Health Care Programs Eligibility (2024)

Health Care Programs Eligibility

Health care coverage is available to individuals and families who meet certain eligibility requirements. The goal of these health care programs is to ensure that essential health care services are made available to those who otherwise do not have the financial resources to purchase them.

It is very important that individuals and families obtain health care coverage. In Michigan, there are many health care programs available to children, adults, and families. Specific coverages may vary depending on the program and the applicant's citizenship status (some non-citizens may be limited to coverage of emergency services only). The Michigan Department of Health and Human Services (MDHHS) determines eligibility for most of the health care programs that are administered by the State of Michigan).

All of the health care programs in Michigan have an income test, except Children's Special Health Care Services, and some of the programs also have an asset test. These income and asset tests may vary with each program. For some of the programs, the applicant may have income that is over the income limit and still be able to obtain health care benefits when their medical expenses equal or exceed their deductible (formerly known as spend-down) amount.

Children|Pregnant Women|Adults|Families

CHILDREN

U-19
U-19 is a Medicaid health care program for low-income children under age 19. There is only an income test. There is no monthly premium for this Medicaid program. Most children who are eligible for U-19 Medicaid are enrolled in a Medicaid health plan. This program provides a comprehensive package of health care benefits including vision, dental, and mental health services.Contact thelocal MDHHS office in your countyto apply for this program or apply online at www.michigan.gov/mibridges.

MIChild
MIChild is a health care program for children who are under age 19 administered by the Michigan Department ofHealth and Human Services. It is for the low income uninsured children of Michigan's working families. MIChild has a higher income limit than U-19 Medicaid. There isonly anincome test. There is a $10 per family monthly premium for MIChild. The $10 monthly premium is forall of the children in one family. The child must be enrolled in a MIChild health and dental plan in order to receive services. Beneficiaries receive a comprehensive packageof health care benefits including vision, dental, and mental health services.Contact thelocal MDHHS office in your countyto apply for this program or apply online atwww.michigan.gov/mibridges. For more information, visit the MIChild websiteat www.michigan.gov/michild.

Children's Special Health Care Services (CSHCS)
Children's Special Health Care Services is a program within the Michigan Department of Health and Human Services that provides certain approved medical service coverage to some children and adults with special health care needs. Children must have a qualifying medical condition and be under 21 years of age. Persons 21 and older with cystic fibrosis or certain blood coagulating disorders may also qualify for services. Click here for more information about Children's Special Health Care Services.

Under 21
Medicaid is available to eligible persons under age 21. There isan income test and an asset test for this program. If income is over the income limit, the person is assigned a deductible. Persons may incur medical expenses that equal or exceed the deductible and still qualify for this program. Beneficiaries receive a comprehensive package of health care benefitsincluding vision, dental, and mental health services. Contact thelocal MDHHS office in your countyto apply for this program or apply online at www.michigan.gov/mibridges.

Supplemental Security Income (SSI)for Children
SSI is a cash benefit for disabled children whose families have low income.The Social Security Administration (SSA) determines SSI eligibility. The beneficiaries are automatically eligible for Medicaid and they receive the comprehensive package of health benefits including vision, dental, and mental health services.Most beneficiaries are enrolled in a Medicaid health plan. Medicaid may continue even if SSI stops.

Special Disabled Children
Medicaid is available to children who received SSI benefits on August 22, 1996, provided the child meetscurrent SSI income and resource standards and the definition of childhooddisability in effect before the 1996 revised disability definition.The comprehensive health care package of Medicaid benefits is available.Contactthelocal MDHHS office in your countyto apply for this program.

Pregnant Women

Pregnant Women

Medicaid is available to an eligible woman while she is pregnant, including the month her pregnancy ends and during the two calendar months following the month her pregnancy ends, regardless of the reason (for example: live birth, miscarriage). There is an income limit for this program. The comprehensive health care package of Medicaid benefits is available. Contact thelocal MDHHS office in your countyto apply for this program or apply online at www.michigan.gov/mibridges.

Group 2 Pregnant Women
A woman who has income that exceeds the income limit for Pregnant Women (above), may be eligible for Medicaid under the Group 2 Pregnant Women program. If the income is over the income limit, the pregnant woman is assigned a deductible. Persons may incur medical expenses that equal or exceed thedeductible and still qualify for this program. Contact thelocal MDHHS office in your countyto apply for this program or apply online at www.michigan.gov/mibridges.

Maternity Outpatient Medical Services (MOMS)

Maternity Outpatient Medical Services (MOMS) is a health coverage program administered by the Michigan Department ofHealth and Human Services. The MOMS program provides health coverage for pregnant or recently pregnant women who are eligible for Emergency Services Only (ESO) Medicaid. MOMS provides coverage for outpatient prenatal services and pregnancy-related postpartum services fortwo months after the pregnancy ends. Medicaid ESO covers labor and delivery services. Contact thelocal MDHHS office in your countyto apply for this program or apply online at www.michigan.gov/mibridges.

ADULTS

Healthy Michigan Plan

The Healthy Michigan Plan provides comprehensive health care coverage for a category of eligibility authorized under the Patient Protection and Affordable Care Act and Michigan Public Act 107 of 2013. The Healthy Michigan Plan provides health care coverage for individuals who are 19-64 years of age; have income at or below 133% of the federal poverty level under the Modified Adjusted Gross Income (MAGI) methodology; do not qualify for or are not enrolled in Medicare; do not qualify for or are not enrolled in other Medicaid programs; are not pregnant at the time of application; and are residents of the State of Michigan. All criteria for MAGI eligibility must be met to be eligible for the Healthy Michigan Plan. For more information, visit www.healthymichiganplan.org or www.michigan.gov/mibridgesto apply.

Caretaker Relatives
Medicaid is available to eligible parents and people who act as parents,caring for a dependent child. These people arecalled caretaker relatives. There isan income test and an asset test for this program. If the income test is over the income limit, persons may incur medical expenses that equal or exceed the deductible and still qualify for this program. Beneficiaries receivea comprehensive package of health care benefits including vision, dental, and mental health services. Contact thelocal MDHHS office in your countyto apply for this program or apply online at www.michigan.gov/mibridges.

Supplemental Security Income (SSI)for Adults
SSI is a cash benefit to low incomeadults who are aged, disabled, or blind. The Social Security Administration (SSA) determines SSI eligibility. SSI beneficiaries are automatically eligible for Medicaid and the comprehensive package of health care benefits including, vision, dental, and mental health services. Medicaid may continue even if SSI stops. Contact the Social Security Administration to apply for this program.

Aged, Blind, Disabled(AD Care)
Medicaid is available to persons who are aged, blind, or disabled. There are income and asset tests. If the income is over the income limit, persons may incur medical expenses that equal or exceed thedeductible and still qualify for this program. Most beneficiaries are enrolled in a Medicaid health plan and receive acomprehensive package of health care benefits including vision, dental, and mental health services. Contact thelocal MDHHS office in your countyto apply for this program.

Disabled Adult Children (DAC)
A person who had a disability or blindness that began before age 22 may be eligible to receive Medicaid benefits in his adult years. He must also be receiving DAC benefits from Social Security.Most beneficiaries are enrolled in a Medicaid health plan andreceive a comprehensive package of health care benefits including vision, dental, and mental health services. Contact thelocal MDHHS office in your county to apply for this program.

MI Choice
The MI Choice waiver provides home and community-based health care services for adults aged 65 or older and adults with disabilities. The program's goal is to allow persons, who would otherwise require nursing home care, to receive these services in their home and in the community. MI Choice beneficiaries are not enrolled in a Medicaid health plan but still receivea comprehensive package of health care benefits including vision, dental, and mental health services. In addition, the waiver may provide other benefits to help the person remain at home. To see if you are eligible for MI Choice and to apply for the program, please contact your local MI Choice waiver agency.

Medicare Savings Program (MSP)
The Medicare Savings Program pays for certain Medicare costs. There is an asset test. The Michigan Department of Health and Human Services (MDHHS) may help pay the following, depending on the person’sincome:

  • Medicare premiums
  • Medicare coinsurance
  • Medicare deductible

In some cases, the Michigan Department ofHealth and Human Services (MDHHS)may refund the beneficiarya portion of the Medicare Part B premium on an annual basis. Contact thelocal MDHHS office in your countyto apply for this program.

Plan First Family Planning

Plan First is a health coverage program administered by the Michigan Department of Health and Human Services. The Plan First program benefit is limited to family planning services such as, contraceptive services and supplies, reproductive health services, and other preventive services. Individuals eligible for the Plan First benefit include those of any age or gender who have income at or below 195% of the Federal Poverty Level (FPL), are residents of the State of Michigan, and meet Medicaid citizenship requirements. For more information, visit Plan First (michigan.gov). Contact the local MDHHS office in your county or apply online at www.michigan.gov/mibridges.

FAMILIES

Many times, the entire family may be eligible for health care benefits:

Low Income Families (LIF)
Medicaid is available to families under the Low Income Family (LIF) Program. There are income and asset tests. Families that receive cash assistance (Family Independence Program or FIP) are automatically eligible for this program. Other familiesmust apply at thelocal MDHHS office. Families don't have to apply for FIP in order to receive health care coverage under this program. Most beneficiaries are enrolled in a Medicaid health plan and receive acomprehensive package of health care benefits including vision, dental, and mental health services.

Special N Support
Special N Support is available to families that received Low Income Families (LIF) Medicaid or cash assistance (FIP) butare no longer eligibledue toincome from spousal support payments.Special N Support is available forfour months. Most beneficiaries are enrolled in a Medicaid health plan and receivea comprehensive package of health care benefits including vision, dental, and mental health services. Your Family Independence specialist will let you know if you qualify for this program.

Transitional Medical Assistance (TMA)
TMA is available to families that have received LIF or cash assistance (FIP)in at leastthree of the last six months. The family is no longer LIF/FIP eligible becausea parent has too much income from employment. TMA is available for up to 12 months and the family does not need to fill out a new application. Most beneficiaries are enrolled in a Medicaid health plan and receivea comprehensive package of health care benefits including vision, dental, and mental health services. Your Family Independence Specialist at the Department of Health and Human Services will let you know if you qualify for this program.

Health Care Programs Eligibility (2024)

FAQs

What is one requirement of the Affordable Care Act answers? ›

The Affordable Care Act (ACA) requires most Americans to have qualifying health insurance called "minimum essential coverage." Under the ACA's individual shared responsibility provision (also known as the "individual mandate"), most Americans must maintain minimum essential coverage.

What is the income limit for Healthy Michigan? ›

The Healthy Michigan Plan provides health care coverage for individuals who: Are age 19-64 years. Have income at or below 133% of the federal poverty level (approximately $16,000 for a single person and $33,000 for a family of four)

What is the monthly income limit for Medicaid in Michigan in 2024? ›

In 2024, the Medically Needy Income Limit (MNIL) in MI is $1,255 / month for an individual and $1,703 / month for a couple.

What questions does healthcare.gov ask? ›

Your Marketplace application will ask you for information about any job-based plan you or anyone in your household is eligible for. It will ask you for employer contact information for each person in your household who has a job.

What is a requirement of the Affordable Care Act? ›

One provision contained in the law is known as the “individual mandate” which requires that all Americans (regardless of age) be covered by health insurance (through a group or individual plan) or pay an annual financial penalty assessed by the Internal Revenue Service, unless waived under certain limited circumstances ...

What are three main points of the Affordable Care Act? ›

The law has 3 primary goals:
  • Make affordable health insurance available to more people. ...
  • Expand Medicaid to cover all adults with income below 138% of the FPL. ...
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.

How much can you make in Michigan and still get food stamps? ›

Who is eligible for Michigan Food Assistance Program?
Household Size*Maximum Income Level (Per Year)
1$19,578
2$26,572
3$33,566
4$40,560
4 more rows

What qualifies for low income in Michigan? ›

Low income ratings range from $36,150 for a single person to $55,900 for a single person in Livingston. For one person households the extremely low rating from the Michigan State Housing Development Association ranges from $13,550 in many counties to $21,000 in Livingston.

What is the most affordable health insurance in Michigan? ›

Cheapest health insurance in Michigan
TierCheapest planMonthly cost
CatastrophicOscar Secure$241
BronzeBlue Cross Local HMO Bronze Secure$261
SilverAmbetter from Meridian Clear Silver$318
GoldMolina Healthcare Gold 1$335
Jul 12, 2024

Who is eligible for Medicaid in Michigan for seniors? ›

Michigan Medicaid Nursing Home Medicaid Eligibility Criteria

Michigan residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets.

What's the difference between Medicaid and Healthy Michigan Plan? ›

The Healthy Michigan Plan is a type of Medicaid coverage. Medicaid is a partnership between federal and state governments. They work together to provide coverage. The federal government gives rules and resources.

What is the poverty level in Michigan? ›

Some key metrics from the data include: 13% of Michiganders were living on income below the federal poverty line, which is about the same as the previous year. The national poverty rate is 11.5%. 17.6% of children under age 18 were in households below the federal poverty line.

Is HealthCare.gov worth it? ›

Consumers who went on HealthCare.gov, compared plans, and selected the plan that best fit their health and financial needs paid 38 percent less per month on average than the consumers whose plans were automatically renewed. Plans purchased on HealthCare.gov are comprehensive and guaranteed to cover the essentials.

What happens if you don't have a HealthCare.gov account? ›

If you don't have a Marketplace account: Contact the Marketplace Call Center. A representative can help you submit an application over the phone. Call 1-800-318-2596 (TTY: 1-855-889-4325). If you already have a Marketplace account: Log in with your username and password.

What are some health care questions? ›

Healthcare interview questions
  • How do you stay informed on current healthcare advancements? ...
  • Tell me about yourself and how you realized you wanted to be a healthcare provider. ...
  • What kind of care does an older client need? ...
  • Why did you choose to work in the healthcare sector?

What is one requirement of the Affordable Care Act (Apex) brainly? ›

Answer and Explanation:

The state shall ensure that necessary health benefits are provided. Diagnosis and tests were also included in the law. Lifetime coverage caps were removed. Insurance cover was provided for senior citizens, children and dependent family members.

What is the requirement of the Affordable Care Act Apex? ›

Most coverage must now include Essential Health Benefits (EHBs). No more annual dollar limits on coverage for EHBs. No more lifetime limits on EHBs. Insurance companies have to spend at least 80% of your premium dollars on actual medical expenses, not overhead and profit.

What is one of the goals of the Affordable Care Act ________? ›

Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL). Expand the Medicaid program to cover all adults with income below 138% of the FPL.

What is the Affordable Care Act quizlet? ›

Affordable Care Act (ACA) attempts to reform the healthcare system by providing more Americans with Affordable Quality Health Insurance and by curbing the growth in healthcare spending in the U.S..

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