• An online tool next month will help Medicaid beneficiaries see what they must do, if anything, to maintain coverage next year
  • Meanwhile, more than 5,000 more Michigan immigrants will lose routine coverage next month
  • They are two of several Medicaid changes under the ‘One Big, Beautiful Bill’ passed last year

In just three months, a sweeping Medicaid overhaul starts for hundreds of thousands of people in Michigan, including new work requirements for some.

But with federal guidance still being released as late as this month, state officials and patient advocates are scrambling to build systems that beginning in January will require 650,000 Michiganders to work 80 hours a month for their coverage or prove they have an excuse not to.

All this has anxious patients turning to their healthcare providers for answers — but providers tell Bridge they are looking for answers too. 

Kim Vermeersch, a certified navigator at Scheurer Health in Pigeon, at the top of Michigan’s Thumb has already fielded patient questions: Do these new rules affect me? How do I keep my Medicaid? 

Like other patient advocates, Vermeersch is awaiting final guidance about eligibility and the paperwork beneficiaries will need to submit to continue coverage — now twice a year, rather than once. 

side view of a woman in a medical setting
Kim Vermeersch, a certified patient navigator, helps patients sort insurance options at Scheurer Hospital in Michigan’s Thumb. (Jeff Shrier for Bridge Michigan)

“We can’t help (the patients) because we don’t really know” the details yet, said. 

There’s some relief on the way.

Michigan has hired more than 400 people to help beneficiaries sort through new requirements and paperwork, using part of the $54.3 million lawmakers budgeted earlier this year to ready the state for the Medicaid overhaul. 

Additionally, the Michigan Department of Health and Human Services announced $12.25 million in grants Sept. 15 for local organizations to hire community navigators who — similar to Schuerer’s Vermeersch — will help residents maintain, or enroll in, Medicaid coverage.

Meanwhile, the health department this month sent letters, texts and online messages to some 650,000 Michiganders enrolled in Health Michigan Plan to alert them of the new rules. 

And next month, the department will launch an online tool to help those same beneficiaries understand how the new rules apply to them. Some other states have begun rolling out their online screening tools. Among them: New Jersey, West Virginia, Louisiana, Indiana, and Wisconsin. 

The changes are part of last year’s HR1, or the so-called “One Big Beautiful Bill.” 

Related:


The Republican-led law, which triggers budget cuts in other areas of spending, too will trim more than $900 billion from the federal budget over 10 years, in part, by removing millions of Americans from government-sponsored health insurance by 2034, according to some of the first estimates by the Congressional Budget Office.

More specifically, the law will require working-age adults in expanded Medicaid programs — known in Michigan as the Healthy Michigan Plan — to work at least 80 hours a month, or do community services for 80 hours a month, or prove that they are eligible for exemptions.

The law has been a massive undertaking. States must refine eligibility criteria and build new processing systems — all the while alerting millions of beneficiaries of upcoming changes.

Complicating matters: Some beneficiaries may not realize they have a Medicaid plan, or they don’t know if it’s a “traditional” fee-for-service Medicaid plan or an expanded Medicaid plan. Only those covered by expanded plans face new work rules.

The state’s new online tool will ask beneficiaries a series of questions as a rough test run for when they renew Medicaid benefits.

Developed by Detroit-based Civilla, a design firm specializing in government communications, the tool will help beneficiaries better understand whether they’ll have to work or will be excused from working — and critically, what documentation they’ll need to submit to maintain coverage.

Costs for the tool, as well as webinars designed to distribute information to nonprofits, are covered by a $385,000 grant by the Michigan Health Endowment Fund, a philanthropy focused on health.  

screengrab of a document
Detroit-based Civilla previously helped Michigan redesign communications, making letters shorter, simpler and — with bright colors — more difficult to ignore in a pile of mail. (Bridge file photo)

The test runs won’t count when it comes to eligibility, but they will allow beneficiaries to better understand whether they have to work or be engaged with the community for 80 hours a month and how to prove those hours or prove they’re exempt from those requirements.

“I don’t need the entire Medicaid population to know everything about work requirements,” said Meghan Groen, who leads the state’s nearly $28 billion Medicaid program at the Michigan Department of Health and Human Services.

“What I need them to know is how it impacts them and their family, and what they’re going to need to be able to comply with” the rules.

After rules take effect Jan. 1, eligibility reviews are staggered throughout the year.

What qualifies as an exemption?

Among the most sweeping questions is this: Who will qualify as too sick to work?

Earlier this month, the Centers for Medicare & Medicaid Services issued a 33-page slide deck to guide states in determining who is too sick to work. It offered examples of hypothetical patients, some with common chronic conditions.

Under a three-tiered framework of “medical frailty,” states choose which codes and documentation to review for eligibility, including Medicaid hospital, outpatient visits and medication records.

Beneficiaries fall into three categories, according to their diagnoses:

  • Tier 1: People with diagnoses so severe they are automatically exempted from work requirements. Diagnoses include metastatic cancer, end-stage renal disease, or amyotrophic lateral sclerosis — also known as ALS or Lou Gehrig’s disease — a fatal, progressive nervous system disease.
  • Tier II: People with less severe diagnoses will require more documentation to confirm they are too sick to work. The state might already have that paperwork, which could include hospital admissions, medication or durable medical equipment records. 
  • Tier III: These are beneficiaries whose records are insufficient to exempt them from work rules and will require a “manual review process,” including, for example, documentation from a doctor.
two colorful graphics on Medicaid
The Michigan Department of Health and Human Services has produced letters, posters and social media posts to reach some 650,000 Michiganders who must comply with new rules beginning Jan. 1. (Graphics courtesy of Michigan Department of Health and Human Services)

First to lose coverage: 5K immigrants

Some changes will take place well before the start of 2027. On Oct. 1, the first big block of Medicaid beneficiaries to be hit with the new eligibility requirements, including about 5,000 Michigan immigrants, no longer will have Medicaid coverage for routine care. They instead will transition to coverage for emergency services only. 

Some worry the change will have a “chilling effect” on noncitizens, even for those who will remain eligible — like Cubans and Haitians —  said Christine Sauvé, spokesperson for the Michigan Immigrant Rights Center.

Immigration status is complex, and the new requirements are confusing.

“Families may think ‘this might affect me,’” she said, so they simply skip services. Undocumented immigrants don’t qualify for Medicaid.

Staff at the immigrants rights center are already working through a handful of cases in which beneficiaries who are eligible for continued coverage have been told they’re not, Sauvé said.

The backdrop

But Groen at the state said Michigan is in a good position to automatically reenroll many beneficiaries.

The state automatically will be able to confirm their continued eligibility for Medicaid by checking other state documents —  paperwork submitted for other benefits or caregiver information, for example.

Those were lessons learned when the state, under federal orders, cleaned up its rolls at the end of the COVID public health emergency. 

At the beginning of this 12-month “redetermination process,” the state was able to match about 12% of Medicaid beneficiaries to existing state documents; by the end of the year, had expanded its “document-matching” so that 60% of beneficiaries could be automatically reenrolled, Groen said.

Additional information

More information about new work requirements can be found here.

In addition to people who are deemed too medically frail to work, Michiganders are exempt from Medicaid work requirements that begin Jan. 1 if they: 

  • Are already subject to work requirements for cash benefits through the Temporary Assistance to Needy Family (TANF) program, or food benefits under the Supplemental Nutrition Assistance Program, or SNAP, benefits
  • Are pregnant or gave birth within the past 12 months
  • Is a parent or caregiver of a child age 13 or under
  • Is a caregiver of someone with a disability and who needs help with daily activities)
  • Is an American Indian or Alaska Native (AI/AN).
  • Was in foster care at age 18 and is currently younger than age 26.
  • Is a disabled veteran
  • Is in a treatment program for a substance use disorder
  • Is in jail or prison now or in the past three months
  • Is living with a substance use disorder
  • Has a physical, intellectual or developmental disability that makes it hard to do daily activities
  • Has a mental health disorder
  • Has a serious health condition that requires regular treatment
  • Is experiencing temporary hardship, such as being in a hospital, nursing facility, psychiatric hospital, facility for people with intellectual disabilities or traveling for medical care for yourself or a dependent because it is not available in your community or living in an area with a high unemployment rate.

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