Michigan Healthy Kids

The Children’s Health Insurance Program in Michigan is available to residents under the age of 19 whose family income is over the limit for Medicaid eligibility. Administered by the Department of Community Health, MIChild is for children without any insurance coverage. Pregnant women under the age of 19 are also eligible for MIChild benefits if their income is above the criteria for Medicaid. To apply, the child must have a Social Security Number, or have applied for one, and be a U.S. citizen or a qualified immigrant, resident alien, or national.

If you meet the income requirements for MIChild and are accepted for a health plan, you must pay a $10 monthly premium. The $10 premium charge will cover every child in a family, regardless of how many children are enrolled. Coverage through MIChild is comprehensive, therefore if a child has any other insurance they will not be approved. As with Medicaid, MIChild covers the gamut of health services, including physician’s visits for illness or injury, preventative care, hospital treatment, ambulatory surgery and care, lab work, and more individualized services, as well.

 

Eligibility and Income Guidelines

In order to qualify for the MIChild program in Michigan, a child must meet the age, insurance, and residency requirements mentioned above, and also have income at a certain level above the state’s allowance for entry into Healthy Kids Medicaid. Healthy Kids accepts children under 19 with a household income up to 150 percent of the Federal Poverty Level.

For MIChild, applicants between ages 1 and 18 must have an income above 150 and less than or equal to 200 percent of the Federal Poverty Level (FPL), in relation to their family size. For those applying for infants under age 1, the family income must exceed 185 percent and fall at or below 200 percent of the FPL. Below are the current guidelines according to the 2012 FPL.

 

Family Size (Children 1 – 18)                         Annual Family Income

1                                                                                        $16,756

2                                                                                        $22,696

3                                                                                        $28,636

4                                                                                        $34,576

5                                                                                        $40,516

6                                                                                        $46,456

7                                                                                        $52,396

8                                                                                        $58,336

 

Family Size (Children Under 1)                  Annual Family Income

1                                                                                        $20,665

2                                                                                        $27,991

3                                                                                        $35,317

4                                                                                        $42,643

5                                                                                        $49,969

6                                                                                        $57,295

7                                                                                        $64,621

8                                                                                        $71,947

 

Children who qualify cannot have any other form of comprehensive group or individual health insurance, though they may have certain types of stand-alone policies. Such supplemental plans can include catastrophic, dental, or vision only coverage, as they only cover one aspect of medical care. The child who is applying for benefits cannot have had any insurance through a parent’s employer for at least six months prior to enrollment. However, if the group insurance plan ended on the account of being laid off or any other involuntary loss of employment, the six month rule will be waived.

 

Benefits and Providers

Multiple health insurance carriers in Michigan offer MIChild health plans, under which specific benefits and health care providers will vary. As the programs are still regulated by the state, most plans will offer the same types of health services. Coventry Cares of Michigan, Blue Cross Blue Shield of Michigan, Molina Healthcare of Michigan, HealthPlus of Michigan, Priority Health, and Midwest Health Plan are some of the health plans available. Delta Dental provides the majority of dental coverage for MIChild members, though some medical plans also include dental care. Medical coverage under MIChild usually includes the following hospital and physician services.

Physician Care

  • Office visits
  • Physical exams
  • Inpatient doctors visits and services
  • Vaccinations
  • Professional services
  • Certified Nurse Midwife Services

Hospital Care: Inpatient and Outpatient

  • Semi-private room and board
  • Regular nursing care
  • Laboratory, radiology, pathology, and anesthesia services
  • Labor and delivery
  • Newborn nursery care
  • Special care, such as operating room, intensive care, and coronary care
  • Transplant services
  • Short term restorative and rehabilitative nursing care

Professional Care

  • Emergency and Urgent Care visits (in and out of area)
  • Emergency Medical Transportation
  • Ambulance services
  • Non-urgent transportation
  • Home health care
  • Podiatry and chiropractic care
  • Maternity services (including pre and post-natal care)
  • Birthing and parenting classes
  • Well-baby care
  • Family planning
  • Breast cancer screening
  • Prescription medications
  • Hospice services
  • Vision and hearing exams and supplies (includes hearing aids)
  • Blood lead screening and follow-up
  • Certified pediatric nurse practitioner care
  • STD treatment
  • Medically necessary weight loss services
  • End Stage Renal Disease (ESRD) treatment
  • Medical supplies
  • Durable medical equipment
  • Orthotics and prosthetics
  • Health education and wellness services
  • Physical and speech therapies
  • Outpatient mental health care (20 visit limit)

Dental Care

  • Cleanings
  • Examinations
  • Bitewing X-rays
  • Fluoride treatments
  • Sealants
  • Fillings
  • Space maintainers
  • Extractions
  • Stainless steel crowns
  • Emergency care to resolve pain

 

MIChild Costs

Each health plan operates differently, but in order to receive care you must pay a $10 monthly premium, and seek care through a  provider who participates in MIChild and your health plan’s network. There are no copayments or deductibles through the MIChild program. Services that are not covered will require the family to pay out-of-pocket, though there is a $600 maximum for all families per year.

 

Resources

Michigan Department of Community Health: MIChild

Apply for MIChild benefits

MDCH Contact:

Capitol View Building

201 Townsend St

Lansing, MI 48913

MDCH: 517-373-3740

TTY: 800-649-3777