Michigan and Indiana are among the seven states using a Section 1115 demonstration waiver to implement Medicaid expansions in ways that differ from the terms of the Affordable Care Act (ACA). While each waiver is unique, Michigan and Indiana’s waivers include some similar provisions. Some of these features are not found in other waivers approved to date, although additional states have expressed interest in pursuing similar models.
This issue brief explains some of the key components in Michigan and Indiana’s waivers and presents insights based on their early implementation experiences. The findings are based on 22 in-person and telephone interviews conducted in July and August, 2016 with state officials, providers, health plans, beneficiary advocates, and enrollment assistors in Michigan and Indiana, and incorporate data and reports from the state Medicaid agencies and other publicly available sources. We also conducted four focus groups (two in each state) with beneficiaries enrolled in waiver coverage to learn about their firsthand experiences.
Insights gained through the research include:
- Medicaid expansion design, whether through traditional state plan authority or waivers, is highly dependent on the features of a state’s underlying Medicaid program.
- Implementation of complex programs involves collaboration with a variety of stakeholders, sophisticated IT systems, and administrative costs.
- Premium costs and complex enrollment policies can deter eligible people from enrolling in coverage.
- Health accounts can be confusing for beneficiaries.
- Beneficiary and provider education and tangible incentives appear central to implementing healthy behavior incentive programs.