Michigan expands Medicaid to cover pregnant women and children of Flint

Michigan obtained approval for its Section 1115 waiver request to extend Medicaid coverage to Flint residents affected by exposure to lead. The demonstration will extend Medicaid coverage to 15,000 additional children and pregnant women. Additionally, under the program, 30,000 Medicaid beneficiaries in the Flint area will be able to access expanded benefits.


The expanded coverage will apply to children up to age 21 and pregnant women who used Flint’s water system from April 2014 through a date when the water is deemed safe. The coverage will be limited to those with incomes up to 400 percent of the federal poverty level. However, Michigan will provide individuals with higher incomes an opportunity to purchase coverage without subsidies. The state will provide targeted case management services as part of the arrangement in order to assist impacted residents with obtaining medical, social, and educational services. The demonstration will last for a period of five years.

Water crisis

The lead exposure problem began two years ago when the city’s water supply was changed from Lake Huron to the Flint River. Following the source transition, residents noticed changes in their water—discoloration and bad smell and taste. Ultimately it was determined that lead was present in the water. Research indicated that children from the area younger than five—the population most vulnerable to lead poisoning—showed elevated blood lead levels. According to the Centers for Disease Control and Prevention (CDC), lead can have serious long-lasting effects on children, from learning difficulties to death. The approval of the waiver request follows a declaration by the President that the Flint water crisis reached a state of emergency.


Other states have used Medicaid in emergency situations in the past. For example, approximately 350,000 New Yorkers were covered by Disaster Relief Medicaid (DRM) for the four-month time period following the September, 11, 2001, attacks. Michigan also used a Section 1115 waiver to expand its Medicaid program under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The state’s demonstration waiver, known as the “Healthy Michigan Plan” was initially approved on December 23, 2013. The Healthy Michigan Plan covers eligible adults with income up to and including 138 percent of the federal poverty level.