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Common Questions About Medicaid

These are common questions about Medicaid.

Common Questions about Medicaid

What is Medicaid?

Medicaid (also called Medical Assistance, or MA) is health insurance for people with low income. In Michigan, there is traditional Medicaid (TM) and the Healthy Michigan Plan (HMP). HMP started in 2014 as part of the Affordable Care Act. Once you are enrolled, TM and HMP work just like other health insurance.

To learn more, read An Overview of Medicaid.

Who is eligible?

In order to be eligible for Medicaid, you must meet certain requirements. Some requirements have to do with how much income you have. Others have to do with non-financial things like your citizenship and Michigan residence. You could also be eligible based on age, disability, or blindness. The Michigan Department of Health and Human Services (MDHHS) will review your application to decide if you are eligible.

To learn more, read An Overview of Medicaid.

What is Freedom to Work?

The Freedom to Work law allows people with disabilities to get Medicaid while working. To be eligible, you must meet all of the following requirements:

  • Be disabled according to Social Security Administration standards
  • Be working
  • Be between the ages of 16 and 64
  • Be a Michigan resident
  • Have a Social Security number or work with the Michgian Department of Health and Human Service (MDHHS) to get one
  • Be a U.S. citizen or an immigrant with a specific status
  • Report certain information to MDHHS
  • Apply for any state or federal benefits for which you could be eligible

To learn more, read the “Freedom to Work: Working and Getting Medicaid” section in the article Income and Asset Limits for Medicaid. You can also speak with someone at the Michigan Medicare/Medicaid Assistance Program (MMAP). Your local legal services office may also be able to help you. Use the Guide to Legal Help to find a legal services office near you.

You can also contact a local Federally Qualified Health Center (FQHC). They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

What are Medicaid work rules?

Starting January 1, 2020, all “able-bodied adults” getting Medicaid through the Healthy Michigan Plan must do at least 80 hours a month of qualifying activities. Able-bodied adults are 19 to 62 years old, not pregnant, and do not have a disability that makes them eligible for Medicaid. Qualifying activities include working, going to school, job or vocational training, and community service.

Some people are exempt and don’t have to follow the work rules. To learn more about exemptions and the work rules in general, read Medicaid Work Rules (coming soon).

Are there special rules for disabled adult children?

Some disabled adult children (DAC) are eligible for Medicaid if they meet certain requirements. In order to be eligible, they must:

  • Be at least 18 years old
  • Have received Supplemental Security Income (SSI) in the past but stopped getting it because they became eligible for DAC Retirement, Survivors, and Disability Insurance (RSDI) benefits
  • Be eligible for SSI if not for the RSDI benefits

To learn more, you can speak with someone at the Michigan Medicare/Medicaid Assistance Program (MMAP). Your local legal services office may also be able to help you. Use the Guide to Legal Help to find a legal services office near you.

You can also contact a local Federally Qualified Health Center (FQHC). They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

How do I apply?

To apply for Medicaid, submit an application to the Michigan Department of Health and Human Services (MDHHS). The fastest way to apply is online through the MI Bridges Portal. If you apply online, you will have proof of your application. You can also apply in person at your local MDHHS office. Your local MDHHS office has to give you a paper application form if you ask for it. You can also print an application form and fill it out before going to MDHHS.

You can have a friend or family member help you complete the application. If you have trouble reading or writing, MDHHS must help you, but you need to let them know that you need help. Some MDHHS offices have computer stations where you can apply online through the MI Bridges Portal with help from an employee.

When you apply, you will be asked to prove important parts of your application. This means you may have to show documents such as your birth certificate, Social Security card, state ID card, driver license, or passport. You may also need documents that show your income and expenses. This could include pay stubs and bank statements. These documents must be less than 30 days old.

When you submit your application, you are swearing that all of the information you gave is true and complete to the best of your knowledge. If you don’t understand a question, it is better to ask for help than to guess.

If you speak limited English, MDHHS must provide you with an interpreter. Be sure to tell MDHHS that you need an interpreter or need help understanding documents in English. You have a right to bring your own interpreter if you prefer. The application is also available in Spanish and Arabic. You can also apply online and have someone help you.

In most cases, MDHHS has 45 days to make a decision after you apply. If MDHHS needs to make a disability determination as part of your application, it has 90 days to make a decision. If you are pregnant when you apply, MDHHS has 15 days to make a decision.

What can I do if my Medicaid is terminated or if my coverage is reduced and I don’t agree with it?

If the Michigan Department of Health and Human Services (MDHHS) takes an action or makes a decision you do not agree with, you can request a hearing. You can use the Do-It-Yourself MDHHS Hearing Request tool to complete your request. Make a copy of the form to keep for your records.

You can fax, mail, or drop off your request in person. If you fax your request, keep the fax confirmation for your records. If you choose to mail your request, you may want to send it by certified mail. Be sure to direct it to the Hearing Coordinator, not your caseworker. 

If you drop off your request, sign the log book in the office lobby (if available). If you have a camera phone, take a picture of your signature in the log book for your records. You could also ask the person who takes the form to stamp your copy as proof of when you dropped it off.

You should request a hearing before the effective action date listed on the notice. The effective action date for Medicaid is always at the beginning of the month. If the person does this, federal law requires their coverage to continue.

An old MDHHS policy required Medicaid hearing requests to be received by MDHHS within 10 days of the notice date. MDHHS changed this policy but has not fixed its computer system. This means people getting Medicaid continue to get notices that require their hearing requests be received in 10 days.

If you got a notice and requested a hearing before the effective action date, but your Medicaid was not restored, contact Lisa Ruby ([email protected]) of the Michigan Poverty Law Program.

What is Modified Adjusted Gross Income (MAGI) and why is it important for Medicaid?

When determining eligibility for certain Medicaid programs, the Michigan Department of Health and Human Services (MDHHS) will look at your household’s size and its Modified Adjusted Gross Income (MAGI). MAGI is often the same amount as the Internal Revenue Service’s number for Adjusted Gross Income. MAGI is used to determine eligibility for tax credits for people who get their insurance through the insurance marketplace for the Healthy Michigan Plan. MDHHS also uses MAGI when determining eligibility for certain traditional Medicaid categories.

Some examples of groups of people MAGI applies to are:

  • Childless adults between 19 and 64
  • Pregnant women
  • People who are parents or are a caretaker of a dependent child (caretaker relatives)

Some examples of groups of people that MAGI does not apply to are:

  • People 65 or older, blind, or disabled
  • People getting long-term care (LTC) services
  • People eligible for or who get Medicare

If you have concerns about how your MAGI is being calculated, you can speak with someone at the Michigan Medicare/Medicaid Assistance Program (MMAP). MMAP is a free, state-wide counseling service designed to help people with questions about health care.

Your local legal services may also be able to help you. Use the Guide to Legal Help to find a legal services office near you. Even if they are not able to represent you, they could still offer you advice and other help.

Another place where you could find help is from a local Federally Qualified Health Center (FQHC). FQHCs are community-based health care providers that get funding from the Health Resources & Services Administration. They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

What is a Medicaid Deductible (Spend-Down)?

Some people who are over the income limit but have high medical expenses may still be eligible for a Medicaid program. These people are responsible for a certain amount of their medical care before their program will cover the rest. This is known as the Medicaid deductible, or spend-down. If you fall into this category, the Michigan Department of Health and Human Services (MDHHS) will determine the amount you are responsible for each month before your coverage kicks in. Eligibility is established on a monthly basis. Your coverage will begin when your bills meet or go over your deductible. Every bill you get will keep adding up until you reach your deductible amount. In some cases, if a bill goes over your deductible, your Medicaid may cover the part that is over. If you have questions about this, you can speak with someone at the Michigan Medicare/Medicaid Assistance Program (MMAP). MMAP is a free, state-wide counseling service designed to help people with questions about health care.

Your local legal services may also be able to help you. Use the Guide to Legal Help to find a legal services office near you. Even if they are not able to represent you, they could still offer you advice and other help.

Some examples of charges that count towards your deductible are:

  • Hospital, doctor, or clinic visit bills
  • Dentist visit bills
  • Cost of medical supplies and equipment
  • Cost of medication
  • Cost of transportation to get medical care
What is a divestment?

A divestment is any transfer of income or an asset for less than its fair market value (less than what it is worth). In other words, if you give property to someone for free or for much less than it’s worth, it is a divestment. If you get certain Medicaid services and you divest property, you can be penalized. Only people getting the following will be penalized for a divestment:

  • Long-term care (LTC)
  • Home help services
  • Home health services
  • The Waiver Program

There is no minimum value of a transfer to be labeled a divestment. If the transfer happens it is a divestment, and the amount transferred does not matter. If the Michigan Department of Health and Human Services (MDHHS) finds that you divested property, there will be a penalty period during which you won’t get your benefits. However, you will not lose eligibility.

To learn more, read the “Divestments” section in the article Income and Asset Limits for Medicaid.