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HB 5814

Human services: medical services; retroactive coverage for medical assistance under the medical assistance program; modify. Amends 1939 PA 280 (MCL 400.1 - 400.119b) by adding sec. 106c.

2025-2026 Regular Session Introduced by Joe Aragona and 5 co-sponsors

Michigan would provide limited retroactive Medicaid coverage from 1–2 months before application, depending on eligibility category, starting Jan 1, 2027.

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Bill Summary · HB 5814

Summary of HB 5814 (2025-2026) — Michigan

Overview

  • Bill: HB 5814
  • Session: 2025-2026
  • Jurisdiction: Michigan
  • Topic: Human services; medical services; retroactive coverage for medical assistance under the medical assistance program
  • Amends: 1939 PA 280 (The Social Welfare Act), by adding new Sec. 106c
  • Primary aim: Establish limited retroactive coverage for medical assistance (Medicaid) in Michigan, aligned with federal law and defining eligibility groups affected.

Key Provisions

  1. Retroactive Medicaid Coverage Window Starts

    • Beginning January 1, 2027, the Michigan Department of Health and Human Services (the department) must make medical assistance available to an eligible individual up to one month before the month in which the individual applied (or had an application submitted on their behalf).
    • This retroactive coverage is contingent on the applicant meeting eligibility criteria and applying for medical assistance.

  2. Limitations on Retroactive Eligibility (Subsection 2)

    • Retroactive eligibility is not unlimited; it is capped based on the applicant’s eligibility category:
      • Medicaid Expansion Population: Retroactive coverage may extend up to 1 month before the month of complete application submission.
      • Non-Expansion Medicaid Population: Retroactive coverage may extend up to 2 months before the month of complete application submission.

  3. Definitions (Subsection 3)

    • “Medicaid expansion population” is defined as individuals who:
      • Are eligible for medical assistance under 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) (the ACA Medicaid expansion category),
      • Meet citizenship requirements under 42 C.F.R. 435.406,
      • Are eligible for medical assistance in Michigan.

Effective Date and Timeline

  • Effective starting January 1, 2027, retroactive Medicaid coverage is required to be provided within the limits stated above.
  • The bill specifies a phased implementation date, providing time for the department to administer the changes.

Who Is Affected

  • Medicaid beneficiaries and applicants in Michigan:
    • Those in the Medicaid expansion population (as defined) and those in the non-expansion population who apply for medical assistance.
  • Department of Health and Human Services (DHHS):
    • Responsible for implementing retroactive coverage and ensuring compliance with the federal framework (42 U.S.C. 1396a(a)(34)).

Practical Impact

  • Increased retroactive coverage window: For many applicants, coverage can retroactively apply to medical expenses incurred up to 1–2 months prior to application submission, depending on category.
  • Financial relief for applicants: Eligible individuals may receive medical coverage for prior periods, potentially reducing liability for outstanding medical bills incurred before a complete application was submitted.
  • Administrative alignment with federal standards: The approach references 42 U.S.C. 1396a(a)(34), ensuring consistency with federal provisions on retroactive eligibility decisions.

Procedural Details

  • The bill is introduced and referred to the Committee on Insurance.
  • It includes multiple co-sponsors, indicating legislative support from several members.

If you’d like, I can compare this bill’s retroactive window to current Michigan policy or to federal standards, or provide a brief pros/cons analysis of the potential impact on applicants and the department.

Compiled from official sources — confirm details with the bill’s official record.

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