March 31st marks the official end date set by the federal government for requiring state agencies to provide continuous Medicaid enrollment for their beneficiaries. Around 400,000 Michiganders are at risk of losing coverage after being deemed ineligible for the program once the continuous coverage provision ends.
Brian Peters, CEO of the Michigan Health & Hospital Association (MHA), one of the nation’s largest state hospital associations, spoke to State of Reform, sharing his outlook and insights about Michigan’s unwinding period.
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State of Reform: How is MHA preparing for the unwinding period?
Brian Peters: “We’ve been thinking about this issue for quite some time knowing that the PHE would eventually come to an end, and that we would have a very significant number of Michiganders who would lose coverage from the traditional Medicaid program and certainly from the Healthy Michigan Plan as well.
The good news is, today, we have more options for coverage than we did in years past. That’s because we have a health insurance exchange, with the ACA, which allows the opportunity for folks to secure coverage in that fashion, and other programs, public and private. Medicare may be an option for some if they qualify. Traditional Medicaid may be an option for some.
We don’t automatically presume folks would lose coverage. So, what we’re going to do is to educate our members, our hospitals, particularly those that see a very significant number of Medicaid patients in their emergency departments. This is a place where we can communicate to folks and let them know what’s coming down the road here very shortly, and really educate them on their options. The end goal is to make sure that every Michigander has some form of coverage.
It’s critically important because we know that folks who have good insurance coverage are more likely to see primary care providers, more likely to come and deal with healthcare problems at an earlier stage, before that worsens, and their status is severely compromised. Certainly, that is helpful for the viability of hospitals and other healthcare providers as well.”
SOR: Are you working with MDHHS when it comes to outreach efforts for Michiganders and what are your timelines?
PB: “We are working directly with MDHHS. They have a robust toolkit that we certainly are helping to convey to our member organizations. We have a series of educational webinars that we’re offering our member organizations and our members. They have the opportunity to learn from experts and ask [them] questions. We are doing everything we can to get those tool kits and information in the hands of people who can share it with Michiganders.
I would also say that, thankfully, we have an administration here in Michigan, the Whitmer administration, which has been very supportive, right from day one, making sure that everyone has appropriate coverage. They have been very good about hopefully sequencing this, in such a way, so that we do not have a flip of the switch. Where one day we have this large number of people that is covered—and the next day—this large group of people is not covered. I think this is a very likely outcome in a number of other states.
Fortunately, in Michigan, as I said, we have an administration that gets it and is supportive to try to stage this in such a way so we do not have this large surplus of people who lose coverage automatically in one fell swoop.”
SOR: Do you think Michigan will open its own exchange marketplace?
BP: “Yes, I do. I actually do think that is a likely scenario. I can’t tell you exactly when that is going to happen. But I do think we are moving in that direction. Again, the political dynamic that we have now is conducive to that. I think there has always been interest in having that degree of control and ownership as opposed to defaulting on the federal exchange. I do think we are moving in that direction, and we certainly welcome that no matter what the reality is. We are going to work with the administration and legislature to try and do right by Michiganders—so they have the best options available for coverage. That is something we have always supported at the MHA.”
SOR: Now that Michigan has a trifecta government, what do you expect to happen and what type of legislation is on your wishlist?
BP: “It comes down to the strategic priority for our organization, which is rooted in our mission. Our mission is very simple: it is to advance the health of individuals in our communities. So, all of our legislative asks are really with that mission in mind.
So, we look at things like the workforce crisis in healthcare today. We know that because hospitals, nursing homes, behavioral health facilities, and a number of other provider organizations are short-staffed, we know that is creating access issues for Michiganders. With that in mind, we asked the legislature and the administration to support a new appropriation at recruitment and retention to hospital workforce. I am very pleased that last week, we were successful in [allocating] $75 million [in] appropriations to do exactly that.
Beyond that, we are very mindful that because we are now boarding more patients in hospitals than ever before. That means these are patients that should be discharged to another setting. But we can’t discharge them because there is nowhere to send them. So, hospitals are really having to take care of those patients—day in and day out—around the clock. Many of them, unfortunately, have committed verbal or physical abuse against our front-line care workers.
We have hospitals that are spending a great deal of resources in creating more secure physical environments that cost a lot of money, and no one is stepping up. So, we asked the legislature to again look at potential appropriations to offset those new costs that we are incurring.
When we look at maternal health and child health, we want to support our labor in delivery in hospitals around the state. So, we are asked for an increase in investment because we know that is at risk. We asked for a number of items that all relate to the financial viability of our Michigan hospitals both small and large—urban and rural.
I would say we are struggling right now because we have this dynamic increase in our labor cost and supply chain cost. It is something you hear from every section of the economy right now. The difference is, in our world, hospitals are significantly restricted in our ability to pass those costs on because Medicare tells us what to pay; Medicaid tells us what to pay; and private insurance contracts are negotiated many years, sometimes, in advance, and they do not turn on a dime. So, we are looking for help from the legislature this year, and we think this is a good opportunity to secure much needed funds.”
SOR: Are there any critical issues you want to address?
BP: “One issue that is very central to our mission is health equity. In other words, when we say advancing the health for individuals and communities—that means for everyone. I know we have a challenge in Michigan and across the county, quite frankly, when it comes to health equity in certain populations. Populations who are not receiving the same sort of access and care, who have environmental situations that are challenging like transportation, housing, and food insecurity. These are all things that contribute to poor health outcomes.
So, when we work with the legislator and the governor going forward, I think more and more, we—and our member hospitals and health systems—are going to prioritize health equity. There are some stories to tell already. We committed to this work. We are on the journey, and I am really proud to say there are better days ahead.”
This interview was edited for clarity and length.