Tomorrow is the day we’ve been waiting for and working toward for months. The Healthy Michigan Plan will open for enrollment, bringing a new, affordable health coverage option to hundreds of thousands of Michigan residents.

The collective impact of Michigan’s Health Centers in Health Insurance Marketplace outreach, community education and enrollment assistance has been impressive. But, we’ve got a lot of work ahead to reach and assist this new population of potential enrollees.

When facing a challenge and opportunity as large as the Healthy Michigan Plan it’s sometimes hard to know where to start. So, MPCA has put together a multitude of resources to support and guide the dedicated work of staff, providers, board members and volunteers in organizations statewide.

These new resources are available online at www.mpca.net/oetoolkit and we’ve featured the top ten resources and strategies in a new fact sheet called “10 Things You Can Do to Build Healthy Michigan Plan Awareness.” Can you implement four strategies? How about six? Accomplishing all ten will put your organization well on its way to ensuring your community gets covered!

Stay tuned to MPCA’s website and email networks in addition to this blog for more information, news, updates and progress reports in the days and weeks ahead.

Six of the nine Michigan organizations receiving funding are already Health Centers—Cassopolis Family Clinic, Cherry Street Health Services, Covenant Community Care, Health Delivery Inc., Traverse Health Clinic, and Western Wayne Family Health Centers. Three of the nine Michigan organizations are community-based providers of primary and preventive health care but have not received funding under the Health Center Program before: Community Mental Health & Substance Abuse Services of St. Joseph County, Detroit Central City Community Mental Health, and MyCare Health Center in Macomb County. For many residents in these communities, the nearest provider is either miles away or too expensive.

Below is a summary of how each of the nine Michigan organizations is using the funding it was awarded to open a new Health Center to connect their neighbors with the health care they need.

Cassopolis Family Clinic Network was awarded $650,000 in New Access Point funding to help support the medically underserved in Southeast Berrien County by establishing the Niles Community Health Center. The new facility is located at 24 North Saint Joseph Ave. Suite G, in Niles across from Niles Community Hospital. The new site, which opened February 24, is receiving new patients with a projection of serving an additional 3,600 community residents.

Cherry Street Health Services operates a network of more than 20 Health Centers throughout Kent, Montcalm, and Ionia counties. It was awarded $858,333 to operate the Barry Community Health Center, located within the Barry-Eaton District Health Department in Hasting, Michigan. The new site located at 330 W. Woodlawn in Hastings opened on February 3, and is expected to serve an additional 3,700 Barry County residents with primary medical, dental, and behavioral health services.

Community Mental Health & Substance Abuse Services of St. Joseph County was awarded $812,500 to expand services to provide primary and preventive medical care, in addition to the comprehensive behavioral health care and substance abuse services it has provided St. Joseph County residents for more than 30 years. The new full-service Health Center located at 677 E. Main St. in Centreville, opened February 26. Patient navigators and community health works help connect at-risk individuals to needed services.

Covenant Community Care received $650,000 to increase the capacity of its network of Health Centers, which includes a school-based Health Center and a mobile community-based dental program, by opening an additional site in west Detroit. In collaboration with Joy-Southfield Community Development Corporation (JSCDC), Covenant Community Care opened its sixth Health Center at the current location of JSCDC’s free clinic at 18917 Joy Road in Detroit on February 17. An estimated 7,500 additional primary medical, dental, and behavioral health care visits from residents in the west-side of Detroit is expected in the first year at the new Health Center site.

Detroit Central City Community Mental Health received $793,500 in funding to expand its services to include primary and preventive health care to meet the complex needs of Mid-town Detroit. Having provided comprehensive behavioral health care services for more than 40 years, Detroit Central City Health Center will be able to serve an additional 3,500 local residents. The new integrated Health Center provides primary medical, dental, and behavioral health care for all ages, including complete health care for the entire family such as health screenings, well-child visits, OB/GYN, pediatric and adolescent medicine, internal and geriatric medicine, HIV/AIDS care, physicals, care for chronic conditions such as diabetes, asthma, and high blood pressure. Detroit Central City Health Center opened the first week of March. Its location at 3427 Woodward Ave. in Mid-town Detroit provides easy access to bus routes.

Health Delivery, Inc. (HDI), a Saginaw-based Federally Qualified Health Center network that has operated Health Centers throughout Mid-Michigan for the past 40 years, was awarded $858,333 in new funding to open the first two Health Center sites in the Huron County Thumb Area of Michigan. The Thumb Area Community Health Center, located at 1080 S. Van Dyke Rd. in Bad Axe on the Huron Medical Center campus, opened its doors on February 24. HDI’s Behavioral Health Primary Care Center, located at 1108 S Van Dyke Rd. also in Bad Axe, opened on March 3. Additionally, a portion of the funding was used to expand dental services and extend hours at HDI’s sites in Shiawassee County.

MyCare Health Center, a collaboration of safety net providers to meet the primary health care needs of the most vulnerable residents of Macomb County, received $866,667 in funding to support five Health Center sites. MyCare Health Center will serve approximately 4,000 additional Macomb County residents sites in Center Line, Mount Clemens, Clinton Township (2), and Madison Heights. Through a network of referral providers, MyCare Health Center will enhance the primary care services it offers onsite to increase access to obstetrics/gynecology, oral health, and behavioral health services. Additionally, two MyCare sites have fully integrated behavioral health and primary care services.

Traverse Health Clinic, a major community-based provider serving Traverse City and surrounding areas, has provided access to health care services since the mid-1970s. Originally a free clinic, the organization was certified by the Centers for Medicare and Medicaid Services as a Federally Qualified Health Center (FQHC) Look-Alike in fall of 2013. Soon after, Traverse Health Clinic received $866,667 in funding from the Health Resources and Services Administration to transition to a Health Center Program grantee. The additional funding will enable Traverse Health Clinic to care for increased numbers of people, providing comprehensive primary and preventive medical, dental, and behavioral health care services at its facility located at 3155 Logan Valley Rd. in Traverse City, Michigan.

Western Wayne Family Health Centers (WWFHC) was awarded $145,070 to open its third Health Center site on March 5. Serving Lincoln Park, River Rouge, Ecorse, and the surrounding areas, WWFHC’s new Health Center will serve an additional 5,550 patients by providing much needed access to primary medical, dental, and behavioral health care, as well as pharmacy services. It is located at 25650 W. Outer Dr. in Lincoln Park.

MPCA applauds the hard work of these organizations in finalizing and executing their respective projects in the midst of the most transformative time in health care policy in recent history. We look forward to many years of collaborating with each of the organizations to continue the mission of promoting, supporting, and developing comprehensive, accessible, and affordable community-based health care services for everyone in Michigan.

Family Medical Center of Michigan hosted three Affordable Care Act sign-up events in the first half of March, assisting over 100 people at their event in Lenawee County. Read more

Advantage Health Centers hosted an Obamacare Education and Enrollment Event in Detroit along with Affirmations, MichUHCAN, and Jamison & Green Associates as a part of a larger effort to encourage the LGBT community to enroll. Read more

Hamilton Community Health Network’s Navigators and Certified Application Counselors are educating Genesee County area residents about their options for health care coverage. Read more

Cherry Street Health Services partnered with the Grand Rapids Public Library to host an Affordable Care Act Enrollment Session, where Health Center Certified Application Counselors answered questions and helped people enroll – read more. Cherry Street Health Services is also hosting an event on March 20 at the Flat River Community Library in Greenville to educate, answer questions, and help community members enroll in health insurance. Read more

In the latest release of enrollment numbers, U.S. Health and Human Services (HHS) reported that Michigan had the 8^th highest percent of eligible individuals enrolled in Marketplace plans. This is up from the 10^th highest, as reported for January. Check out MPCA’s blog article explaining these numbers. For information and assistance in getting enrolled in an affordable health care plan, your local Health Center has the resources to help you! You can locate a Health Center near you here.

The new report, which provides enrollment data through March 1, 2014, offers an in-depth look at enrollee demographics, plan selection patterns, and information on Marketplace financial assistance, in addition to Medicaid/CHIP eligibility assessments.

The most recent indicators for the State of Michigan are:

• 144,587 Michigan residents have selected a plan in the Marketplace
  • Michigan’s enrollment total exceeded HHS projections for the state by nearly 16,000 enrollees
  • 28,013 residents have also selected a stand-alone dental plan
• 19.9% of the eligible population in Michigan has enrolled
  • Michigan currently has the 8^th highest percentage of eligible residents enrolled, improving from 10^th highest (15.5%) at the end of January
• Gaps remain between them number of individuals who applied and were eligible to enroll and those who actually selected a plan
  • 313,644 Michigan residents were found eligible to enroll in a Marketplace plan; 187,057 were found eligible to enroll with financial assistance. Since 144,587 actually selected a plan, we still have work to do in assisting and encouraging applicants to complete their enrollment.
• The percentage of young adults (age 18-34) enrolling through the Marketplace in Michigan held steady at 26%
  • Michigan’s young adult enrollment is slightly higher than the average for all states (25%) but lower than we would hope as over one-third of premium tax credit eligible individuals in Michigan fall into this age group
• 87% of Michigan’s enrollees selected a Silver medal level plan or higher
  • This is higher than the average for all states (80%) and a good indicator of positive plan selection decisions
• 87% of Michigan’s enrollees received financial assistance through the Marketplace
  • 80% of those who received financial assistance selected a silver plan, which shows most enrollees are maximizing the potential impact of cost-sharing reductions
• 40,347 Michiganders were assessed eligible for current Medicaid or CHIP coverage
  • This number remains low but will climb dramatically when the Healthy Michigan Plan is implemented

We’ll continue to analyze enrollment trends as the first Marketplace open enrollment period comes to a close and we begin enrolling Michiganders in the Healthy Michigan Plan in the weeks to come.

MARHC was established in 1978 to help meet health care needs of the state’s rural communities by developing a network of rural health care providers and advocate organizations. Within the first two years it became clear that great need existed outside of rural communities, as well. To help meet that need, the Association broadened its work to support initiatives in urban, migrant, homeless, as well rural underserved communities across the state.

Fast forward 34 years, today MPCA is the voice for 39 Health Center organizations, which serve more than 600,000 Michiganders at over 230 health care delivery sites, and other community-based providers.

“Just as the health care system has undergone tremendous transformations over the past 34 years, so has MPCA,” said Kim Sibilsky, MPCA’s CEO. “Our mission of promoting, supporting, and developing comprehensive, accessible, and affordable community-based health care services to everyone in Michigan remains the same, however. It is our vision, and the guiding force in all we do, that every Michigander has convenient, affordable access to quality health care.”

The board and staff at MPCA is honored to continue this mission to help build a healthier Michigan and country by supporting and partnering with Michigan Health Centers, as well as the diverse public, private, and nonprofit organizations with which we collaborate at the local, state, and national levels. Happy birthday, MPCA!

You can learn more about the history of MPCA and Michigan Health Centers at www.mpca.net/history.

Attendees of this year’s Forum participated in over 70 meetings with State Senators and Representatives in their offices. More informal discussions also took place during a legislative luncheon. In addition to increasing awareness of the services that Health Centers provide in communities across the state, board and staff members asked for the Legislators’ support of MPCA’s 2014 policy priorities—enhancing the state’s primary care workforce policies and promoting behavioral health access and integration.

MPCA was honored that Senator John Moolenaar and Representative Matt Lori, chairs of the Community Health Appropriations Subcommittee in their respective chambers; and Senator Jim Marleau and Representative Gail Haines, chairs of the Health Policy Committee in their respective chambers, were able to join the morning general session to share updates on the 2014 state legislative budget and health policy issues and priorities.

We were also honored that Michigan Department of Community Health Director James Haveman joined us to give an update on the work that is being done to implement the Healthy Michigan Plan.

“As we continue to make progress on the Healthy Michigan Plan implementation, it is important that we recognize the important contributions made by the Health Centers in Michigan, as well as the Michigan Primary Care Association,” said Director Haveman. “Thanks to the efforts of our partners across Michigan, nearly half a million Michiganders will have access to health care that will help them take charge of their health, become healthier Michiganders, and in turn, help contribute to the comeback of Michigan. Our work does not stop here, however. Michigan Health Centers and MPCA will be integral to finding, and enrolling eligible residents into the Healthy Michigan Plan in the coming months. We’ve already accomplished so much together, and I look forward to our continued partnership.”

You can watch a recording of Director Haveman’s address below.

During the Fourm, MPCA presented Senator Randy Richardville (R-Monroe) and Representative Mike Shirkey (R-Clark Lake) with the Champion for the Medically Underserved Award for their leadership in ensuring more Michigan residents have insurance coverage through the bi-partisan Healthy Michigan Plan.

“Health Centers were established nearly 50 years ago to ensure access to care for all, regardless of insurance status or income level. The historic passage and implementation of the Healthy Michigan Plan is a monumental step toward achieving that mission, and this award is a token of our appreciation on behalf of thousands of Michigan residents,” said Kim Sibilsky, MPCA’s Chief Executive Officer.

Pictures from the 2014 MPCA Legislative Forum are posted in a photo album on the MPCA Facebook page.

“Thank you for a great day with our legislators. It was very informative and encouraging—encouraging because our legislators recognize and support Health Centers, us. Also, chatting with other Michigan Health Center administrators, providers, and board members makes me feel proud and privileged to be a part of this movement,” said Ted Hilleary, Board Chair, Center for Family Health.

Access to Coverage
In addition to painting a picture of the lack of access to affordable health care coverage, the report reveals that most uninsured adults have been without coverage for 5 years or more. Adults with health insurance tend to have continuous coverage over time, but many have disruptions or changes to their plans, mostly due to changes in employment status employment. The numbers are sizable: 18 million adults lose or gain coverage during the year, and 17 million have changes in their insurance plan.

There has been a monumental effort during open enrollment to educate consumers about their new coverage options under the ACA and assist them in enrolling in plans. These report findings demonstrate that there will be a need for outreach and enrollment assistance that goes beyond helping consumers access care for the first time and provides continuous support to enroll and keep people in coverage, as well.

Choosing a Health Plan
The surveys found that people did not always prioritize the lowest cost when picking a health insurance plan. Thirty-two percent of people surveyed reported choosing a plan because of the benefits that were offered, 29% because the cost would be low, and 22% because of provider networks.

Internet access is an important tool for enrolling in a plan and maintaining coverage under the ACA. While most uninsured adults have access to the Internet, 19% of those qualifying for Medicaid (<138% FPL) and 14% of those eligible for the premium tax credit (139-400% FPL) reported that they did not have Internet access readily available. In addition, a regular monthly premium must be paid to maintain coverage, and 23% of uninsured adults (100-400% FPL) indicated that they did not have checking or savings accounts.

Certified Application Counselors and Navigators play a central role in helping consumers choose a health insurance plan. The task of filtering and explaining options in Healthcare.gov must consider the various priorities that people balance in plan selection and point consumers to resources that provide additional plan information. Consumers also rely on assisters to help them overcome logistical obstacles to access and payment.

Getting Care
Most people without insurance have little connection to the health care system. More than 41% of uninsured adults reported no health care visits in the last year, as compared to 10% of Medicaid beneficiaries and 13% of adults with employer coverage. A substantial number has health needs, many of which are unmet or met with difficulty due to cost.

Outreach may be needed to help those enrolling in plans for the first time to find a regular provider and establish a pattern of regular preventive care. Those who rely on care at an emergency room or urgent care center may need guidance in navigating the primary care system. Health Centers will play a critical role in ensuring access to primary and preventive care for those newly enrolled in coverage through the Marketplace, or the Healthy Michigan plan when it is available beginning in spring 2014. You can read more about the role of Health Centers here.

Data Tables
For a better understanding of uninsured adults and their patterns of coverage, you can link to data tables in the report:

Table A1: Demographics of Adults, by Insurance Coverage

Table A2: History of Uninsurance and Attempts to Gain Coverage Among Currently Uninsured Adults, by Income

Table A4: Reasons for and Problems with Choosing Health Plan, Among Adults who Had and Made a Choice, by Income

Table A6: Knowledge of Coverage Pathways available under the ACA, by Income and Coverage

If you have any questions about this article, please contact Julie Tatko, MPCA Program Coordinator, Outreach, Education & Enrollment.

Sarah Kliff said it best in her post for the Washington Post’s Wonkblog— “counting the number of people who have signed up for Obamacare turns out to be vexingly difficult. After four months of open enrollment, now seems like an excellent time to break down what we do and don’t know about the exact number of people gaining coverage through the Affordable Care Act.”

Kliff’s post refers extensively to the monthly updates on health insurance enrollment published by the U.S. Department of Health and Human Services’ Assistant Secretary for Planning and Evaluation. The reports provide enrollee demographics, intel on plan selection and information on Marketplace financial assistance, in addition to Medicaid/CHIP eligibility assessments.

Building on Wonkblog’s analysis of national enrollment data, I wanted to share some of the most recent indicators for the the State of Michigan infused with a little editorial context.

• 112,013 Michigan residents have selected a plan in the Marketplace.
  • Michigan’s enrollment total exceeded HHS projections for the state by just over 12,000 enrollees. However, we still have a lot of work ahead to reach the 161,000 enrollee target set for the end of March.
• 15.5% of the eligible population in Michigan has enrolled.
  • Michigan has the tenth highest percentage in the country and the second highest amongst states using Healthcare.gov.
• There are still significant gaps between them number of individuals who applied and were eligible to enroll and those who actually selected a plan.
  • 255,055 Michigan residents were found eligible to enroll in a Marketplace plan; 147,654 were found eligible to enroll with financial assistance. Since 112,013 actually selected a plan, there appears to be a need for stronger follow-up on applications to capture those who submitted but haven’t yet enrolled.
• The percentage of young adults (age 18-34) enrolling through the Marketplace in Michigan increased slightly from 25% cumulatively in January to 26% in February.
  • Michigan’s young adult enrollment is slightly higher than the average for all states (24%) but lower than we would hope as over one-third of premium tax credit eligible individuals in Michigan fall into this age group.
• 88% of Michigan’s enrollees selected a Silver medal level plan or higher.
  • This is again higher than the average for all states (81%) and a good indicator of positive plan selection decisions. Consumers appear to be choosing higher value plans over those that are simply cheapest.
• 86% of Michigan’s enrollees received financial assistance through the Marketplace.
  • Nearly 80% of those who received financial assistance selected a silver plan, which shows most enrollees are maximizing the potential impact of cost-sharing reductions.
• 34,032 Michiganders were assessed eligible for current Medicaid or CHIP coverage.
  • Admittedly, this number is very low right now. It will climb dramatically when the Healthy Michigan Plan is implemented later this spring.

With only 41 days left in the Marketplace open enrollment period, we won’t have to wait long to see how the amazing outreach and education efforts  in communities across the state impact coverage enrollment. We’ll be sure to continue to dig into the enrollment data to better understand our collective impact in the months to come.

Pictured here us a snapshot from a past Traverse Health Clinic Matinee Dental Day, which featured a showing of the movie “Tooth Fairy” and a local firefighter who dressed as the Rock.

It’s National Children’s Dental Health Month (#NCDHM) and Traverse Health Clinic is celebrating in a fun way. On February 22, 2014, the Michigan Health Center serving Grand Traverse, Benzie, and Leelanau counties is hosting Matinee Dental Day at the State Theatre in Traverse City. Dental assistants from Northwestern Michigan College will perform a dental-themed skit to teach kids about the importance of dental health, to be followed by a showing of “Rise of the Guardians” and the distribution of free dental care kits. Kids get all this for the admission price of just 25 cents, the same price the State Theatre charged when it opened in 1916 and which Rene Louchart, RDH, dental health coordinator at Traverse Health Clinic says some children pay in pennies.

“We have hosted Matinee Dental Days for several years, both in February for National Children’s Dental Health Month and in October for National Dental Hygiene Month,” said Louchart. “It’s always a fun time, and great way to teach children and parents how to prevent cavities, maintain healthy gums, and build good dental habits to last a lifetime.”

The annual observance of children’s dental health began as a one-day event in 1941, and the American Dental Association (ADA) held the first national observance of Children’s Dental Health Day in 1949. The ADA extended the one-day event to a week-long celebration in 1955, and then to a month of awareness events known as today’s National Children’s Dental Health Month.

Statistics show that increasing awareness of healthy habits—including visiting a dentist by the age of 1—continues to be critical. According to the Children’s Dental Health Project, 44% of U.S. children will have at least one cavity by kindergarten, and kids with cavities in baby teeth are three times more likely to develop cavities in their adult teeth. What’s more, millions of kids are eligible for dental coverage through Medicaid or the Children’s Health Insurance Program (CHIP) but are not enrolled. Events like Traverse Health Clinic’s Matinee Dental Days are helping to increase awareness and connect kids to care and coverage.

Individuals and families that don’t have a regular dentist can find a Michigan Health Center near them by using the Find a Health Center look-up at www.mpca.net. Michigan Health Centers provide comprehensive, quality, affordable primary and preventive care regardless of insurance status and fees are based on household income, and they are located in 230 different sites across the state.

On February 5, Governor Rick Snyder presented to a joint session of the House and Senate Appropriations Committees his proposed budget for Fiscal Year 2015, which begins October 1, 2014. The major themes of his budget focus on significant increases to higher education (6.1% increase), K-12 education (3% increase), local government (15% increase), and Early Childhood Education ($65 million).

Of political interest is a proposal to provide some tax relief in the way of higher Homestead Property Tax credits.  This is in contrast to some of the proposals already put forward by both the House and Senate to lower the income tax (see “Senate, House Deliberating Income Tax Cut Proposals” in the January 31, 2014, issue of the MPCA eUpdate).

Of particular interest to Michigan Health Centers are proposals to expand the Healthy Kids Dental program to Kalamazoo and Macomb counties ($15.7 million), increase funding for nurse home visitation in Northern Lower Michigan and the Upper Peninsula ($2.5 million), and to begin funding the implementation of recommendations for strengthening the state’s mental health system as outline in the Mental Health and Wellness Commission’s report released last month ($15.6 million). (See “Michigan’s Mental Health & Wellness Commission Releases Recommendations in Comprehensive Report” in the January 24, 2014, issue of the MPCA eUpdate for a summary of “Improving the Quality of Life by Supporting Independence and Self-Determination.”)

Lest we forget last year’s battles so soon, Governor Snyder’s FY 2015 budget proposal includes funding to continue implementation of the Healthy Michigan Plan (Michigan’s expanded Medicaid program). The Governor actually projects a $243.4 million SAVINGS to the state in FY 2015 because many services currently covered entirely by state funds will now be covered partially by the federal government as a result of Medicaid expansion. We need to continue to recognize and celebrate this important achievement!

Lastly, one area of concern in the Governor’s proposed budget is that it does not call for the continuation of $1.4 million in Graduate Medical Education funding that was allocated for spending in the current fiscal year (FY 2014).

Budget hearings will now begin in both the Michigan House and Senate, with a target date of June 1, 2014, for finalization. MPCA will continue to follow these budgets and keep you updated.