What Are The Qualifications For Medicaid In Michigan


How To Apply / Learn More

Medicaid enrollment, Healthy Michigan, begins

The MI Choice Waiver program is operated by the Michigan Department of Community Healths Medical Services Administration and is available statewide across Michigan. There is room in this program to accommodate approximately 18,000 participants. However, there is a waiting list to receive services via this waiver. New applicants can expect approximately a six to twelve month waiting list to begin services.

To apply for the program, one should contact their local Michigan Area Agency on Aging. Some limited information about this program is available on the Michigan Department of Health & Human Services webpage.

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What Is Michigan Child Health Insurance Program

Children in Michigan are eligible for Medicaid or the Childrens Health Insurance Program through the states MIChild health care program, which is handled by the Department of Community Health.

The program is designed to serve low-income, uninsured children from Michigans working families. The program is for kids 19 years of age and younger. There is a $10 per family monthly premium fee, regardless of how many children in the household receive services. Beneficiaries receive comprehensive health care benefits, including dental, mental health and vision care in addition to well-check appointments.

Services for MIChild include:

  • Doctor visits and well-check appointments
  • Hearing and speech therapy

Income And Asset Limits

HMP and each TM category have income limits. Some TM categories also have asset limits. The limits vary depending on the program. HMP programs do not have asset limits.


Income is money you get. MDHHS will look at the money you get from things like:

  • Wages from your job, including self-employment
  • Child support
  • Disability benefits
  • Unemployment

MDHHS sometimes doesnt count all the money you get as income. For example, if you get SSI, that wont be counted.


Assets are things you own. Some examples are cash, personal property, and real property. Real property is land and the things on it. Personal property includes investments, retirement accounts, life insurance policies, and trusts. There is no asset limit for TM categories for eligible children, pregnant women, and some families with minor children. Most other TM categories have asset limits. HMP does not have asset limits.

To learn more about income and asset limits, read Income and Asset Limits for Medicaid.

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Supplemental Security Income Related Medicaid

You are automatically eligible for TM if you get SSI if both of these are true:

  • You are a Michigan resident
  • You cooperate with third-party resource liability requirements

A third-party resource is a person, entity, or program that is or could be liable to pay for part or all of your medical expenses.

Even if you dont get SSI, you may still be eligible for either HMP or TM based on your age, or being disabled or blind. To learn more about this, you can speak with someone at the Michigan Medicare/Medicaid Assistance Program . MMAP is a free, state-wide counseling service designed to help people with questions about health care.

Your local legal services office may also be able to help you for free. Use the Guide to Legal Help to find a legal services office near you. Even if they are not able to represent you, they could still offer you advice and other help.

Another place where you could find help is from a local Federally Qualified Health Center . FQHCs are community-based health care providers that get funding from Health Resources & Services Administration . They often have patient advocates who can help answer questions about Medicaid. Use the locator tool to find a FQHC near you.

What Kinds Of Work Or Other Activities Count

Michigan Rx Assistance Programs

Theres actually a broad range of activities that people with Healthy Michigan Plan coverage can do to meet the requirement and keep their coverage.

These include doing one of these things at least 80 hours a month :

  • going to school in person or online
  • looking for a job
  • getting treated for a problem with drugs or alcohol
  • volunteering at a nonprofit organization
  • doing unpaid job-related work to help them in a future job

Whatever they do, they must report it to the state every month, starting in February, or risk losing their coverage. The reporting period is special for this month. After that, people can start reporting on the 11th of the month, and can do it any time until the end of the next month.

People who have to report can sign up to get phone calls or texts to remind them to do it.

Very low-income people who get food assistance or monthly payments from the state already have to report these kinds of activities they dont have to report again for their Healthy Michigan Plan coverage.

The state sent out letters in December to everyone it believes will need to report. They looked like this.

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Are There Options If I Make More Than The Limit

There might be some options to still receive Medicaid benefits if you make more than the income limit in your state.

The options do differ from state to state, but the majority do offer a pathway for those who would be considered medically needy and have high medical expenses.

If someone who requires a lot of medical care has too high of an income, they might be able to spend that income on their medical costs and then have that count against their income.

For example, if someone was $500 over the income limit in their state and that state has a program for the medically needy, they might be permitted to spend that excess income on their medical expenses and then receive Medicaid benefits after. This helps those with high than average medical costs be put on more equal footing for income eligibility requirements.

Not every state offers this particular program, however. For a great resource on the sorts of waivers, exceptions, and other eligibility information, visit this website. Once you click on your state of residence, you should be able to see which waivers are available in your state for those who exceed the income limit.

The Problem With Michigan Work Requirements For Medicaid

The problem with Michigan work requirements for Medicaid is some disabled employees might not fit into any recognized exception. We saw this potential when a person hurt on-the-job found their workers comp benefits disputed. The burden is on the disabled employee to file an Application for Mediation or Hearing and prove their disability. But how would MDHHS view this persons status under the Medicaid rules?

Medicaid is an important benefit for disabled employees who find their workers comp benefits disputed. They can use this health insurance to pay for medical treatment and get the care they need. It also allows them to get medical evidence that their condition is work-related so they can hold the insurance company responsible. If they later receive a workers comp settlement or award, Medicaid gets reimbursed.

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Premiums And Healthy Behavior Requirements Set To Take Effect In October 2020 But Could Be Delayed Due To Covid

SB897, the legislation that created the states Medicaid work requirement, also required the state to seek a waiver from CMS to allow for new eligibility rules for people who have been enrolled in Medicaid expansion for at least 48 months and whose income is above the poverty level these provisions were also approved by the Trump administration, but in order to focus on the Medicaid work requirement, Michigan delayed the healthy behavior and premium requirements until October 2020.

At that point, affected enrollees will have to complete a health behavior assessment with increasingly challenging healthy behavior requirements, and they will have to pay 5% of their income in premiums. This is an increase from the 2% of income premiums that already apply to Healthy Michigan enrollees with income above the poverty level. And its worth noting that under the ACA, in states where Medicaid has not been expanded, people in this income range pay up to slightly more than 2% of income for the second-lowest-cost silver plan in the exchange although Medicaid has lower out-of-pocket costs than a plan in the exchange, even with cost-sharing reductions.

There are various enrollees who will be exempt from the 48-month requirements, including pregnant women, medically frail enrollees, and people enrolled in the Flint Michigan Section 1115 demonstration. For Native Americans and children under 21, the additional premiums do not apply but the healthy behavior requirements do apply.

What Does Medicaid Cover In Michigan

Successful Start for Healthy Michigan Medicaid Enrollment

Anyone who signs up for the Medicaid program will receive a copy of everything that is covered under their package. The main things covered are:

  • Dental Care or Healthy Michigan Plan
  • Emergency Services
  • Chiropractic care
  • Pharmacy costs

The prescription drug plan for Michigan is provided to members at no cost as long as they are filled out at an approved pharmacy. There are some drugs that you may need to get prior approval before you will be able to get them filled out. As long as the drugs you are prescribed are on the drug list then they will be filled. There are sometimes when more information is needed from a doctor for certain types of medications and you may see a delay in receiving your medications.

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An Experienced Estate Planning Attorney

Our law firm is one of the most experienced estate planning law firms in the country, with more than 34 years background helping clients in Michigan. In fact, our firm has assisted more than 10,000 families with their planning needs, resulting in millions of dollars of life savings and assets protected.

Our Attorneys are Experienced with all types of Medicaid Crisis Situations

Let our firm resolve your crisis or question and help you regain control of your life during this time. We have nearly three decades of experience in helping Michigan families apply for and obtain Medicaid benefits under a variety of circumstances, and we can help you, too.


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How Do I Apply For The Healthy Kids Program

There are three ways to apply for the Healthy Kids program:

You can apply online faster through http://healthcare4mi.com.

PO Box 30763Lansing, MI 48909

If you have questions about appeals, call the Michigan Office of Administrative Hearings and Rules for the Department of Health and Human Services at 1-800-648-3397.

Michigan Medicaid Eligibility Summary

We hope this post on Michigan Medicaid Eligibility was helpful to you.

If you have any questions about Medicaid in the state of Michigan, you can ask us in the comments section below.

Help us spread the word! If you found this post on Michigan Medicaid Eligibility helpful, help us spread the word by sharing it using the Share this button below.

Be sure to check out our other articles about Medicaid.

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Injured While On The Job Contact Our Lawyers For A Free Consultation

To speak with an experienced workers comp attorney about your workplace injury claim in Michigan, call us now, or fill out our contact form for a free consultation. There is absolutely no cost or obligation. Were here for you.

Our workers comp attorneys have been exclusively helping injured workers in Michigan for more than 35 years. Our attorneys can help you better understand Michigan workers comp laws and what happens after someone has been hurt on the job. To see what our own clients have to say about the caring, compassion, and communication they received from us, you can read in their own words about their experience here on our testimonials page from clients we have helped.

Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call 316-8033 for a free consultation today.

Related information:

  • 30101 Northwestern Highway, Suite 250
  • Farmington Hills, MI 48334
  • 645 Griswold St, Suite 1308
  • Detroit, MI 48226
  • 330 Fulton Street East #250
  • Grand Rapids, MI 49503

Eligibility For Medicaid Waivers In Michigan

Michigan Medicaid: Eligibility, Income Limit ...

The Medicaid program provides assistance with medical costs for people with limited resources or income. It also helps with the cost of certain services that Medicare does not cover. The cost of long-term care can quickly strain many peoples financial resources. Medicaid can help people in this situation if they meet the programs eligibility criteria. According to rules established by Congress, this would primarily apply to long-term inpatient nursing care. Since many people would prefer to remain in their homes if possible, federal law allows waivers in certain circumstances. One type of waiver is known as a Home and Community-Based Services waiver. It allows state Medicaid programs to assist with the cost of long-term care services based in the home or the community, instead of in an inpatient facility. Michigan offers this through the MI Choice Waiver Program, or MI Choice.

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Reasons To Choose Priority Health

  • We are one of the top-rated Medicaid plans in Michigan, with a rating of 4 out of 5 in NCQA’s Medicaid Health Insurance Plan Ratings 2019-2020.*
  • We offer more opportunities to get the right care with added benefits like care management and virtual care when and where you need it.
  • Priority Health Choice Medicaid plans meet all of the criteria in all six care categories from the Michigan Medicaid Consumer Product Guide, which include: overall rating of health plan, doctor communication and service, getting care, keeping kids healthy, living with illness and taking care of women.

*Due to COVID-19, NCQA has canceled the release of 2020-2021 Health Plan ratings. The most recent ratings are 2019-2020

Michigan Medicaid Eligibility Guidelines

To qualify for Medicaid in Michigan, an individual must meet the eligibility requirements of the program.

There are several Medicaid programs that people in Michigan can be eligible for. Each program has its own income and asset requirements.

However, all applicants must meet the general requirements below in order to qualify for Michigan Medicaid.

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Medicaids Rules For Immigrants:

  • Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
  • Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
  • Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get.

See If You Qualify For The Healthy Michigan Plan

Michigan Senate to vote on bill requiring Medicaid recipients to work

The Healthy Michigan Plan provides health care benefits to Michigan residents at a low cost so that more people can have health care coverage. Individuals are eligible for the Healthy Michigan Plan if they:

  • Are age 19-64 years
  • Have income at or below 133% of the federal poverty level*
  • 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
  • Are residents of the State of Michigan

*Eligibility for the Healthy Michigan Plan is determined through the Modified Adjusted Gross Income methodology.

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Are Annuities Countable Assets

When reviewing a Medicaid application, DHHS will include some, but not all, of the applicants assets in their evaluation. The assets that are counted are known as countable assets or countable resources. They include cash and various other assets. For a list of non-countable assets, click here.

In order to be eligible for Medicaid coverage, an applicants total amount of countable assets must be below a certain amount. DHHS will look at recent sales and purchases of assets, and look to see if an applicant has disposed of anything below fair market value. This can lead to a finding of ineligibility for a certain amount of time, known as a penalty period.

If a person who is seeking Medicaid benefits for long-term care purchases an annuity in order to reduce their countable resources, Medicaid says this is ordinarily considered a transfer for less than fair market value. It establishes criteria, however, for annuities that are allowable for Medicaid eligibility.

Michigan Medicaid Income Limits Summary

We hope this post on Michigan Medicaid Income Limits was helpful to you.

If you have any questions about Medicaid in the state of Michigan, you can ask us in the comments section below.

Help us spread the word! If you found this post on Michigan Medicaid Income Limits helpful, help us spread the word by sharing it using the Share this button below.

Be sure to check out our other articles about Medicaid.

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What Is A Medicaid

A Medicaid compliant annuity must meet the following list of criteria, found in part 401 of the BEM:

  • The Medicaid applicant or their spouse purchases the annuity for the sole benefit of themselves or their spouse
  • The annuity is irrevocable
  • The issuer of the annuity is licensed to issue commercial insurance products in the United States and the State of Michigan
  • The annuity pays out in the beneficiarys expected lifetime and
  • The annuity makes regular monthly payments in equal or almost-equal amounts, meaning that it does not include any lump sum or balloon payments at any point during its term.

Funding for an annuity can also come from other retirement resources without interfering with Medicaid eligibility, according to part 401 of the BEM, under certain circumstances. For example, an individual retirement annuity, as defined by § 408 of the Internal Revenue Code, is considered a Medicaid-approved annuity. An annuity purchased with the proceeds from a simple IRA or certain other retirement plans is also approved by DHHS.

Annuities can be a great tool for Medicaid planning in a spousal situation. However, it is important to note one additional requirement of a Medicaid compliant annuity, when the annuitant dies the State of Michigan must be named as the beneficiary of any remaining assets in the annuity, up to the amount Medicaid paid for the spouse receiving benefits.


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