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 Healthcare.gov.
  • 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.

Traverse Health Clinic Celebrating National Children’s Dental Health Month with Matinee Dental Day

THC_matinee dental day 2

Pictured here us a snapshot from a past Traverse Health Clinic Matinee Dental Day, which featured a showing of the movie “Tooth Fairy” and a local firefighter who dressed as the Rock.

It’s National Children’s Dental Health Month (#NCDHM) and Traverse Health Clinic is celebrating in a fun way. On February 22, 2014, the Michigan Health Center serving Grand Traverse, Benzie, and Leelanau counties is hosting Matinee Dental Day at the State Theatre in Traverse City. Dental assistants from Northwestern Michigan College will perform a dental-themed skit to teach kids about the importance of dental health, to be followed by a showing of “Rise of the Guardians” and the distribution of free dental care kits. Kids get all this for the admission price of just 25 cents, the same price the State Theatre charged when it opened in 1916 and which Rene Louchart, RDH, dental health coordinator at Traverse Health Clinic says some children pay in pennies.

“We have hosted Matinee Dental Days for several years, both in February for National Children’s Dental Health Month and in October for National Dental Hygiene Month,” said Louchart. “It’s always a fun time, and great way to teach children and parents how to prevent cavities, maintain healthy gums, and build good dental habits to last a lifetime.”

The annual observance of children’s dental health began as a one-day event in 1941, and the American Dental Association (ADA) held the first national observance of Children’s Dental Health Day in 1949. The ADA extended the one-day event to a week-long celebration in 1955, and then to a month of awareness events known as today’s National Children’s Dental Health Month.

Statistics show that increasing awareness of healthy habits—including visiting a dentist by the age of 1—continues to be critical. According to the Children’s Dental Health Project, 44% of U.S. children will have at least one cavity by kindergarten, and kids with cavities in baby teeth are three times more likely to develop cavities in their adult teeth. What’s more, millions of kids are eligible for dental coverage through Medicaid or the Children’s Health Insurance Program (CHIP) but are not enrolled. Events like Traverse Health Clinic’s Matinee Dental Days are helping to increase awareness and connect kids to care and coverage.

Individuals and families that don’t have a regular dentist can find a Michigan Health Center near them by using the Find a Health Center look-up at www.mpca.net. Michigan Health Centers provide comprehensive, quality, affordable primary and preventive care regardless of insurance status and fees are based on household income, and they are located in 230 different sites across the state.

Governor Snyder Presents Fiscal Year 2015 State Budget Proposal

by Douglas M. Paterson, MPA, Director of State Policy, Michigan Primary Care Association

On February 5, Governor Rick Snyder presented to a joint session of the House and Senate Appropriations Committees his proposed budget for Fiscal Year 2015, which begins October 1, 2014. The major themes of his budget focus on significant increases to higher education (6.1% increase), K-12 education (3% increase), local government (15% increase), and Early Childhood Education ($65 million).

Of political interest is a proposal to provide some tax relief in the way of higher Homestead Property Tax credits.  This is in contrast to some of the proposals already put forward by both the House and Senate to lower the income tax (see Senate, House Deliberating Income Tax Cut Proposals” in the January 31, 2014, issue of the MPCA eUpdate).

Of particular interest to Michigan Health Centers are proposals to expand the Healthy Kids Dental program to Kalamazoo and Macomb counties ($15.7 million), increase funding for nurse home visitation in Northern Lower Michigan and the Upper Peninsula ($2.5 million), and to begin funding the implementation of recommendations for strengthening the state’s mental health system as outline in the Mental Health and Wellness Commission’s report released last month ($15.6 million). (See “Michigan’s Mental Health & Wellness Commission Releases Recommendations in Comprehensive Report” in the January 24, 2014, issue of the MPCA eUpdate for a summary of “Improving the Quality of Life by Supporting Independence and Self-Determination.”)

Lest we forget last year’s battles so soon, Governor Snyder’s FY 2015 budget proposal includes funding to continue implementation of the Healthy Michigan Plan (Michigan’s expanded Medicaid program). The Governor actually projects a $243.4 million SAVINGS to the state in FY 2015 because many services currently covered entirely by state funds will now be covered partially by the federal government as a result of Medicaid expansion. We need to continue to recognize and celebrate this important achievement!

Lastly, one area of concern in the Governor’s proposed budget is that it does not call for the continuation of $1.4 million in Graduate Medical Education funding that was allocated for spending in the current fiscal year (FY 2014).

Budget hearings will now begin in both the Michigan House and Senate, with a target date of June 1, 2014, for finalization. MPCA will continue to follow these budgets and keep you updated.

Healthy Michigan Plan Enrollment Timeline

On February 6, 2014, the Michigan Department of Community Health (MDCH) indicated that wide-scale enrollment for the Healthy Michigan Plan (Michigan’s expanded Medicaid program) will likely begin in April 2014.

Previously, the educated assumption had been that while coverage would begin on or around April 1st, Michigan residents would have the opportunity to apply before that date. Today’s comments from MDCH solidify a timeline which focuses on enrollment beginning in April; however, a specific date has not been provided.

“Our goal is for the Healthy Michigan Plan to begin in April,” said MDCH spokesperson Angela Minicuci. “The exact specifics of when enrollment will begin or when coverage will begin will be determined as we roll out the Plan. We’ve seen what happens when enrolling a large volume of people into health coverage with a system that is not prepared. We are determined to make sure our systems are capable to avoid any issues or delays for the consumers.”

MDCH’s comments differ from informal reports which indicated the Healthy Michigan Plan application could be available online next month. A previous statement indicated enrollment could begin as soon as early February.

“Bottom line is that while we completely understand that people want information regarding enrollment, the last thing we want to do is rush to get a program up that will only cause delays and issues for residents,” Minicuci said. “We are going to do this right and ensure our systems are ready and prepared for this new influx of beneficiaries.”

MPCA’s guidance for Michigan Health Centers during this period of coverage transition continues to focus on a stratified assistance approach:

  • For individuals with income above 100% of the Federal Poverty Level (FPL), complete a Health Insurance Marketplace application as soon as possible.
    • Individuals in the 100-133% FPL range will ultimately qualify for the Healthy Michigan Plan and will need to transition their coverage when Healthy Michigan enrollment begins. Assisting individuals within this income range in signing up for the text message update service is also encouraged—they can sign up by texting INFOMI to 69866.
  • For individuals below 100% FPL, provide basic education about the Healthy Michigan Plan, assist clients in signing up for the text message update service by texting INFOMI to 69866, and collect contact information for follow-up (with consent) when enrollment begins.

While both the MI Bridges and healthcare4mi.com application portals have undergone updates in recent weeks, neither currently contains an application for the Healthy Michigan Plan. MPCA will notify Michigan Health Centers as soon as the application is online.

MPCA is drafting a timeline for Michigan Health Centers to utilize in planning Healthy Michigan inreach and outreach strategies based on MDCH’s comments. The timeline will provide a framework for activities over the course of the next several weeks.  Please check MPCA’s outreach and enrollment toolkit to download the new resource when it is available.

Happy 5th Anniversary to CHIPRA

by Phillip Bergquist, Director of Health Center Operations, CHIPRA Project Director, Michigan Primary Care Association

When President Obama signed the Children’s Health Insurance Program Reauthorization Act (CHIPRA) on February 4, 2009, he said the law fulfilled “one of the highest responsibilities we have—to ensure the health and well-being of our nation’s children.”

chipra 5th anniversary imageCHIPRA paved the way for significant gains in access to health insurance coverage and health care for children across the country. Today, 4 million more children are insured through Medicaid or CHIP than when the law was enacted. The rate of uninsured low-income children decreased 3% from 2008 to 2012, despite the economic downturn. Nationwide the number of eligible but uninsured children dropped from 4.9 million in 2008 to 3.7 million in 2012.

So, how did Michigan do? Pretty well!

  • The number of uninsured kids in Michigan dropped from 123,707 in 2009 to 104,453 in 2011, a reduction of nearly 20,000
  • The three-year average number of low-income uninsured children in Michigan decreased by 7,000, from 81,000 (2008-2010) to 74,000 (2010-2012).
  • From 2009 to 2012, the number of children insured by Medicaid and MIChild grew from 972,754 to 1,038,554- an increase of 65,800
  • The percentage of Michigan children with health insurance reached 96% in 2012
  • The State of Michigan received over $26 million in CHIPRA Performance Bonuses since 2009 for implementing program features that support enrollment and coverage retention
  • Community organizations across the state received over $2.6 million in CHIPRA outreach and enrollment grant funding to help reach eligible children, enroll them in Medicaid and CHIP, and help kids retain their coverage

Michigan Primary Care Association (MPCA) was the proud recipient of two CHIPRA outreach and enrollment grants, each with a unique but complimentary focus on children’s coverage issues in Michigan. Through the first grant, MPCA’s outreach team assisted over 29,000 children, teens, and pregnant women with health coverage, and directly enrolled over 2,700 residents in Medicaid and MIChild. We developed 340 new outreach partnerships, participated in 270 outreach events, and provided training for 460 additional application assisters.

MPCA’s second grant provided resources to implement an innovative client communications program. This program has increased the coverage retention rate (a measure of enrollees who remain insured after renewal) by 21% amongst a group of over 100,000 Medicaid/CHIP enrolled Health Center patients. The Medicaid/CHIP beneficiaries participating in MPCA’s project now have a retention rate 10% higher than all other beneficiaries in the state.

MPCA jointly lead the state’s largest back-to-school enrollment campaign in recent history. The campaign, called Enroll Michigan, generated a 20% overall increase in statewide applications for Medicaid and MIChild in one month.

Finally, the resources made available to MPCA, Michigan Health Centers, and hundreds of partners who participated in CHIPRA initiatives re-energized outreach and enrollment professionals and laid the groundwork for the extensive coverage efforts underway today. In many ways, the early successes in educating and assisting Michiganders in enrolling in Health Insurance Marketplace plans can be traced back to strategies and resources developed through CHIPRA support.

Earlier this week, U.S. Department of Health and Human Services Secretary Kathleen Sebelius wrote, “There is much to celebrate on behalf of our nation’s children and of course there is still more work to be done.” She’s right! Despite our progress, 90,000 Michigan kids remain uninsured, the majority of whom are eligible for low-cost or free coverage. As we move forward in the flurry of activities surrounding Affordable Care Act coverage expansion let’s not forget our challenge and commitment to connect these kids to coverage.

I join the Secretary in saying Happy 5th Anniversary to CHIPRA, and I, too, “look forward to the important work of making the next five years in children’s coverage as successful as the last.”

New Health Center Opens in Michigan’s Barry County

Barry Community Health Center staff

Barry Community Health Center staff

On February 3, 2014, Cherry Street Health Services officially opened Barry Community Health Center in Hastings, Michigan. It is one of the newest Health Center delivery sites in the state, and is part of a nationwide network of more than 1,200 Health Center organizations that are increasing access to care.

Cherry Street Health Services received funding from the U.S. Department of Health and Human Services (HHS) for the new Health Center on November 7, 2013. That’s when HHS announced a total of $150 million in fiscal year 2014 grant awards under the Affordable Care Act to support 236 new Health Center sites across the country, including $6.2 million to nine organizations in Michigan. The funding will ultimately enable an additional 42,210 Michiganders to access health care at a Michigan Health Center.

Barry Community Health Center, located within the existing Barry-Eaton District Health Department, provides medical and behavioral health services, and it anticipates serving over 3,700 Barry County residents with over 11,600 visits during its first year of operation. It is open Monday through Friday, 8 am-5 pm, with extended hours on Tuesday until 7 pm to offer the community more access. For more information about Cherry Street Health Services, Barry Community Health Center, and the other Health Centers that Cherry Street Health Services operates across West Michigan, visit cherryhealth.org.

Today, 39 Michigan Health Center organizations provide quality, affordable primary and preventive care—regardless of an individual’s insurance status or income level—for over 600,000 Michiganders at 230-plus Health Center facilities across the state. To learn more about how the other Michigan Health Centers are using the new access point funding announced in November 2013 to meet health care needs across the state, click here.

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!

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The New HealthCare4MI.com

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The Old HealthCare4MI.com