MDCH opens enrollment for Adult Benefits Waiver Program

The Michigan Department of Community Health has announced an open enrollment period for the Adult Benefits Waiver Program, Oct. 1-Nov. 30. The program provides basic medical care for low income, childless adults between the ages of 21 and 65 years of age who don't qualify for Medicaid. There are assets and income tests. Adult Benefit Waiver program medical coverage is limited. For example, inpatient coverage is not included. However, pharmacy services are. Some counties have a county health plan that a person must be enrolled in to receive benefits, and some services may require prior authorization from the county health plan or state if there is no health plan in the county of residence. Applications should be submitted for medical assistance at local Michigan Department Human Services offices. For more information on this program contact Cheryl Porter-Hawkins, at 313-871-3751.

State budget restores Medicaid dental

Oral health advocates saved Medicaid dental coverage in the fiscal 2011 appropriation bill, signed by Gov. Granholm. Highlights of the bill include:

·         $12 billion for the state's Medicaid system, which provides health care and mental health services for more than 1.7 million Michigan residents, including nearly one million children.

·         Restoration of adult dental, podiatric, and limited optical services, which were eliminated in the current fiscal year.

·         Full funding for the Adult Benefit Waiver program which provides health care for more than 60,000 childless adults.

Health reform passes next threshold

Just as political resistance heats up in Washington, the first phase of health reform has been implemented. Most notably, young adults under age 26 are now covered under their parents' health insurance plan. There are several other more subject benefits that have taken effect. Here's a list compiled by Gary Benjamin, a member of the MichUHCAN Board of Directors and longtime friend of the Health Authority.

• These apply to all carriers: Insurers no longer can have lifetime maximums for beneficiaries. Those who have "maxed out" may re-enroll in their insurance policy, and no policy can be cancelled because of your illness became too big of an expense for your insurance company. 
• Rules for group carriers only:  Children with pre-existing conditions may not be denied coverage to the age of 19. The limit for maximums is $750,000 in 2011; $1,250,000 in 2012; and $2,000,000 in 2013; annual caps become illegal in 2014.  
• For individual health plans: the provisions listed above go into effect for new plans bought after March 23, 2010, or when plans are renewed each year. Call personal career to determine the exact date

Rules that are "grandfathered" for individual plans include: no co-pays or deductibles for preventive services, access to ob-gyn services without a referral; banning higher rates for out-of-network medical care; and internal and external appeals regarding claims decisions. The definition of "grandfathered" refers to provisions that are not required of the insurance carrier until one of the following happens: the plan eliminates all or substantially all benefits to diagnose or treat a particular condition, or the plan increases co-pays, deductibles, or your personal share of the premium (co-pay) under a formula established in the law; or your employer decreases its contribution to the plan by more than five percent; or the plan adds an annual or lifetime limit.

Next changes for all carriers:

• On Jan. 12, 2011, insurance companies must spend at least 80 percent of your premium dollar on health care. This does not apply to self-insured plans.
• On Mary 23, 2011, all insurance companies must have simple, easily understood documents explaining their coverage.

For comprehensive information on the new health reform law, visit www.healthcare.com.

Is your church committed to 'faithful reform'?

People of faith continue to promote a vision of a health care future that includes everyone and works to create healthy communities. However, not everyone believes in health equity; worse, people within religious congregations disagree on the moral need for comprehensive health care for all.

Is your congregation promoting "faithful reform" of health care? Do you have an active health ministry? If so, is it explaining the benefits of health reform in your congregation? Find out more about a "faith-inspired vision of health care" by visiting www.faithfulreform .org or call 216-685-0796.

Backgrounder

Free clinic director envisions transitional role

            "The most important part of the (national health reform) legislation is the increase in eligibility for Medicaid to 133 percent of the federal poverty level and extending it to childless adults," notes Sr. Mary Ellen Howard, executive director of Cabrini Clinic. "This will affect many who sit in our waiting room. Unfortunately, it doesn't take effect until Jan. 1, 2014." Four years is a long time and will require considerable work by free clinics, she says. Heading the "to-do" list are these items:

1. Help those who are uninsured and do not have access to health care.
2. Protect the legislation as it stands and ensure that it is implemented at the national and state levels in a just manner.
3. Educate the public which is still trying to understand what health reform means. Cabrini Clinic will counsel its clients, explain options, help with Medicaid enrollment, and help refer them to a medical home.
4. Increase primary care providers.
5. Permanently increase Medicaid levels to Medicare levels so more providers will agree to treat Medicaid patients.
6. Health reform has improved the health system, but hasn't fixed it. Sr. Mary Ellen advocates that continuous improvement is required to ensure that the American health system meets the needs of all of its citizenry.

Finally, once health reform has taken hold and most of the uninsured have been enrolled in Medicaid and find a medical home, the mission of free clinics will need to evolve to meet other needs. But the there will still be needs in the safety net. "My colleagues in Detroit tell me that we are going to be ar4ound for a long time," according to Sr. Mary Ellen. "Passing health reform was just the beginning. We have a lot of work ahead."