Michigan to Partner with Federal Government to Create Health Exchange

In the three months following the Supreme Court’s decision upholding the constitutionality of the Affordable Care Act (ACA), states have been evaluating their options under the provisions of the Act.  One option involves the establishment of a health insurance exchange.  Health insurance exchanges are intended to be the vehicle through which millions of Americans will obtain health insurance as mandated by the ACA.  Under the ACA, each state may elect to establish an exchange to facilitate the purchase of health insurance coverage.  However, states are not required to do so.  If a state elects not to create its own exchange, a federally-facilitated exchange will be formed by the Department of Health and Human Services (HHS).  Federally-facilitated exchanges can be established directly by HHS or through a partnership with a non-profit entity.

To date, the states have been divided on what to do about the health exchanges.  Currently, sixteen states have announced that they will create their own, state-based exchanges.  Conversely, seven states have announced that they will take no action and let HHS directly establish a federal-facilitated exchange.  Four states have announced that they will create a partnership with HHS under the framework of a federally-facilitated exchange.   Twenty-three states remain undecided.

Michigan is one of the four states that intends to create a partnership with HHS for the establishment of a health exchange.  Because of the partnership, Michigan’s exchange will not be completely controlled by the federal government.  However, the federal government has not released many of the operational details of the federal exchange or the partnership option.  Here is what we know so far.

The operation of a health exchange will be broken down into twelve categories.  These categories are: 1) legal authority/regulation; 2) plan management; 3) eligibility and enrollment; 4) customer service; 5) finance and accounting; 6) oversight and monitoring; 7) SHOP; 8) risk adjustment and reinsurance; 9) human resources and organization; 10) technology; 11) privacy and security; and 12) contracting, outsourcing and agreements.  Under the partnership exchange model, Michigan will have limited responsibilities.  These responsibilities include plan management, the in-person component of customer service and a narrow role in eligibility and enrollment.  The scope and breadth of these responsibilities remain to be defined.

Because a federal partnership is still a federal exchange, HHS would ultimately sign off on all decisions, except those related to the few areas of authority retained by the states.  We do know that Michigan will be required to make changes to its business processes and IT systems.  The federal government will direct many of these changes, and Michigan may be financially obligated to support these changes.  Federal grant resources with no state match can still be used for the establishment of a federal partnership exchange.  Michigan officials are scheduled to meet with HHS officials next week to discuss in detail how the health exchange will be established and operated in Michigan.

At the state level, Michigan plans to create an entity called the MIHealth Marketplace (MIHM) to handle its responsibilities of the partnership.  Governor Snyder’s vision for MIHM is for it to be a non-profit corporation controlled by a board of directors.  The board of directors will likely consist of seven voting members, with the OFIR Commissioner to serve as an additional non-voting member.  Because of the exchange’s impact on Medicaid, Governor Snyder is also considering adding the Medicaid Director as a non-voting member.  An executive director will run the day-to-day operations of MIHM.  Governor Snyder’s plan also includes a large advisory board of various stakeholders including businesses, consumers, providers and other interested individuals to participate in MIHM decision-making.

Currently, Michigan has yet to enact legal authority for MIHM.  On September 30, 2012, Michigan must choose its Essential Health Benefit (EHB) package and submit it to HHS.  The EHB will determine plan benefits in both off and on exchange plans for individual and small group markets.  This decision will apply for 2014-15.  Despite Michigan’s election to form a partnership exchange with HHS, Michigan can still establish a state-based exchange to take over operations in 2015.  According to Steven Hilfinger, Chief Regulatory Officer, Director of the Michigan Department of Licensing and Regulatory Affairs, Michigan has focused on partnering with the federal government because of the deadlines involved in the exchange process.

The upcoming timeline of critical steps in the health care exchange process are as follows.  On November 16, 2012, Michigan must submit a letter from Governor Snyder that includes Michigan’s “blueprint” to the  federal government for exchange certification.  On January 1, 2013, the federal government must certify each state regarding its readiness to have an exchange operational by the “go live” deadline.  The “go live” deadline is October 1, 2013.  At this point, open enrollment begins.  On January 1, 2014, benefits of exchange plans begin, and on January 1, 2015, exchanges must be financially self-sustaining.

© 2012 Michael P. James, J.D., M.B.A., CSSGB

To find out more about the Michigan health exchange and the impact the Affordable Care Act has on health care, contact attorney Michael James at mjames@michaeljameslaw.com, 810-936-4040 or www.michaeljameslaw.com.  Michael James provides representation and counseling related to all facets of business enterprise and healthcare matters.

What Does it Take to be a Successful Collegiate Entrepreneur?

College is about investing in your future.  For most students, the investment is rooted in obtaining an education to help achieve career goals.  However, some students have a different investment strategy.  These students often forego extracurricular activities and endure countless sleepless nights in an effort to launch their careers while still in college.  For some collegiate entrepreneurs, the investment has paid off exponentially.  But how were collegiate entrepreneurs like Gates, Dell and Zuckerberg able to achieve such great success?

Regardless of whether you are trying to create the next social media revolution from your dorm room or start a property management company in your college town, there are a number of key principles that every aspiring collegiate entrepreneur should adhere to.  While these principles will not guarantee success, they will help you overcome some of the most common obstacles that hinder entrepreneurial ventures.

First, you must have clarity.  Before you start a venture, you need to have a goal for what you would like to accomplish and a plan for how you are going to achieve it.  Sound simple?  In practice, clarity takes time.  Clarity involves identifying existing products/services, evaluating the market, sizing up potential competition and focusing on specific customers/consumers.  These steps will not only help you gauge the feasibility of your idea, but they will also bring your idea into focus.  Once you take these initial steps, you need to develop a strategy to bring your idea to life.  This strategy should be memorialized in a comprehensive business plan.  A business plan will guide you through the startup process and will serve as an important tool to gain support from investors and strategic partners.  Ultimately, if you are unable to clearly articulate your idea and plan, your venture will not succeed.

Second, you must stay focused.  One of the biggest mistakes made by entrepreneurs is that they get involved in too many projects at the same time.  Once you have your idea and plan in place, stick with it.  You must stay focused on your plan in order to achieve success.  Don’t start the next venture until you have stabilized the first one or seen it through.  Dividing your time and resources between too many projects is a surefire way to guarantee failure.  In addition, stay focused on what you are good at.  If you have never written a line of computer code, it is probably not a good idea to start a smartphone app company on your own.  You will have a higher likelihood for success if your venture is centered around your strengths.  Finally, you need to set intervals to honestly evaluate the development of your venture.  These benchmarks or milestones will help you stay focused on achieving your goals and help you assess your progress.  Initially, make sure to give yourself extra time and start small with your benchmarking.

Third, you have to be patient.  Patience is by far the most important principle to achieve success.  You are going to spend an immeasurable amount of time refining your idea, developing a viable business plan and starting up your venture.  You have to give your plan time to work! Don’t waste time and energy constantly evaluating your venture.  Instead, focus on value-added activities and wait for your planned benchmarks to size up your progress.  Don’t let impatience be the downfall of your venture.

Finally, you have to be ready to adapt your idea and business plan.  Unexpected change is almost the only certainty in today’s business environment.  If your venture is going to succeed, you need to embrace the change that surrounds you instead of fighting against it.  In addition, you need to surround yourself with the right people.  For entrepreneurs, the “right people” are going to be those individuals who are good at the things that you are not good at.  Your human capital should complement your skill sets and fill any voids identified in your business planning process.  Ultimately, your venture needs to achieve a healthy balance between staying focused on its goals and being ready to adapt to sudden and progressive change in the market.

If your investment strategy for college involves building the foundation for your own business, you need to make sure you have the right investment tools.  Although every business is unique, the principles discussed above are proven cornerstones for successful entrepreneurial ventures.  Collegiate entrepreneurs who want to transform an idea into a successful career should integrate these principles into their existing or future undertakings.

© 2012 Michael P. James, J.D., M.B.A., CSSGB

To find out more about starting your own business or to gain guidance related to your venture, contact attorney Michael James at mjames@michaeljameslaw.com, 810-936-4040 or www.michaeljameslaw.com.  Michael James provides representation and counseling related to all facets of business enterprise and healthcare matters.

Accountable Care Organizations in Michigan

Learn about how accountable care organizations are changing health care in Michigan and across the country. Please do not hesitate to contact me should you have any questions or wish to discuss the impact of the Affordable Care Act on health care business and practice.


© 2012 Michael P. James, J.D., M.B.A., CSSGB

To find out more about the Affordable Care Act, contact attorney Michael James at mjames@michaeljameslaw.com, 810-936-4040 or www.michaeljameslaw.com.  Michael James provides representation and counseling related to all facets of business enterprise and healthcare matters.