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Issue Alert - 07-11-01

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Date:

Nov 01, 2007

Program Area:

Adult Medical Program (AMP) -- also known as Adult Benefits Waiver (ABW) or County Health Plan A

Issue Summary:

Enrollment in the AMP/ABW/Plan A will be open December 1, 2007 until enrollment is filled.

Persons Affected:

Uninsured individuals (or those with County Plan B coverage) with income below 35% of the federal poverty level and cash assets of less than $3,000.

For More Information:

Center for Civil Justice 320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558 E-mail: info@ccj-mi.org

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000 (734) 998-6100 (734) 998-9125 Fax


Background

The Adult Medical Program (AMP) provides health coverage to uninsured individuals who are unable to qualify for Medicaid and who have monthly income below 35% of the federal poverty level ($298 for an individual, $413 for a couple) and cash assets (bank accounts, securities, cash) totaling less than $3,000. When evaluating income eligibility for AMP, the Department of Human Services (DHS) considers gross income, but excludes the first $200 plus 20% of the remainder of an applicant’s earned income.

AMP is also known as the Adult Benefits Waiver (ABW) program, because it is partially funded with federal SCHIP (State Children’s Health Insurance Program) funds under a waiver granted by the federal government.

Although DHS determines eligibility for AMP/ABW, the health coverage for eligible recipients is provided either by the Department of Community Health (DCH) or, in some counties, by the County Health Plan. When the AMP/ABW coverage is provided by the county, it usually is known as County Health Plan A.

Beginning July 1, 2004, enrollment in the AMP/ABW program was frozen, except for brief periods. During the freeze, no new applications are approved (including applications by AMP/ABW recipients who fail to complete their yearly redeterminations on time).

What's Happening?

Individuals who submit applications to DHS on or after December 1, 2007 may be approved for AMP/ABW, if they qualify.   DCH will leave the enrollment period open until the enrollment reaches its maximum level.  Because DCH has not given a specific date when the open enrollment period will end, applicants should submit their applications as soon as possible after December 1st.  It is not clear how much advance notice DCH will give before closing enrollment. 

IMPORTANT NOTE:  Unlike Medicaid, AMP/ABW policy does NOT require proof of identity or U.S. citizenship, unless questionable.  See DHS Program Eligibility Manual Items 220 and 225. (DHS bulletins and policy manuals are available online at http://www.mfia.state.mi.us/olmweb/ex/html/ or by using the quick link at the Michigan Poverty Law Program (MPLP) website, http://mplp.org/.)  for individuals applying for AMP/ABW.  However, applicants who may be eligible for Medicaid because they are disabled or have children in their care may be required to apply for Medicaid, which does require proof of identity and citizenship.

Individuals who do not have a photo ID or proof of citizenship and are asked to provide those

documents should seek legal advice.  (see “Finding Legal Help”, below.)   

ANOTHER IMPORTANT NOTE: During past open enrollment periods, DHS refused to approve AMP/ABW for individuals whose applications for medical coverage were PENDING in the open enrollment period if their applications were SUBMITTED prior to the start date of enrollment. Therefore, individuals who have an application for medical coverage pending at DHS should submit a new application -- or meet with their DHS caseworker to update and re-sign their pending application -- during December 2007.

DHS must RECEIVE the application on or after December 1 in order for the individual to be considered for AMP eligibility. Applications received prior to December 1 or after the enrollment period closes will be denied AMP based on the freeze.

What Should Advocates Do?

Get the word out about the open enrollment period.

Share this information with other agencies or organizations that work with very low income, uninsured, childless adults -- including persons with disabilities who may not meet the stringent standard for disability-based Medicaid, persons who are homeless, domestic violence survivors, etc.

Get the word out to local medical providers, including free clinics and federally qualified health centers.

Share this information with attorneys who represent Social Security and SSI disability applicants, to assist those who need medical coverage but may be unable to establish Medicaid eligibility while their RSDI/SSI case is pending.

Assist clients who are being asked to submit citizenship or identity verification documents by contacting the caseworker or the supervisors about the requirement.  Clients who are denied because they fail to provide citizenship or identity documents should request a hearing.

What Should Clients Do?

If you are uninsured or have County Plan B coverage should submit an application to DHS during December 2007 (or as soon after that as possible). Check the box for "medical assistance."

If you already have applied for medical assistance or Medicaid, you must RE-APPLY if your application was submitted before December 1, 2007. You can re-apply by meeting with your caseworker to update and re-sign you pending application if it has not been approved or denied yet. It must be re-signed after November 30, 2007 and before open enrollment ends.

If you cannot complete the full application form, you can
(1) submit an 1171F "Filing Document" to protect your application date, or
(2) submit the application with just your name, address, birth date and signature.

DHS must help you fill out the application if you ask them for help. The Filing Document is available at DHS or online at http://michigan.gov/fia (click on "Doing Business with FIA" and "Forms & Applications").

Clients who are being asked to submit citizenship or identity documents should contact an advocate immediately.  Clients who are denied because they fail to provide citizenship document should request a hearing. 

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee.

You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org.

You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.