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Issue Alert - 04-06-02

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Date:

Jun 03, 2004

Issue Summary:

The Michigan Department of Community Health is closing enrollment in the Adult Medical Program effective July 1, 2004.

Persons Affected:

Adults with income below about 35% of the federal poverty level who do not qualify for Medicaid and do not have other health insurance.


Background

Adult Medical Program (AMP)-- previously known as State Medical Program (SMP), and also known as Adult Benefits Waiver (ABW) program

What's Happening?

The Department of Community Health (DCH) has announced a "temporary enrollment freeze" in the Adult Medical Program (AMP), effective July 1, 2004. The DCH announcement is available online at http://www.michigan.gov/documents/All_Provider_04-08_92749_7.pdf. The announcement states that "future open enrollment periods will be conducted as program funding and enrollment capacity permits." The current AMP caseload is about 86,000, but DCH apparently anticipates that it will only have funds to pay for a caseload of 77,000 in fiscal year 2004. Therefore, it is expected that enrollment will not be re-opened until the caseload has been reduced considerably. FIA has not yet issued instructions regarding implementation of the enrollment freeze. Therefore, individuals who may be eligible for AMP should apply immediately in an effort to establish eligibility before the freeze goes into effect on July 1, 2004. It is not clear what policies and procedures will be followed for any future enrollment periods. In some counties, the County Health Plans may be able to provide coverage to individuals who cannot access AMP because of the freeze, through their "Plan B" programs that serve low income individuals who cannot qualify for coverage under AMP or Medicaid. However, many counties do not operate County Health Plans and those that do frequently have only a very limited number of slots for individuals who are not eligible for AMP.In order to reduce the AMP caseload and ensure that AMP is available for those with no other way to access health coverage, it is important to ensure that individuals who may be eligible for Medicaid -- particularly those who have disabilities -- are applying and qualifying for Medicaid.

What Should Advocates Do?

1. Get the word out about the freeze.2. Assist AMP-eligible individuals in applying and qualifying for AMP before the July 1 freeze goes into effect. Current monthly AMP income limits are $264 for a single individual ($530 if earned income) and $413 for a couple (roughly $716 earned). 3. Be sure that individuals who may be Medicaid eligible are pursuing Medicaid. If you are assisting individuals in applications for SSI or Social Security disability benefits, assist them in pursuing a separate Medicaid application at FIA as well. If you are assisting an individuals who have AMP/County Plan A coverage and who have significant disabilities, be sure that they understand the advantages of pursuing disability-based Medicaid and SSI. (Medicaid coverage is much more comprehensive than AMP.)4. Help individuals find legal help if they have been denied Medicaid or SSI.

What Should Clients Do?

1.Apply for AMP right away if you think you might be eligible. 2.Apply for Medicaid if you are unable to work because of medical problems, emotional or mental health problems, or learning disabilities, or other disabilities. 3. Get legal help if you are denied Medicaid, SSI, or Social Security Disability benefits4. Ask whether your county has a County Health Plan for the uninsured if you are denied AMP. Contact your local County Health Department and FIA to find out about local health resources.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan LawHelp web site (http://MI.LawHelp.org) or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.