- Associated Press - Thursday, December 17, 2015

LANSING, Mich. (AP) - Michigan secured a federal waiver Thursday that it needed to ensure that 600,000 low-income adults continue qualifying for Medicaid coverage beyond April.

The waiver, announced by Republican Gov. Rick Snyder, was required by the end of December under the state’s 2013 law that expanded Medicaid eligibility through President Barack Obama’s health care law. Otherwise, the expansion that began in 2014 and is known as Healthy Michigan would have ended in May.

“I’m proud of this program, our residents and Michigan’s continued leadership in health care innovation,” Snyder said in a statement. “I appreciate the work of the Centers for Medicaid and Medicare Services and thank it for its partnership and approval of our unique approach to keep Michigan moving forward.”

Despite strife over the Medicaid expansion backed by Snyder, the GOP-led Legislature enacted it - but only after including some provisions unique to Michigan. One required adults with incomes between 100 and 133 percent of the poverty level and who have been enrolled for four years to buy private insurance through the federal health exchange or pay higher copays and contribute more to health savings accounts.

The approved waiver is different from what had been spelled out in law.

Beginning in April 2018, any Medicaid enrollee between 100 and 133 percent of the poverty line will have to engage in a healthy behavior or else buy private insurance through the federal health exchange. A grace period will be given to new enrollees. Medicaid copays and contributions will be reduced if participants choose to attest to a healthy behavior or, as is already the case, undergo an annual health risk assessment to flag obesity, alcohol use and smoking.

The new requirements apply to about 100,000 people. All 600,000 would have lost coverage, however, if the waiver had not been approved.

A feature of Michigan’s waiver request that drew scrutiny called for raising the cost-sharing limit to 7 percent of income, up from a federal 5 percent limit. Beneficiaries will not pay that much, either by meeting a healthy behavior requirement or going onto the exchange.

“This agreement is consistent with Michigan’s proposal and ensures important beneficiary protections guaranteed under the Affordable Care Act,” said Ben Wakana, spokesman for the U.S. Department of Health & Human Services.

Michigan Department of Health and Human Services Director Nick Lyon welcomed the new waiver’s enhanced emphasis on healthy behavior incentives and said the waiver is “well within the parameters of the statute.” The state later will seek federal approval of operational protocols specifying the kinds of incentives to be recognized in 2018.

Enrollees’ actions will “really dictate the type of coverage they’ll have in the future,” Lyon said in an interview. “What’s hugely important is this helps us further strengthen the concepts that the governor proposed and the Legislature supported of encouraging and promoting healthy behaviors that lead to more healthy, productive lives for our citizens.”

Senate Health Policy Committee Chairman Mike Shirkey, R-Clarklake, said the waiver “looks promising” upon a quick initial review.

“However, since the language of the letter does not match up well with the language in the Healthy Michigan statute, it requires a bit of further scrutiny to insure the approval addresses the spirit and intent of the legislation,” he said. “Of equal importance are the details of how the department and health plans execute this next phase of Healthy Michigan, again with the emphasis of meeting the requirements of the law.”

Hospital and insurance executives, Democratic lawmakers and advocates for the poor applauded the news.

Medicaid expansion is a key component of Obama’s health overhaul. However, a U.S. Supreme Court ruling made it optional for states. Thirty states plus Washington, D.C., have expanded Medicaid. Six have done so with federal waivers.

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Follow David Eggert at http://twitter.com/DavidEggert00 . His work can be found at http://bigstory.ap.org/author/david-eggert

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