Draft Policy Issued on Healthy Michigan Plan MI Marketplace Option

Posted on January 18, 2018

The Michigan Department of Health and Human Services (MDHHS) recently issued a draft proposed policy regarding the April 1 launch of the MI Marketplace Option and is seeking stakeholder input by Feb. 16. The MI Marketplace Option is the coverage program for current Healthy Michigan Plan enrollees who meet all of the following criteria:

  • Have been enrolled in a Healthy Michigan Plan health plan for 12 consecutive months or more (note: this does not apply to beneficiaries in fee-for-service plans)
  • Have incomes above 100 percent of the federal poverty level under the Modified Adjusted Gross Income methodology
  • Are age 21 years or older
  • Are not pregnant
  • Are not American Indian or Alaska Native
  • Do not have cost-share exempt status
  • Have not completed a healthy behavior as described in the Updates to the Healthy Behaviors Incentives Program section of the draft proposed policy (beginning on page eight)
  • Are not medically exempt

The MI Marketplace Option is made up of its own provider network and has benefits that differ from the Healthy Michigan Plan in that they align with the essential health benefits required to be met by insurers who sell on the individual exchange. Key differences include the lack of vision and dental coverage and differing pharmacy formularies.

Featured in Monday Report. Click to view the full edition.The draft proposed policy does include some information of interest to providers, including elements related to MI Marketplace Option cost sharing, copay collection, more detail on covered benefits, Program Enrollment Type (known as PET) codes, and more. Members are encouraged to review the draft proposed policy and submit comments by the Feb. 16 deadline. Submission information is available on the cover page of the policy. The MHA is currently reviewing the draft policy in detail and will submit comments as well. Members with questions should contact Ruthanne Sudderth at the MHA. 

Tags: Healthy Michigan, proposed policy, MI Marketplace

Posted in: Issues in Healthcare, Member News

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