The Healthy Michigan Plan sits beside your group plan, not in place of it
The Healthy Michigan Plan is Michigan’s Medicaid coverage for low-income adults. This page covers who it reaches, what the federal text says about people who also have employer coverage, and what we could not confirm.
The Eligibility Conditions.
MDHHS, which administers the program, lists these conditions on its program page: age 19 to 64; income at or below 133 percent of the federal poverty level, figured with the modified adjusted gross income method; not eligible for or enrolled in Medicare or other Medicaid programs; not pregnant at application; and Michigan residency. People apply through MI Bridges, by calling the Michigan Health Care Helpline at 1-855-789-5610, or at a county MDHHS office. Michigan’s eligibility policy item for the program, Bridges Eligibility Manual item 137, adds that there is no asset test.
Notice what is missing. Neither the MDHHS page nor item 137 mentions employer coverage. The federal text for this group, section 1902(a)(10)(A)(i)(VIII) of the Social Security Act and 42 CFR 435.119, lists age, pregnancy, Medicare, other mandatory Medicaid groups and income. As we read it, access to an employer plan is not among the conditions. That is our reading of the text, not an MDHHS statement, and we could not find MDHHS guidance on the point.
How It Plays Out With Your Plan.
Take an employee who is offered your plan and also meets the program’s conditions. If the employee enrolls in both, your plan is a third party that may owe for care. Under 42 U.S.C. 1396a(a)(25) the state must take reasonable steps to find such coverage and, when a third party is liable, seek reimbursement. Your plan’s side of that is simple to state: it pays under its own terms. ERISA section 609(b), 29 U.S.C. 1169(b), says the plan must disregard the person’s Medicaid eligibility in enrolling the person and in paying benefits.
Now take the employee who declines your plan and relies on Medicaid. Nothing we found makes that the employer’s problem. Federal law does let a state pay premiums for employer coverage in some cases, under sections 1906 and 1906A of the Social Security Act. Whether Michigan does so is covered, with what we could not confirm, on our MIChild and premium payment page.
Why It Matters for Plan Design.
Contribution strategy is where this surfaces. If your required employee contribution leads lower-paid workers to decline coverage, some of them may qualify for the Healthy Michigan Plan, and your enrollment mix can shift without any change to your plan. We can model your participation by contribution tier. What we do not do is tell you which employees qualify, because MDHHS decides eligibility.
Whether your offer is affordable for federal employer-mandate purposes is a separate question, covered on our ACA page. Employees also ask HR about this program. A short, accurate answer helps: MDHHS decides, applications go through MI Bridges, and HR does not need to assess anyone’s income.
What To Do Now.
Give HR a one-line script for Medicaid questions that points to MI Bridges and the Michigan Health Care Helpline and stops there.
Check that your enrollment forms and plan document do not make Medicaid status a condition of enrolling or of receiving benefits.
Ask your carrier or administrator how it responds when the Michigan Medicaid agency asks for coverage information. Our third-party liability page explains why that request can arrive.
Common Misreadings.
Telling an employee that employer coverage does or does not disqualify them. The sources we read do not say, so refer the employee to MDHHS.
Confusing this program with MIChild, which is Michigan’s CHIP program for children, or with Marketplace subsidies, which follow their own rules.
Overlooking the parent rule. Under 42 CFR 435.119(c) a state may not cover a parent or caretaker living with a dependent child unless the child receives Medicaid or CHIP or is enrolled in minimum essential coverage. We did not verify which plan designs count as minimum essential coverage.
Missing the 2027 change. MDHHS says a work requirement begins January 1, 2027. See our work requirements page.
Related Rules And Tools.
Affordable Care Act for Employers
The employer mandate, affordability and reporting rules.
Participant Contribution Timing for Group Health Plans
When employee contributions must reach the plan.
HIPAA Special Enrollment and the Newborns Act
Special enrollment events and the notices that go with them.
Laws And Sources
MDHHS, Healthy Michigan Plan: Conditions, how to apply and the work requirement start date.
Bridges Eligibility Manual 137: Michigan’s eligibility policy item for the Healthy Michigan Plan.
42 U.S.C. 1396a: Section 1902, including the adult group in paragraph (a)(10)(A)(i)(VIII) and third-party liability in (a)(25).
42 CFR 435.119: The federal adult group rule.
29 U.S.C. 1169: ERISA section 609(b), state Medicaid rights.
Quick Answers.
Short replies on this page’s topic, each tied to a fuller guide.
Can an employee be on our group plan and the Healthy Michigan Plan at the same time?
Possibly, but we could not confirm how MDHHS treats it. The federal text for the program does not list employer coverage as a condition, and the MDHHS pages we read do not address it. If both apply, the group plan is a third party that may owe for care before Medicaid. Send the employee to MDHHS for an answer on a specific case.
Does the Healthy Michigan Plan change how we design our group plan?
No requirement in the sources we read does. Your plan must disregard Medicaid eligibility when enrolling someone or paying benefits under ERISA section 609(b), but plan design is otherwise yours. Contribution levels can affect who enrolls, so they are worth modeling.
Where do employees apply for the Healthy Michigan Plan?
MDHHS lists three routes: online through MI Bridges, by phone at the Michigan Health Care Helpline, 1-855-789-5610, or at a local MDHHS county office. HR does not decide eligibility.
The Rest Of This Series.
Michigan Medicaid and Employer Group Health Coverage
The overview page for this series.
MIChild and Premium Payment for Employer Plans
Michigan’s CHIP state plan and premium payment, with what we could not confirm.
Third-Party Liability and Medical Child Support
Plan and employer duties when a state agency or support order reaches your plan.
Work Requirements in 2027
The Healthy Michigan Plan work rule and what it may mean for HR.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →
Cookies on This Site
We use cookies to keep the site working properly and to understand how it is used. You can decline anything that is not essential. See our Privacy Policy for the detail.
- Essential — needed for the site to load and for you to move around it. These cannot be switched off.
- Analytics — tell us which pages get read, so we know what is worth writing more of.
- Advertising — set by third parties such as ad and social platforms to measure and target campaigns.