This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

When the federal public health emergency for COVID-19 expired in May 2023, over 500,000 Michiganders stood to lose their Medicaid health insurance coverage. But the state of Michigan did more than most other states to help residents "unwind" from emergency Medicaid policies, which simply kept Medicaid patients covered without requiring re-application.
Monique Stanton.
"During the global pandemic, it was essential for people to have access to health care, to treat COVID and to continue to treat all of the other conditions," says Monique Stanton, president and CEO of the Michigan League for Public Policy (MLPP). "What we saw during COVID is that having access to coverage is really essential."
 
The MLPP reported in August that, since being cleared to resume Medicaid eligibility and paperwork checks on April 1, 2023,  "… both red and blue states have cut off Medicaid coverage for nearly 4 million people because they lack the proper paperwork. In at least four states, half of all the people who have lost coverage for any reason are children."

Michigan was not among the states rushing to cut off Medicaid eligibility, but rather worked hard to keep residents on the rolls. The Michigan Department of Health and Human Services (MDHHS) implemented strategies like notifying all Medicare beneficiaries by mail, sharing its Medicaid unwind toolkit with providers and community organizations, and updating its website with the latest information and resources. MDHHS also shared unwind information via text messaging, Facebook, Twitter, and radio advertisements. In June 2023, many Michiganders began the Medicaid renewal process online at michigan.gov/mibridges.

"We know that if more people have access to coverage, especially coverage from a culturally competent provider, we can help reduce health disparities and make sure that people are able to get treatment when they need it, especially preventive care and managing chronic disease," Stanton says. "Preventative care is really essential. Over the long term, it helps reduce the overall cost of care. Earlier prevention is less costly than having to treat something significant."
 
Of those completing the renewal process in Michigan, 46,774 were determined ineligible to remain on Medicaid. Another 223,834 have been determined ineligible because of procedural reasons, mainly for not responding and renewing their applications.
 
"We wanted to figure out ways the state could intervene before they lost coverage, so that they could maintain their coverage," says Alison Hirschel, director and managing attorney for the Michigan Elder Justice Initiative (MEJI). "If they continued to be eligible, we didn't want them to be cut off accidentally or because they didn't get paperwork back."

Safety-net program extends coverage for lifesaving therapies

Among the nearly 300,000 Michiganders who have lost or will lose Medicaid coverage, many live with life-threatening diseases, such as kidney failure that requires routine dialysis or a cancer diagnosis being treated with chemotherapy. With funding from the Michigan Health Endowment Fund, MEJI is collaborating with MDHHS on a safety-net program that will ensure these Michiganders will continue to get the medical treatment they need.
 
"We wanted to make sure that people who were getting life-sustaining treatment — urgent, urgent treatment — were able to continue receiving that treatment, even if they would otherwise be ineligible for Medicaid," Hirschel says. "We asked the question, 'What happens if someone really should be terminated because they're no longer eligible, but they're getting dialysis, or they're getting chemotherapy, or they're getting some other life-sustaining treatment?"

Hirschel notes that more than 3,000 Michiganders living with life-threatening diseases so far have had their Medicaid coverage renewal date moved ahead to May 2024.
 
"We talked to national experts. We talked to lots of different people in the state. We came up with a range of proposals and strategies that we thought might work," Hirschel says. "We were delighted that the state took them and ran with them — and came up with a way to extend coverage for people who were receiving those life-sustaining treatments."

Now, each month, MDHHS examines Medicaid beneficiaries' diagnostic codes to determine which patients are receiving those life-sustaining treatments. Those identified will continue to receive coverage for these treatments through May 2024.

"I want to give the state huge kudos for all the work they put in. We came up with some extra ideas, but they were really thinking about this long and hard," Hirschel says. "At a meeting of Medicaid directors, each state was supposed to talk about something that they were proud of. The state of Michigan talked about the safety net program. It doesn't appear that any other state was thinking about that issue, about how do you keep people in these dire circumstances on Medicaid for as long as possible?"
 
Early on, the MDHHS collaborated with one of the state's Medical Care Advisory Council workgroups to figure out how to help residents undergoing lifesaving treatment during the Medicaid unwinding period. The workgroup outlined four groups of beneficiaries — those receiving chemotherapy, radiation, immunotherapy infusions, and dialysis.
Nicole Hudson. 
"We recognize and understand that some beneficiaries would be undergoing lifesaving treatment during this Medicaid renewal period, and the loss of Medicaid coverage could result in catastrophic health impacts for those beneficiaries," says Nicole Hudson, MDHHS senior adviser on special projects. "We were able to take a multi-step approach to looking at those beneficiaries."
 
MDHHS reviews lists of Medicaid beneficiaries actively receiving one of those four treatments and checks to see if they've been able to "passively renew," i.e., automatically be renewed based on eligibility information already in the system.
 
"If we're automatically able to renew them, they get a letter letting them know that their Medicaid coverage has been extended," Hudson says. "If we weren't able to automatically renew them, then we check to see whether they have another form of comprehensive insurance."
 
MDHHS is moving those who are unable to renew Medicaid and have no other insurance coverage to the last month of the unwinding period, May 2024, so they have the maximum time to transition to other insurance coverage.
 
"This provides a little bit of extra time should they need to purchase a plan on the [Health Insurance] Marketplace and be able to figure out which is the right plan for them," Hudson says. "... [In] the next phase, we'd like to discover a way that we can help with a warm handoff to [Marketplace] navigators."
 
Help is available for all

Funded by the federal Centers for Medicare and Medicaid Services (CMS), navigators are individuals or organizations trained to help consumers and small businesses look for health coverage options through the Marketplace and complete enrollment forms. Four out of five people enrolled in Marketplace plans pay $10 or less per month for their coverage. 
 
"There are many subsidies available. There is assistance available. Navigators are available to help," Hudson says. "If they don't know where to go to get assistance, the [Michigan] Department of Insurance and Financial Services has actually set up their own website to help beneficiaries who are transitioning."
 
Hudson also encourages people who have had Medicaid coverage to turn in their paperwork if they have missed the deadline. Michiganders have 90 days to respond after their Medicaid is closed. Those who are found eligible for Medicaid will be reinstated back to the date that their coverage was originally closed. Any medical bills incurred during that time will be covered.
 
"Anyone out there who's getting paperwork from the state, please make sure you're returning it, even if you think you're not eligible for Medicaid anymore," Hudson says. "Members of your household might still be eligible. You may be over the income threshold for Medicaid, but your children might not be, or other members of your household. If you received follow-up paperwork from your caseworker, make sure that you turn that in."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Alison Hirschel photo by Roxanne Frith. All other photos courtesy of the subjects.