Michigan Still Grappling Over Medicaid Expansion

The struggles to expand Medicaid under the Affordable Care Act in Michigan are continuing, with Republican lawmakers suggesting that enrollees should receive coverage for only a limited time.

The proposal was put in a bill late last week that would require Michigan to obtain a waiver from the Centers for Medicare and Medicaid Services that would allow a lifetime enrollment cap of 48 months per individual. Children, the disabled and those over the age of 65 would be excluded from the restriction.

However, the bill, HB 4714, would also require Medicaid enrollees pay premiums equaling as much as 5% of their annual income – as much as $1,500 a year for some households that would qualify – as well as co-payments for care.

The proposed restriction is modeled on a four-year cap on welfare benefits enacted in most of the U.S. about a decade ago. However, there has never been such a restriction placed on enrollment in the Medicaid program, which provides benefits to tens of millions of working poor in the U.S. Last spring, the agency warned states in a memo that time-related caps would not be permitted as part of Medicaid expansion under the Affordable Care Act.

"It goes entirely to our belief that government assistance is not an entitlement, nor is it a lifestyle, if you're an able-bodied adult," said Michigan House Speaker Jase Bolger.

Gov. Rick Snyder, also a Republican, has yet to officially take a stand on the bill. Earlier this year, he announced his support for expanding Medicaid under the ACA. About 400,000 Michiganders would be eligible under the expansion if the income cutoff for eligibility is raised to 138% of the federal poverty level, or $31,322 for a family of four.

The Michigan Health and Hospital Association does not support it, although it expressed encouragement that it indicates a shift from the GOP legislators of abandoning the idea of Medicaid expansion entirely.

The bill has also come under intense fire from Democratic lawmakers, who have called it “heartless” and likely to drive up the state's healthcare costs in the long-term.

"This plan is a slap in the face to anyone in desperate need of healthcare who had hoped our state would do the reasonable thing and accept federal funds to expand Medicaid,” said Tim Greimel, the leader of the Democratic caucus in the Michigan House.