacted by a suspicious caller seeking your personal information, contact Michigan’s Health Insurance Consumer Assistance Program at 877-999-6442 or

If you have any questions about the instructions in this article, please contact Julie Tatko, MPCA Program Coordinator, Outreach, Education & Enrollment.


An Update for Michigan’s Health Coverage Outreach and Enrollment Assisters

As you may have heard, the U.S. House of Representatives’ Energy & Commerce Committee is holding hearings to uncover why isn’t functioning well. On Thursday, October 24, 2013, committee chair Congressman Fred Upton (R-MI) began the hearings by questioning the contractors tasked with creating the website. While it’s important to find out why the website glitches exist and persist three weeks into the first Health Insurance Marketplace open enrollment period, it is more important to remember that the Affordable Care Act is a law, not a website.

About four hours of testimony (you can watch it here), as well as countless media reports, tell us there are problems with the consumer experience on the website, problems with the system that determines eligibility, and problems with the data hand-off to insurers (834 form). All of those processes are expected to work more smoothly by the end of November, according to the contractors now overseeing the project. This graphic from the Washington Post breaks down what’s wrong with This graphic from the U.S. Department of Health and Human Services  explains what it’s doing to fix In short, the Administration recognizes that the website’s problems are beyond too many people visiting at once, so it’s implementing a strategy it believes will alleviate the frustration many Americans have felt as they’ve attempted to enroll in affordable health coverage.

So where does that leave the hundreds of people across Michigan who have completed hours of federal training and strategized their outreach and enrollment efforts around this website? It provides opportunities to:

  • Continue educating our communities
  • Engage in more outreach now and schedule appointments later, allowing for a consistent flow through the next 150+ days of open enrollment
  • Voice our opinions about how to improve systems
  • Compile other community resources and learn more about how to connect people to a health care home, not just to an insurance card

We have to do our best to inform those relying on us as a resource through the enrollment process that, eventually, the website will work. If it doesn’t work when we need it to, we’ll forge through the paper application and complete the plan selection and enrollment at a later date. The bottom line is, we will do everything within our power to help our neighbors receive the benefits of the Affordable Care Act – whether it is the benefits that are already available, or the benefits to come starting January 1, 2014. We can assure the residents of our communities that they won’t be penalized for not having coverage on January 1, and that some may even qualify for an exemption.

We should also be prepared to answer questions about Medicaid expansion.  According to a Michigan Primary Care Association (MPCA) analysis, about 124,000 of Michigan Health Centers’ adult patients who are currently uninsured will likely be eligible for coverage under Healthy Michigan, the state’s newly expanded Medicaid program that is expected to be available around April 1, 2014. As we encounter questions about Healthy Michigan, we should have systems in place at our sites to capture information so that when the application is open and available, we can connect eligible individuals to coverage.

For those currently eligible for tax credits and/or cost-sharing reductions through the Health Insurance Marketplace, but who will also be eligible for Healthy Michigan coverage down the road, we recommend they apply in the Marketplace now and sign up for text message updates from MPCA so they are notified when the Healthy Michigan Plan opens for enrollment. Text “InfoMI” to 69866 to sign up. Those who are not eligible for tax credits and/or cost-sharing reductions now, but who will be eligible for Healthy Michigan coverage down the road should also sign up for the text messaging program and visit to learn about the free and low-cost health care services available now.

Even as I type this message to you, is not fully functional, and it looks really, really, really bad, but I’m confident that the site will be revived. In the meantime, there’s plenty of work for us to do to help our communities. We’ll undoubtedly hear a lot more about and the Affordable Care Act in the next few weeks from the media, family, and friends, but I advise you to use facts when assisting clients and remember to act in their best interest. Congressman Sander Levin (D-MI) will speak during a House Ways and Means Committee hearing this morning, and on Wednesday, HHS Secretary Kathleen Sebelius will give testimony during an Energy and Commerce Committee hearing.  MPCA continues to follow developments as they happen, and we’ll continue to support you as you work diligently to enroll people in affordable health insurance.

–Natasha Robinson, MPCA Program Specialist, Outreach, Education, and Enrollment