Legislative Analysis
Phone: (517) 373-8080
REPEAL HEALTHY MICHIGAN PLAN
http://www.house.mi.gov/hfa
WORK REQUIREMENTS
Analysis available at
House Bill 4224 as reported from committee http://www.legislature.mi.gov
Sponsor: Rep. Julie M. Rogers
Committee: Health Policy
Complete to 4-11-23
SUMMARY:
House Bill 4224 would repeal sections 107a and 107b of the Social Welfare Act, which were
added by 2018 PA 208. Under a waiver granted by the Centers for Medicare and Medicaid
Services (CMS), the 2018 legislation created workforce engagement requirements for
beneficiaries enrolled in the Healthy Michigan Plan (HMP), Michigan’s Medicaid expansion
program, and established reporting and verification criteria for those required to prove their
compliance with those workforce engagement requirements.
Under the legislation, most of the MHP Medicaid beneficiaries who were 19 to 62 years of age
were required to work 80 hours a month or engage in such activities as job training, unpaid
internships, participation in substance use disorder treatment, or community service.
Noncompliance with the workforce engagement requirements could result in the loss of health
care coverage for at least one month and prohibit a beneficiary from reenrolling until they
became compliant. Some exemptions from the work requirements were provided.
However, on March 4, 2020, the U.S. District Court for the District of Columbia issued an
order that vacated CMS’s approval of the waiver that provided the basis for the state to establish
work requirements under the HMP. Without the waiver, the requirements of sections 107a and
107b could not be implemented.
MCL 400.107a and 400.107b (repealed)
BRIEF DISCUSSION:
Shortly before the U.S. District Court for the District of Columbia issued its order in 2020 that
prevented the implementation of Michigan’s law to require work requirements for beneficiaries
of the Healthy Michigan Plan, the U.S. Court of Appeals for the District of Columbia Circuit
had affirmed the district court’s decision to vacate a similar Medicaid waiver issued to
Arkansas. 1 In 2021, the current administration determined that such work requirements for
Medicaid eligibility do not align with the goals of the Medicaid program. In April 2022, the
U.S. Supreme Court effectively dismissed the case by granting a motion by the secretary of the
U.S. Department of Health and Human Services (HHS) to vacate the judgment of the federal
appellate court and remand the case, along with other related cases, to the appellate court. The
1
Gresham v Azar, 950 F3d 93 (DC, 2020). https://scholar.google.com/scholar_case?case=5251918899457822307
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 appellate court was instructed to direct the district court to vacate its judgment, dismiss the
case as moot, and remand the issue to the secretary of HHS. 2
Considering the history and resolution of the litigation, it is unlikely that the CMS would be
required to authorize waivers in the future for states to establish work requirements for
beneficiaries of expanded Medicaid programs. For instance, the appellate ruling in Gresham
noted that Congress did not include a Medicaid work requirement when similar requirements
were added to the TANF and SNAP programs and that the district court had ruled that approval
of the Arkansas Works Amendments was “arbitrary and capricious” and failed to address
whether and how the Arkansas project would “implicate the ‘core’ objective of Medicaid: the
provision of medical coverage to the needy.”
Such hurdles may not be able to be overcome, leading many to believe that House Bill 4224
should be enacted to remove the two sections of law prescribing a work requirement for many
beneficiaries of the Healthy Michigan Plan. To leave sections 107a and 107b on the books
could cause confusion for beneficiaries, advocates, and caseworkers, they argue, as well as
create an undue burden for the Michigan Department of Health and Human Services, which
would have to remain ready to implement the work requirements should a future administration
reestablish a waiver authority for CMS that passes review by the courts. In addition, recent
federal legislation requires each state to restart Medicaid eligibility renewals. This means that
all Michigan residents who participate in regular Medicaid or the HMP must, beginning in June
2023, complete paperwork as part of a redetermination effort to see who still meets eligibility
criteria. Supporters of the bill maintain that the Michigan Department of Health and Human
Services workforce and resources must be prioritized to complete this task and to fill other
mandated services, not be used to stand at the ready to implement a requirement vacated by the
Supreme Court that may never see the light of day again.
Those opposed to the bill argue that work requirements as a condition of receiving health
benefits can be a strong incentive for able-bodied adults to seek employment or training for a
job or career, and that leaving the requirements in statute would enable the state to implement
them should the needed CMS waivers once again be issued and upheld by the courts.
FISCAL IMPACT:
The bill would have no fiscal impact. Due to court order, Medicaid work requirements were
never implemented.
POSITIONS:
Representatives of the following entities testified in support of the bill (3-16-23):
• Michigan League for Public Policy
• Michigan Health & Hospital Association
The following entities indicated support for the bill:
• Michigan Department of Health and Human Services (3-23-23)
• Community Health Alliance of Michigan (3-23-23)
2
https://www.supremecourt.gov/docket/docketfiles/html/public/20-37.html
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 • APTA-MI (3-23-23)
• Michigan Nurses Association (3-23-23)
• AARP Michigan (3-23-23)
• Michigan State Medical Society (3-16-23)
• Kalamazoo Community Foundation (3-16-23)
• National Multiple Sclerosis Society (3-23-23)
The Mackinac Center for Public Policy indicated opposition to the bill. (3-16-23)
Legislative Analyst: Susan Stutzky
Fiscal Analyst: Kent Dell
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their
deliberations and does not constitute an official statement of legislative intent.
House Fiscal Agency HB 4424 as reported Page 3 of 3


Statutes affected:
House Introduced Bill: 400.107
As Passed by the House: 400.107
As Passed by the Senate: 400.107
House Concurred Bill: 400.107