Michigan Eligibility

PROGRAM	QUALIFICATIONS	PROCESS	SPECIAL CONSIDERATIONS
MEDICAID
Adults - Pregnant women - Caretaker relatives Families - Low Income Families (LIF) - Special N - Transitional Medical Assistance (TMA) - TMA Plus Children - Newborns - Healthy Kids < 1 - Healthy Kids > 1 and < 19 - Adopted children, foster care children and dependent wards	Income 185% FPL or less (see chart below) No asset test Income test – see attached chart No asset test Income test – see chart below Deductions (per month): - Work expenses = $90 - Earned income = $30 plus 1/3 of remainder - Child support – deduct $50 of amount received or 100% of amount paid Asset limit: $3000 per family (home and 1 car are exempt) Must be previous LIF recipient Must be previous LIF recipient Must be previous TMA recipient Automatically eligible if mother receives Medicaid Income 185% FPL or less (see chart below) No asset limit. Income 150% FPL or less (see chart below) No asset limit. Automatically eligible	Eligibility for all Medicaid programs is determined by Family Independence Agency (FIA) except where noted. Stipulations on countable income and assets are very complex in Michigan. The Michigan Department of Community Health (MDCH) administers all programs and pays FFS claims. Health plans pay managed care claims. MDCH contracts with Maximus, Inc., which provides enrollment counseling for Medicaid through a program called Michigan Enrolls.	Managed care is mandatory in all but 19 counties, with exceptions for certain populations. Six of the 19 counties have only one health plan and 13 have no enrollment mandate. Mental health and substance abuse are carved out. Managed care enrollees receive enhanced services such as health education. FFS claims paid directly by MDCH. Managed care claims paid by health plans. All pharmacy claims are paid by First Health Services Corporation.
TANF
Families	Income: See tables below. Earned income disregard is $200 plus 20% of remainder. Asset limit: $3,000 (home and 1 car are exempt)	In Michigan, TANF is called the Family Independence Program (FIP). It is the state’s welfare reform program. The Michigan Family Independence Agency (FIA) determines eligibility. Families eligible for TANF are automatically eligible for LIF Medicaid.	Same Medicaid considerations as stated above. There are no separate program requirements for TANF recipients.
Medically Needy
	Must be below specific income levels after medical expenses are used to spend down income – see attached chart. Asset limits: - $2,000 for one person - $3,000 for two people - $3,000 for family group (home and 1 car are exempt)
Elderly/Disabled
- SSI recipients - Qualified Medicare Beneficiaries (QMB) - Specified Low-Income Medicare Beneficiaries (SLMB) - Disabled children - Elderly Prescription Insurance Coverage (EPIC)	Automatically eligible for Medicaid. Income 100% FPL or less Asset limit is twice SSI level. Benefit is Medicare premiums, copays, deductibles. Income 120% FPL or less Asset limit is twice SSI level. Benefit is Medicare Part B premium. No income or asset test. Must be 65+ Income 200% FPL or less (see chart below) -- individuals who are determined to be Medicaid spend-down eligible may apply for enrollment. May not receiving Medicaid benefits. No asset test.	Eligibility for SSI determined by Social Security Administration. Eligibility for other programs determined by FIA except Home Care Children (FIA and MDCH share responsibility) and CSHCS, where MDCH determines eligibility. Medicaid programs available: - AD-Care - Extended care - MIChoice (home and community-based care) - Home care children - Children’s Waiver - Children’s Special Health Care Services (CSHCS)	Most enrollees are enrolled in health plans. Mandates described above. CSHCS is FFS in some counties and managed care in others. Health plans for this program are separate from Medicaid health plans. MDCH contracts with First Health Services Corporation to pay EPIC claims.
S-CHIP (MIChild)
Children < 1 Children > 1 and < 19	Income >185% FPL and <=200% FPL Not eligible for Medicaid. Income >150% FPL and <=200% FPL Not eligible for Medicaid. No asset test.	Program is called MIChild. MDCH subcontracts with Maximus, Inc. to administer the program. Maximus is responsible for making eligibility recommendations (MDCH grants final approval), enrollment/ disenrollment in health plans, maintenance of records, verification of enrollment and membership in health plans, collection of premiums, monitoring of health plans and operating a telephone bank to answer benefit questions (Michigan Enrolls). There is a premium of $5.00 per month.	A child can participate in CSHCS and MIChild. A family may be eligible for TMA-Plus and MIChild. Managed care is mandatory in all counties. All enrollees must select a health plan except pregnant women under a physician’s care.

GROUP SIZE	SHELTER AREA
GROUP SIZE	I	II	III	IV	V	VI
ONE	$341	$341	$347	$367	$383	$401
TWO	436	451	463	481	499	517
THREE	544	556	568	586	604	622
FOUR	669	681	693	711	729	747
FIVE	784	796	808	826	844	862
SIX	944	956	968	986	1,004	1,022
SEVEN	1,035	1,047	1,059	1,077	1,095	1,113
EIGHT or more	Add $76 for each additional person.

GROUP SIZE	SHELTER AREA
GROUP SIZE	I	II	III	IV	V	VI
ONE	$255	$255	$260	$276	$290	$305
TWO	341	346	356	371	386	401
THREE	424	434	444	459	474	489
FOUR	528	538	548	563	578	593
FIVE	624	634	644	659	674	689
SIX	757	767	777	792	807	822
SEVEN	833	843	853	868	883	898
EIGHT or more	Add $76 for each additional person.

GROUP SIZE	SHELTER AREA
GROUP SIZE	I	II	III, IV, V, VI
ONE	$86	$91	$96
TWO	169	179	184
THREE	273	283	288
FOUR	369	379	384
FIVE	502	512	517
SIX	578	588	593
SEVEN	654	664	669
EIGHT or more	Add $76 for each additional person

GROUP SIZE	SHELTER AREA
GROUP SIZE	I	II	III	IV	V	VI
ONE	$255	$255	$260	$276	$290	$305
TWO	341	346	356	371	386	401
THREE	424	434	444	459	474	489
FOUR	528	538	548	563	578	593
FIVE	624	634	644	659	674	689
SIX	757	767	777	792	807	822
SEVEN	833	843	853	868	883	898
EIGHT or more	Add $76 for each additional person.

GROUP SIZE	SHELTER AREA
GROUP SIZE	I	II	III	IV	V	VI
ONE	$261	$261	$266	$282	$296	$311
TWO	353	358	368	383	398	413
THREE	442	452	462	477	492	507
FOUR	552	562	572	587	602	617
FIVE	654	664	674	689	704	719
SIX	793	803	813	828	843	858
SEVEN	875	885	895	910	925	940
EIGHT or more	Add $82 for each additional person.

GROUP SIZE	SHELTER AREA
GROUP SIZE	I	II	III	IV	V	VI
ONE	$127	$132	$137	$137	$137	$137
TWO	251	261	266	266	266	266
THREE	396	406	411	411	411	411
FOUR	533	543	548	548	548	548
FIVE	654	664	674	689	704	719
SIX	793	803	813	828	843	858
SEVEN	875	885	895	910	925	940
EIGHT or more	Add $82 for each additional person.

NUMBER OF PERSONS	SHELTER AREA
NUMBER OF PERSONS	I	II	III	IV	V	VI
ONE	$341	$341	$350	$375	$391	$408
TWO	458	466	475	500	516	541
THREE	493	502	512	532	547	567
FOUR	528	538	548	563	578	593
FIVE	624	634	644	659	674	689
SIX	757	767	777	792	807	822
SEVEN	833	843	853	868	883	898
EIGHT	909	919	929	944	959	974
NINE	985	995	1,005	1,020	1,035	1,050
TEN*	1,061	1,071	1,081	1,096	1,111	1,126

*For each additional person, add $76.

NUMBER IN FISCAL GROUP	COLUMN 1	COLUMN 2	COLUMN 3
NUMBER IN FISCAL GROUP	150%	185%	200%
ONE	$1,074	$1,325	$1,432
TWO	1,452	1,790	1,935
THREE	1,829	2,256	2,439
FOUR	2,207	2,722	2,942
FIVE	2,584	3,187	3,445
SIX	2,962	3,653	3,949
SEVEN	3,339	4,118	4,452
EIGHT	3,717	4,584	4,955
NINE	4,094	5,049	5,459
TEN	4,472	5,515	5,962
For each additional person, add	$378	$466	$504

SHELTER AREA I	SHELTER AREA II	SHELTER AREA III
Alger	Arenac	Alcona
Baraga	Chippewa	Benzie
Gogebic	Delta	Cheboygan
Huron	Houghton	Crawford
Iron	Iosco	Dickinson
Keweenaw	Lake	Gladwin
Luce	Manistee	Hillsdale
Mecosta	Oceana	Jackson
Menominee	Ontonagon	Kalkaska
Presque Isle	Osceola	Mackinac
Schoolcraft	Oscoda	Mason
		Missaukee
		Montcalm
SHELTER AREA IV	SHELTER AREA V	Muskegon
Allegan	Barry	Newaygo
Alpena	Bay	Ogenmaw
Antrim	Clinton	Sanilac
Berrien	Eaton	Wexford
Branch	Grand Traverse
Calhoun	Kalamazoo
Cass	Kent	SHELTER AREA VI
Charlevoix	Lapeer	Genesee
Clare	Leelanau	Ingham
Emmet	Lenawee	Livingston
Gratiot	Midland	Macomb
Ionia	Otsego	Monroe
Isabella	Ottawa	Oakland
Marquette	Saginaw	St. Clair
Montmorency	Van Buren	Washtenaw
Roscommon
St. Joseph
Shiawassee

MICHIGAN PUBLIC THIRD PARTY PAYERS

PROGRAM

MEDICAID

Adults

Families

Children

Medically Needy

Elderly/Disabled