Updates About Health Insurance

After a lengthy session day that took place over the course of 30 hours, the Michigan legislature passed a budget for the 2026-2027 (FY 27) Fiscal Year on July 3. Following the passage, significant questions have emerged about the overall spending total of the budget. On paper, the FY 27 budget totals $75.2 billion. However, the budget authorizes $86.4 billion in spending after federal Medicaid taxes and federal K-12 appropriations were shifted into boilerplate and not included in the topline.

The budget reduces Medicaid appropriations by approximately $479.2 million, ($185 million GF/GP), mostly coming from pharmaceutical program restructuring. About $87 million in savings was assumed by using restricted funds, instead of general fund dollars for certain programs.

Much of the 30 hour marathon session was spent voting on legislation unrelated to the budget, likely part of negotiations with fellow lawmakers ahead of campaign season. Before concluding with the budget bills, the Legislature first passed 66 policy bills that were largely uncontroversial. Highlights include establishing a two-year lobbying ban for certain former elected officials and department heads (HB 4062, 4063 and HB 4064), a bill prohibiting large corporate entities who already own 100+ Michigan homes from purchasing more (HB 6074), and legislation requiring Michigan Medicaid to cover evidence-based group prenatal care services (SB 415).

A full list of the legislation passed alongside the FY 27 budget can be viewed here.

Michigan Attorney General Dana Nessel recently joined a coalition of 24 attorneys general and two governors in filing a lawsuit that challenges the Trump administration’s implementation of the new Medicaid work requirements under H.R.1 (also known as the One Big Beautiful Bill Act or OBBBA).

The lawsuit targets an interim final rule issued by the U.S. Department of Health and Human Services (DHHS) and Centers for Medicare and Medicaid Services (CMS). The coalition argues the new interpretation of the rule would unlawfully narrow expectations for individuals who are considered “medically frail.” The coalition also claims that the interpretation, on top of new administrative burdens, will make it difficult for eligible Medicaid recipients to qualify for exemptions and would cause many to lose coverage.

They also allege that the rule fails to adequately consider the impact on states and the healthcare sector while imposing new compliance requirements after states had already begun implementing H.R. 1. The coalition is seeking to block enforcement of the challenged provisions before the work requirements take effect on January 1, 2027.

The Michigan Senate has passed a package of bills that would create a state-based healthcare exchange in Michigan. Similar legislation was also passed by the Senate last session. If passed, Michigan would move away from the federal healthcare exchange to a newly created exchange run by the state by January 2028.

SB 973 would create the Michigan Health Insurance Exchange and outlines the creation of a 12-member governing board, which would create and oversee a non-profit corporation that provides the health plan marketplace. It also outlines governance, oversight, funding, reporting, and enrollment requirements for the exchange, while requiring the Department of Insurance and Financial Services (DIFS) to certify the qualified health plans according to State and Federal law and the provisions of the legislation.

SB 974updates insurance code definitions to align with the state-based health insurance exchange created under SB 973.

SB 975 requires DIFS to contract with the state-based exchange to certify qualified health and dental plans.

SB 976 would require insurers to provide enrollment information required by the state-based exchange.

SB 977 requires DIFS to apply for a federal waiver to create a state-based reinsurance program and report funding needs to the Legislature’s appropriations committees.

SB 978 repeals a law requiring certain health insurance plans to cover specific emergency and early prescription refills.

Each bill passed along party lines (20-16). The bills need to be passed by the Republican controlled House and signed into law by the Governor before the current session ends in December or would need to be reintroduced again next session.