Medicaid and Michigan Healthcare Policy

Background Information

The American federal government supports such health care programs as Medicare, Medicaid, and the Veterans Health Administration.

Medicare is a federal program for medical insurance of senior Americans (65 and older) and some special categories of younger people. In comparison with younger adults seniors had to pay much more for their health insurance prior to Medicare foundation.

Medicaid is a program for medical insurance for all ages Americans with a low income funded not only by the federal but also a state government. Hence, each state has its own Medicaid program, and each state regulates eligibility, services, and payments. In respect to Medicaid program, all states are obliged to provide “three major state Medicaid home and community-based services programs” that include “waivers, home health, and personal care services.” ¹ It allows every state to target different population groups; in addition, home and community-based services are offered only to the state eligible people. As to personal care, it can include help for shopping, eating, cleaning, and some other services. These services can vary in different states; therefore, each local Medicaid program can provide a wider range of services.

In terms of enrollees of Veterans Health Administration, “about 9.3 million of the nation’s 22 million veterans” take part in the program, and they “qualify for health-care benefits if they have served in the active military and have not been dishonorably discharged.”² Besides, there are “150 VA hospitals and 820 outpatient clinics, as of 2013”, and the agency operates “at least one medical center in each state, as well as in the District of Columbia and Puerto Rico.”³

Obama’s Patient Protection and Affordable Care Act (2010) marked the new era in health care legislation as it requires insurance for all the United States citizens starting 2014. One of the core issues of the Obama’s health care reform stated in 2009, 2010, and 2012 was “the ability to keep doctors or insurance plans that individuals chose.”⁴

Namely, the ACA expands Medicaid coverage “for most low-income adults to 138% of the federal poverty level”, and states should make a decision “whether to adopt the Medicaid expansion” based on the June 2012 Supreme Court decision.⁵ Hence, some states are refusing to expand Medicaid and use “alternative systems such as HMOs for their Medicaid clients.”⁶

However, Michigan is among states that adopted Medicaid Expansion as Governor Rick Snyder “signed into law Michigan’s acceptance of federal funds for the Medicaid expansion”⁷ on September 16, 2012. Thus, the expansion of Medicaid in state Michigan became effective on April 1st, 2015.

Besides, Governor Rick Snyder claimed that in 2011 “Michigan veterans rank 53rd, on a per-capita basis, as recipients of federal VA dollars for total veterans’ benefits, when compared to the 50 states.”⁸ Consequently, “only 30% of Michigan veterans complete the enrollment process and only 19% of Michigan’s total veteran population utilizes their VA health benefits.”⁹ Consequently, the state should encourage veterans to complete the enrollment process to ensure high quality health care for veterans in Michigan.

Medicaid and Veterans in Michigan: Formulation and Implementation of the New Policy

After introduction of Patient Protection and Affordable Care Act, health care in the United States should be focused on improving healthcare quality and lowering health care costs. Hence, heath care programs undergo changes in each state.

For example, the state Michigan will introduce “financial incentives for new Medicaid enrollees to control their use of health care services and to maintain healthy behaviors.”¹⁰ Moreover, the state plans “sharing amounting to as much as 5% of their annual income (approximately $580 to $775 for a single adult) is slated to begin 6 months after Medicaid enrollment” for those with incomes “between 100% and 133% of the federal poverty level.”¹¹ However, there “cost sharing can be reduced to 2% of annual income for new enrollees who demonstrate that they engage in healthy behaviors.”¹² Thus, Medicaid expansion affects state legislature in terms of amending Michigan Medicaid State Plan and also state budgeting.

Moreover, Gov. Snyder signed “an executive order to align family and health related services by creating the Michigan Department of Health and Human Services (MDHHS).”¹³ According to the Governor, “the executive order establishes a framework to eliminate silos in state government and integrate services.”¹⁴ Hence, this new department was created to formulate and implement medical care reforms in the best effective manner.

In terms veterans, “all state service providers and their community partners continue to educate veterans and their dependents on the increased availability of outpatient care.”¹⁵ Moreover, the governor directed “the Department of Military and Veterans Affairs to seek state accreditation from the US Secretary of Veterans Affairs” to help Michigan “become a more committed partner with the United States Department of Veterans Affairs in the provision of veterans’ benefits.”¹⁶ Therefore, the new incentives require close collaboration of the state’s Department of Military and Veterans Affairs and the federal one.

Influence of New Health Care Policy

Although Obama’s Patient Protection and Affordable Care Act is a great value for improvement of health care system in the United States, implementation of the reform will take much time and efforts. Namely, extension of Medicaid coverage will insure low-income citizens to “have important benefits for their access to care, health outcomes, and financial well-being”, and at the same time, it should have “substantial economic benefits for participating states by reducing uncompensated care and sustaining hospitals, community health centers, and other safety net providers that serve uninsured patients.”¹⁷

Besides, health care providers will be much influenced by health care reforms. For example, the Institute for Healthcare Improvement (IHI) developed “the Triple Aim initiative as a rubric for health care transformation: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.”¹⁸ However, accountable care organizations (ACO) and the patient-centered medical home (PCMH) should evolve to achieve the goals of the current reform. Since health care payment models will “shift from fee-for service to global payment,” ACOs will have to shift from “a disease focus to a wellness focus.”¹⁹ For instance, now ACO in rural areas cannot provide “enough access for immunizations to elders”, so collaboration with “the public health authority and local pharmacies”²⁰ should be developed to solve the problem. Hence, wellness issues and close collaboration of healthcare givers and community in educating individuals about healthy lifestyles should improve to accumulate additional funds and develop new incentives to provide preventive medicine.

However, after introduction of ACA, “the business community had lobbied hard against a “mandate”²¹ and won. However, companies that have more than 50 employees “will be assessed a fee per full-time employee in excess of 30 if they do not provide coverage.”²² Hence, due to the fact that large corporations must provide healthcare to their workforce and ACA calls for universal health insurance, other members of business community will have to come to terms with the reform and follow the plan of ACA.

Moreover, as of July 20, 2015, the number signify of partisan way in adoption of Medicaid expansion, “adopted the Medicaid Expansion: 31 states (including DC); adoption of the Medicaid Expansion under Discussion: 1 state; Not Adopting the Medicaid Expansion at this Time: 19 states.”²³ Hence, the states where Democrats control the office and both chambers support the act, and the states with Republicans in charge strongly oppose it.

Ways to Avoid Opposition

Michigan’s plan gained bipartisan support because health care reform in new in the state “includes market-oriented reforms and provisions that will limit the Medicaid expansion’s impact on the state budget if certain benchmarks aren’t hit when the federal government’s share of the funding decreases to 95 percent in 2017 and 90 percent in 2021.”²⁴ Consequently, the authorizing legislation received “a substantial majority in the state House of Representatives and passed by a narrow margin (20 to 18) in the state Senate.”²⁵ Therefore, the Democrats support Medicaid coverage expansion to secure low-income adults, and Republicans oppose the mechanism of the state control over the health care costs. Hence, the state’s office should “increase the role of private health plans, and require some new Medicaid enrollees to contribute toward the costs of their care.”²⁶

Hence, the pragmatic mixture of private and public approaches can make it possible to avoid opposition between Democrats and Republicans and ensure development of health care in the state.

Strategies to Ensure Health Care Quality and Low Costs

Nowadays, states and primary care providers are looking for new models to improve health care and save costs because “Health care should be STEEP – safe, timely, effective, efficient, equitable, and patient-centered.”²⁷ Thus, health policy should be changed to improve healthcare quality with the help of new healthcare models that actively use advantages of communities and advance nursing.

For example, Michigan state should adopt Patient-Aligned Care Team (PACT) program that was introduced in other states by the U.S. Department of Veterans Affairs (VA) to work “in areas as diverse as patient education and system improvement.”²⁸ Namely, PACT includes five members: “a primary care provider”, “a nurse care manager”, “a clinical associate”, “a clerical associate”, and “a veteran who is encouraged to take an active part in making decisions about his or her health.”²⁹ When regular clinic visits are impossible for a patient, consulting is done vie telephone or “telehealth devices.”³⁰ In term of this model, health care promotes “a collaborative team culture, with all members working at their highest level of competency”, develops “electronic health records”, and uses new “telehealth”³¹ technology. Hence, PACT focuses on patient’s needs and preferences when using a veteran as the fifth member of the team.

Outcome of this innovative model of primary care can be demonstrated by the figure of other states participants of 100,000 people who “opted into secure messaging” in one year of 2013; moreover, “phone utilization in primary care rose from 4 percent to 23 percent, and two-day post discharge contact increased from 6 percent to 35 percent.”³² Hence, cost savings of this model showed reduction in “ER/urgent-care visits and acute-care hospital admissions by 43 percent and 47 percent, respectively.”³³ Therefore, use of this innovative policy and new models in Michigan will ensure health care quality for state residents and cost savings for the state.

References

Ahuja, M. (2013). Timeline: Obama’s promise that people can keep their insurance. The Washington Post. Web.

Ayanian, J. (2013). Michigan’s approach to Medicaid expansion and reform. The New England Journal of Medicine, 369(19), 1773-1775.

Cochran, C., Mayer, L., Carr, T., Cayer, N., McKenzie., M. (2015). American public policy: An introduction. Boston, MA: Cengage Learning.

Fauteux, N. (2012). Charting nursing’s future. Implementing the IOM future of nursing report–part III: How nurses are solving some of primary care’s most pressing challenges. Robert Wood Johnson Foundation. Web.

Gov. Rick Snyder: New department to focus on people, promote ‘River of Opportunity’ [Press release]. (2015).

Hacker, K., & Walker, D. K. (2013). Achieving population health in accountable care organizations. American Journal of Public Health, 103(7), 1163-1167.

Hahn, J. A., & Sheingold, B. H. (2013). Medicaid expansion: The dynamic health care policy landscape. Nursing Economics, 31(6), 267-272.

Hicks, J. (2014). Key facts about the Veterans Health Administration. The Washington Post. Web.

Ng, T., Harrington, C., & Kitchener, M. (2010). Medicare and Medicaid in long-term care. Health Affairs, 29(1), 22-28.

Panning, R. (2014). Healthcare reform 101. Clinical Laboratory Science, 27(2), 107-111.

Peters, G. (2006). American public policy: Promise and performance (7th ed.). Washington, DC: CQ Press.

Snyder, R., & Calley, B. (2011). A special message from Governor Rick Snyder: Health and wellness. Web.

Status of state action on the Medicaid expansion decision. (2015).

Footnotes

1. Ng, T., Harrington, C., & Kitchener, M. Medicare and Medicaid in long-term care, p. 24.
2. Hicks, J. Key facts about the Veterans Health Administration, para. 2.
3. Ibid., para 3.
4. Ahuja, M. Timeline: Obama’s promise that people can keep their insurance, para. 1.
5. Status of state action on the Medicaid expansion decision, para. 2.
6. Peters, G. American public policy: Promise and performance, p. 267.
7. Hahn, J. A., & Sheingold, B. H. Medicaid expansion: The dynamic health care policy landscape, p. 269.
8. Snyder, R., & Calley, B. A special message from Governor Rick Snyder: Health and wellness, p. 9.
9. Ibid., p. 9.
10. Ayanian, J. Michigan’s approach to Medicaid expansion and reform, p. 1774.
11. Ibid.
12. Ibid.
13. Gov. Rick Snyder: New department to focus on people, promote ‘River of Opportunity’, para. 1.
14. Ibid.
15. Snyder, R., & Calley, B. A special message from Governor Rick Snyder: Health and wellness, p. 10.
16. Ibid., p. 10.
17. Ayanian, J. Michigan’s approach to Medicaid expansion and reform, p. 1773.
18. Hacker, K., & Walker, D. K. Achieving population health in accountable care organizations, p. 1163.
19. Ibid., p. 1164.
20. Ibid., p. 1166.
21. Panning, R. Healthcare reform 101, p. 109.
22. Ibid.
23. Status of state action on the Medicaid expansion decision, para. 1.
24. Ayanian, J. Michigan’s approach to Medicaid expansion and reform, p. 1775.
25. Ibid.
26. Ibid.
27. Cochran et al. American public policy: An introduction, p. 233.
28. Ibid., p.8.
29. Ibid., p. 9.
30. Ibid., p. 2.
31. Ibid., p. 8.
32. Ibid.
33. Ibid.