Updates About Public Health

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.

Governor Gretchen Whitmer announced last week that the state’s Director of Health and Human Services (MDHHS), Elizabeth Hertel, will be stepping down at the end of June.

Elizabeth Hertel has served as the top MDHHS official since 2021. She oversaw the department’s transition out of the COVID-19 pandemic as well as the development of two state psychiatric hospitals, expansion of substance use disorder programs, and the state’s response to recent federal Medicaid and SNAP changes. One of her major priorities has been restructuring Michigan’s behavioral health system, including efforts to rebid the state’s prepaid inpatient health plans, though implementation of those changes has been delayed following court rulings.

Her successor, Amy Epkey, will begin the role on July 1. Epkey is currently the senior deputy director of the financial operation administration within MDHHS. Hertel said that she plans on relaxing post-budget and spending time with family during the summer months before figuring out what comes next in her career.

The House Oversight Committee heard testimony on Michigan’s Rx Kids program, which provides direct cash assistance to pregnant women and new mothers in participating eligible Michigan communities.

Under the program, participants receive a one-time prenatal payment of $1,500 and monthly payments of $500 for the first six or more months following the birth of a child. The program receives funding through Temporary Assistance for Needy Families (TANF) dollars, the Healthy Michigan Fund, and private philanthropic contributions.

Throughout her testimony, Rx Kids Director Dr. Mona Hanna outlined the program’s identity verification, residency and pregnancy documentation requirements, fraud detection measures, and birth certificate verification that occur before funds are issued. She also testified that roughly 85% of the program’s funding goes directly to the participants, and the remaining 15% is used for operating and administrative costs. Dr. Hanna cited research that shows the program has led to improvements in prenatal care utilization, reductions in premature births, low-birth-weight births, and neonatal intensive care admissions among participants.

Republican members of the committee raised questions around the sustainability, oversight, and funding of the program as well as the long-term goals and eligibility requirements. Another point of concern House Republicans addressed was the lack of safeguards to ensure funds are strictly used for child and family-related expenses.

Hanna responded that the program is designed as an unrestricted cash assistance model and does not monitor individual purchases, instead placing the trust in the recipient. She also stated that taxpayer funds are not used to provide benefits to undocumented immigrants, but that private philanthropic dollars may be allocated for these families.

Discussions surrounding the program and its funding are expected to continue.