UPDATE: In 2020, Medicaid insurance rules and application steps have not been significantly modified.
“What are the requirements for Medicaid in MI?” is a question you must ask before applying for healthcare coverage during the open enrollment period. Medicaid eligibility requirements in Michigan may differ from those of other states.
Low-income families and individuals who lack health insurance can safeguard their future by enrolling in the Michigan Medicaid Health Care Program.
Better known as Medicaid benefits in MI, this government-backed initiative aims to provide beneficiaries who have inadequate health insurance (or no health insurance whatsoever) with healthcare services and resources, as long as his or her criteria matches the Medicaid requirements.
Another question worth asking before enrolling is, “What are the Medicaid application guidelines in Michigan?”
Typically, Medicaid benefits eligibility is based on a mix of factors, and granted to recipients aged 65 or older, family members with dependents, disabled or blind persons, foster care children, psychiatric hospital patients aged 21 or below and pregnant women if the person applying matches the requirements to be eligible for Medicaid.
State residents who may be wondering about the requirement must learn how to qualify for Medicaid in MI. By doing so, they can prevent getting turned away from the benefit program.
So long as income is at, or under 133% of the Federal Poverty Level (FPL) of Modified Adjusted Gross Income (MAGI), recipients will usually meet the Medicaid benefits eligibility requirements. The more information one possesses regarding who is eligible for Medicaid, the better the chances of meeting individual eligibility criteria.
What Are the Financial Medicaid Requirements in Michigan?
States are required by federal law to set out particular Medicaid qualifications pertaining to income. Since eligibility for Medicaid benefits is mainly dependent on the recipient’s income and resources, it is essential that accurate information is provided to meet the financial Medicaid eligibility criteria.
For anyone who is wondering, “What are the income requirements for Medicaid?” the annual household income limits are as follows:
- One-person household – $15,800
- Two-person household – $21,307
- Three-person household – $26,813
- Four-person household – $32,319
- Five-person household – $37,825
- Six-person household – $43,331
- Seven-person household – $48,851
- Eight-person household – $54,384
Annual income charts can be utilized by potential recipients who are interested in finding out how to qualify for Medicaid. Considering the Medicaid benefits eligibility guidelines include an asset test, it is imperative that the applicant meets the following income eligibility for Medicaid benefits:
- Infants below one-year-old – 195 percent of FPL
- Children aged 1-18 years old – 160 percent of FPL
- Pregnant women – 195 percent of FPL
- Adults and parents/guardians – 138 percent of FPL
The asset test and Medicaid eligibility requirements apply to individuals with all health conditions, as well as foster children and SSI/SSDI beneficiaries. Explore the different Medicaid requirements by downloading our informative guide.
What Are the Non-Financial Medicaid Requirements in Michigan?
Health and medical-related assistance can be gained when Medicaid eligibility requirements in MI are met by an applicant living in Michigan. Designed to make healthcare accessible to people on a low income, the Medicaid Health Care Program is made available to an applicant who is pregnant, has a dependent aged 19 or younger or has a child with a disability.
To qualify for Medicaid, applicants must be an official resident of Michigan State. Furthermore, proof of permanent residency, citizenship or a U.S. national identification card needs to be presented when figuring out who is eligible for Michigan Medicaid.
A Social Security Card proving your Social Security number (SSN) will also be accepted for Medicaid benefits in Michigan. Copies of original documents will not be accepted, however.
Learn About Medicaid Expansion in MI
What are the Medicaid application guidelines regarding expansion? The Medicaid program is referred to as the Healthy Michigan Plan.
In order to understand who is eligible for Medicaid expansions in MI, recipients ought to familiarize themselves with the plan and how it is helping newly eligible adults. Income up to 138 percent of the Federal Poverty Level (FPL) can be earned by newly eligible adults who may be wondering how to qualify for Medicaid.
The reformed Healthy Michigan Plan saw 497,000 beneficiaries meet the Medicaid eligibility requirements by January 2015 and by September, more than 100,000 newly eligible recipients enrolled. It was on September 16, 2013, that the law came into effect.
Now that the number of people able to achieve Medicaid benefits eligibility in Michigan has broadened, the “coverage gap” is getting smaller.
Timelier healthcare can be offered as a result of broadening the application guidelines for Medicaid and people’s minds can be put at rest. The road to expansion has had some speed bumps though, with the process taking almost eight months to activate.
Learn About Michigan’s Second Waiver
Michigan submitted a second waiver that got approved in December 2015. Changes to the Medicaid eligibility requirements in MI were detailed in the waiver, stating that new eligibility rules were valid once an enrollee had been involved in the plan for two years.
Two Medicaid application guideline options would then be presented to the beneficiary at the end of the second year:
- Continue receiving coverage in the Healthy Michigan Plan
- Convert to a Qualified Health Plan (QHP)
By choosing option one, the beneficiary need not worry about asking someone, “What are the Medicaid application guidelines?”, because they would already be enrolled in the program.
Nevertheless, the government aims to make it mandatory for recipients to learn the Medicaid qualifications for QHP plan enrollment by the year 2018. No changes will be made to healthcare coverage following the approval of MI’s second waiver.
Learn About Special Enrollment Periods (SEP) in Michigan
What are the requirements for Michigan Medicaid outside of open enrollment?
All is not lost for beneficiaries who missed out on healthcare coverage outside of the open enrollment window, because there is a back-up solution to missed deadlines – get Medicaid benefits during Special Enrollment Periods (SEP).
An SEP allows beneficiaries to receive Medicaid coverage options based on qualifying life events. So, what counts as a qualifying event?
Figuring out who is eligible for MI Medicaid outside of an enrollment period requires some basic research on what is considered an SEP, such as change of address, marriage, divorce, family status changes or plan cancellation.
In addition to qualifying events, it is possible to meet the Medicaid benefits eligibility requirements under the following circumstances:
- Rejection from Medicaid or CHIP
- Difficulty learning how to qualify for Medicaid
- Failure to complete the enrollment process after signing up for the Marketplace
- Failure to create an account and missing the deadline for open enrollment
The Medicaid rules state that a qualifying life event must have happened 60 (or fewer) days before a beneficiary is granted a Special Enrollment Period.
Applicants who are not sure how to qualify for MI Medicaid must visit one of Michigan’s many Michigan Medicaid Health Care Program facilities for professional advice.
Learn more about Medicaid requirements by downloading our comprehensive guide.