Michigan sets Medicaid work rules, with a carve-out for family caregivers

Michigan is preparing to impose Medicaid work requirements on the roughly 678,000 residents enrolled in its Healthy Michigan Plan expansion, effective January 1, 2027, with eligibility checks moving from once to twice a year. Affected adults aged 19-64 must show 80 hours a month of qualifying activities such as employment or community service, or earn at least $580 in a month during the review period. Family caregivers are among those exempt: the state lists parents, guardians, caretaker relatives, or family caregivers of a dependent child 13 and under or a disabled individual. How other exemptions will work remains unsettled. A CMS interim final rule narrowed the 'medically frail' exclusion Congress wrote into H.R. 1, defining 'stable recovery' as five or more years and demanding recurring documentation — a standard the Legal Action Center's Deborah Steinberg argues will create a paperwork burden that cuts off coverage for the nearly 30% of expansion enrollees with a substance use disorder or mental health condition.