Health and Disability

Michigan, in agreeing to accept federal funding to expand Medicaid coverage, tailored the state plan to include personal accountability measures. Those provisions helped win over some Republicans who were otherwise opposed to the Affordable Care Act but required approval from the Centers for Medicare and Medicaid Services.

"We're a leader when it comes to states. It was a very innovative model," Nick Lyon, director of the Michigan Department of Health and Human Services, said Wednesday before the waiver approval, which his team had been working on with CMS. "And anything we can do to build a more preventive mindset really goes a long way towards saving costs in the future."

Healthy Michigan, as originally designed by state lawmakers, included a soft coverage cap. After 48 months, recipients would have to pay higher out-of-pocket costs or purchase private insurance through an Affordable Care Act exchange.

The waiver approval appears to allow for a modified model. All recipients who earn between 100 and 133 percent of the poverty level will have a coverage choice beginning in April 2018, which is four years after Healthy Michigan began.

To qualify for Healthy Michigan, they'll have to meet healthy behavior requirements. If they enroll in the federal marketplace option, they will pay premiums but would still have the opportunity to enroll in Healthy Michigan if they later meet behavior requirements.