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Wednesday, May 23, 2018

Michigan’s Medicaid Work Requirements Bill Will Be Terrible for Family Caregivers

Michigan lawmakers are debating a bill that jeopardizes the Medicaid coverage on which hundreds of thousands of low-income residents rely. While supporters claim the bill will protect people from losing coverage if they take care of family members who are sick or who have disabilities, a close read of the language suggests otherwise. 

People enrolled in Healthy Michigan program may be forced to choose between keeping their health insurance or maintaining their caregiving responsibilities

Earlier this year Michigan’s State Senate passed a bill that would impose a new restriction on Medicaid’s Healthy Michigan coverage for low-income families. Among other requirements, the bill states that, in order to maintain coverage, people must work a minimum number of hours per week.  That bill is now under discussion between the Michigan Senate, Michigan House and Governor Snyder’s administration.  Health insurance for hundreds of thousands of low-income Michiganders is at stake.

The Senate bill includes what is intended to be an exception for people taking care of family members who are sick or who have disabilities.  But the exception is drawn so narrowly that the majority of full-time family caregivers now enrolled in the Healthy Michigan program will have to choose between keeping their health insurance or maintaining their caregiving responsibilities. 

Census data shows that nationally, about 60% of non-elderly adults on Medicaid who do not qualify for Social Security disability are working. Of those who are not, almost one in three are home taking care of a family member who is ill or who has disabilities. In Michigan, this translates to about 100,000 non-elderly family caregivers enrolled in Medicaid.

Senate bill has an extremely narrow exception for caregivers

The Senate bill would put the Medicaid coverage of these estimated 100,000 caregivers at grave risk. On paper, the bill has an exception to the minimum work hours requirement for caregivers. But the exception is drawn narrowly. It is limited to caretakers who meet the following criteria:

  1. They care for a family member who is under the age of six years old, or
  2. They care for “a dependent with a disability which dependent needs full-time care based on a licensed medical professionals order”
  3. They care for “an incapacitated individual” even if the incapacitated individual is not a dependent of the caretaker  

The key standards then, are that either the caretaker is responsible for a family member who needs full-time care or someone else who is “incapacitated.” Separately, the legislation also makes a narrow exception for people with disabilities who are “currently receiving temporary or permanent long-term disability benefits from a private insurer or from the government.”

Consider National City residents Celeste and Larry: Last year, we featured National City residents Celeste and Larry on our blog. Their situation demonstrates how these new legal standards line up poorly with the realities of formal disability determinations and family caregiving. As told by Celeste, they both worked their entire lives until disabilities forced both of them to leave the workforce in their late 50s, and they were on the road to medical bankruptcy until they were able to get coverage through Healthy Michigan. Notably, like most Americans with disabilities, they did not meet the specific standards for Social Security disability—a key reason they need Healthy Michigan coverage. Only 6% of working-age Michiganders receive Social Security Disability Insurance (SSDI) benefits, while about 1 in 4 Michiganders aged 18-64 have a significant disability.

Coverage for family caregivers is jeopardized

The fact that Larry and Celeste and tens of thousands of Healthy Michigan enrollees like them do not qualify for Social Security Disability means that, under the Senate’s bill, their health insurance will depend on the state’s process—if any—for allowing them to somehow apply separately to the state to show that Larry needs full-time care. Michigan will either simply rely on Social Security Disability determinations—cutting most full-time caregivers off from Healthy Michigan—or it will need to set up some Healthy Michigan exemption process separate from the current disability determination.  Either way, coverage for family caregivers will be in grave doubt.

Healthy Michigan has been an enormously successful program and a national model, combining conservative and liberal ideas in a way that clearly works now. For the more than 100,000 full time family caregivers who depend on it, the Senate work requirements bill is a terrible and unnecessary threat.