Affordable Care Act
The Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama in March 2010. The federal law makes sweeping changes to the existing health care landscape, impacting each individual user and provider of health care services nationwide - from hospital systems down to the patient. It is imperative that Michigan family physicians understand the scope of the ACA, particularly as it relates to delivery of care and access for patients in our state. Below are some helpful topics and resources to get you started as well as an overview of what lies ahead.
Healthy Michigan Plan
The Healthy Michigan Plan opened for enrollment on April 1, 2014, making low cost health insurance possible for nearly half a million hard-working, low-income Michigan adults. Designed for residents who make up to 133 percent of the federal poverty level, the Healthy Michigan Plan covers everything from office visits to emergencies to prescriptions at a low cost.
The Healthy Michigan Plan includes premiums that are based on income level, with those making more than 100 percent of the federal poverty level paying up to 2 percent of their income into a health savings account. This account, can be used to pay for out-of-pocket medical expenses. The plan offers incentives for healthy behaviors such as losing weight, quitting smoking, and preventive measures, such as getting a flu shot.
The 10 Essential Health Benefits covered in the Healthy Michigan Plan are: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care. The Healthy Michigan Plan will cover other medically necessary services as appropriate.
Michigan residents have three options for applying:
- Online at www.michigan.gov/mibridges (RECOMMENDED!)
- By calling 855.789.5610
- In person at your local Department of Human Services office
For more information about what the Healthy Michigan Plan covers, who is eligible, and to apply, visit www.HealthyMichiganPlan.org.
Related Resources and Documents for Providers + Patients
- Michigan Department of Community Health - Healthy Michigan Plan
- Healthy Michigan Plan FAQs
- Healthy Michigan Plan Handbook
- Healthy Michigan Plan Information for Providers
- April 2 DCH Letter to Providers on Status of Enrollment
Information for Physician Offices
To inform your patients of the new Healthy Michigan Plan, the Michigan Department of Community Health has provided a number of flyers and handouts that you can print and make available for your patients.
- Healthy Michigan Plan In-Office Handout
- Healthy Michigan Plan Flyer
- Healthy Michigan Plan Black & White Flyer
- Healthy Michigan Plan Brochure
- Healthy Michigan Plan Postcard
If you need additional information, please contact MAFP Headquarters for assistance.
Michigan Health Insurance Exchange
Under the ACA, each state was given the option to create a health insurance exchange or "marketplace" where consumers could purchase insurance from various competiting carriers. Products offered on the marketplace must satisfy minimum benefit requirements known as Essential Health Benefits. Each state chose whether their respective marketplaces would be state-based, federally-facilitated or a partnership exchange (shared responsibilities between the state and federal government). Michigan's marketplace is federally-faciliated, meaning the state has limited influence on how the marketplace is created and administered.
Related Resources and Documents
- Michigan Department of Insurance and Financial Services - Michigan's Health Insurance Marketplace (General Information)
- Health Insurance Marketplace Website
- Premium Estimator
- AAFP Information on Health Insurance Marketplaces
Medicaid Primary Care Fee Uplift
Under Section 1202 of the ACA, certain primary care providers were eligible to receive payment increases for specified services beginning January 1, 2013 through December 31, 2014. Although the implementation of the fee uplift was delayed for several months, the funding has been distributed to the Michigan Medicaid health plans, and all eligible providers who have attested should have received enhanced payments (at 100 percent of Medicare rates) retroactive to January 1, 2013.
Congress failed to extend Federal funding for the policy beyond December 31, 2014; however, Michigan was one of the few states to appropriate state funding for the program. Eligible physicians can now receive a partial fee uplift (approximately 78 percent of Medicare rates) for qualified services performed on or after January 1, 2015.
In Michigan, eligible providers may receive the payments if they self-attest by designating their primary specialty in their Community Health Automated Medicaid Processing System (CHAMPS) enrollment file as one of the three eligible specialties and provide applicable Board certification information.
Related Resources and Documents
- Michigan Department of Community Health - December 2013 Provider "L" Letter on Parity Payments
- Michigan Department of Community Health - October 2013 Provider "L" Letter on Parity Payments
- MAFP Letter to Members - July 2013
- AAFP Information on Medicaid-Medicare Parity
Timeline of Upcoming ACA Provisions
It goes without saying — piloting the Affordable Care Act (ACA) is challenging. To provide some direction, MAFP has compiled a timeline and brief summary of some of the ACA’s main provisions that have gone into effect or are set to go into effect between 2013 and 2015.