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MDRC cultivates disability pride and strengthens the disability movement by recognizing disability as a natural and beautiful part of human diversity while collaborating to dismantle all forms of oppression.

Introduction

Most of us are aware that every part of health care, personal health, substance abuse services, behavioral health, developmental disabilities supports, and long term care, are changing right now and for the next few years. But there is so much going on that it is difficult to see the forest for the trees-or the trees, for that matter. 

Affordable Care Act

In Michigan, the Affordable Care Act insurance possibilities are implemented through the Health Exchange, a marketplace where insurance plans of various kinds can be purchased, and where tax credits based on income can reduce the premium for the plans. These insurance policies have better coverage for behavioral health and substance abuse services than have been available in the past.

Medicaid Expansion

In Michigan, Medicaid expansion has opened up Medicaid eligibility to people who have less than 138% of the Federal Poverty level. This is roughly $16, 243 for a single person. Medicaid expansion is having a dramatic effect on Medicaid enrollment in Michigan, even if expansion doesn’t solve all the problems with Medicaid eligibility. Expansion also opens up Medicaid behavioral health and substance abuse services to many people who haven’t been eligible for them in the past. The current enrollment is over 600,000.

Integrated Care

In Michigan, integrated care for people who are eligible for both Medicaid and Medicare, will be piloted in four areas of the state. The idea is to make it easier for Medicaid and Medicare to work together to produce good health outcomes. You have to be fully eligible for both Medicaid and Medicare to be part of the Integrated Care demonstration projects (people on spend down aren’t included). The hope is that treatment for medical conditions, behavioral health supports, and substance abuse services will be more effective if they are planned together.

The New Community Services Rules

Medicaid pays for a lot of community services, and the new rules will require these services to produce outcomes like those that people without disabilities experience. It will take 5 years to implement these new rules, but planning for implementing them has already started. It is difficult to explain how big an impact these new rules will have, because we all have gotten used to having our choices and opportunities restricted because of the bureaucratic convenience of providers.

 

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