MI Requests Renewal of “Healthy Behaviors” 1115 Medicaid Waiver

December 27, 2017 - Michigan is asking CMS for a renewal of its 1115 Medicaid waiver demonstration that increased the number of insured individuals in the state and led to a reduction in unhealthy behaviors.

The demonstration, entitled the “Healthy Michigan Plan” (HMP), allows beneficiaries at or above 100 percent of the federal poverty line to pay reduced premiums and lower cost sharing totals if members complete health risk assessments (HRAs) and change unhealthy activities such as smoking or substance abuse.

Governor Rick Snyder said that availability of the HMP extended coverage to 650,000 low-income residents in Michigan, reduced uncompensated hospital expenses from $7.21 million in 2013 to $3.77 million in 2015.  

Within their first year of enrollment, 82 percent of beneficiaries experiencing financial barriers to care were able to access ambulatory or ED services.  

“The HMP has made significant impact on the health and well-being of Michigan residents and the proposed waiver extension will enable the state to continue these efforts,” Snyder said. “Given its demonstrated successes and the desire to continue evaluating its unique components, the State is requesting an extension of the current waiver.”

Roughly 59 percent of HMP enrollees did not have insurance the year before enrolling in HMP. The remainder who had insurance reported having Medicaid or a state health plan.

The HMP led to improved member health and more healthy member behaviors, according to data collected from HMP members.

About 48 percent of HMP members said their physical health had improved because of their HMP coverage. Thirty-nine percent of members said their mental health had improved and 39.5 percent said their dental health had improved since HMP enrollment.

Forty-six percent of enrollees completed an HRA because their provider suggested that they do so. Another 33 percent enrollees mailed in a completed HRA and 2.6 percent completed it by phone at enrollment.

HMP members that reported completing the HRA felt it was valuable for improving their health (83.7 percent) and was helpful for their provider to understand their health needs (89.7 percent).

Roughly 38 percent of HMP enrollees stopped smoking or using tobacco in a 30-day period and 75.2 percent of tobacco users said they wanted to quit. Ninety-one percent of enrollees who wanted to quit a tobacco product were working on cutting back or quitting when they became a HMP member.

The HMP also led to an increase in primary care use and a reduction in ED utilization rates.  

Twenty-one percent of HMP enrollees had not had a primary care visit in five or more years before enrolling in the HMP. Seventy-four percent of members said that they had a routine provider visit in the year before enrolling in HMP and another 16.2 percent used an ED for a routine visit.

Approximately 93 percent of HMP beneficiaries said that in the year since enrolling in HMP, they had completed a routine healthcare visit. The number of members using the ED fell to just 1.7 percent, while 75.2 percent reported routine healthcare visits in a doctor’s office or clinic.

Chronic disease prevalence among HMP enrollees was above average, based on CDC chronic disease statistics, as 69.2 percent of enrollees reported having a chronic condition.

About 61 percent of HMP chronic conditions were physical and 32.1 percent of enrollees reported having at least one mental health condition. Thirty-one percent of HMP enrollees reported they had a chronic health condition that was newly diagnosed since enrolling in HMP.  The waiver proposal suggested that HMP started to identify their chronic diseases because many enrollees had little to no healthcare engagement to diagnose and treat these diseases.

Michigan plans to use the waiver renewal to build additional program improvements in the next year. Currently, the waiver is under review from CMS with an open comment period from December 22, 2017 to January 21st, 2018.

Synder concluded the proposal letter by affirming the need for strong federal and state payer partnerships to advance health equity.

“The state looks forward to its ongoing work with federal partners at CMS to ensure that HMP enrollees continue to have access to quality benefits that improve health outcomes.”