A number of communities in Michigan have undertaken the development of community-based initiatives to provide healthcare coverage for low-income uninsured persons who are not eligible for mainstream medical assistance programs. The goal of these programs is to provide some level of basic healthcare services to low-income, uninsured individuals (generally working individuals) that do not qualify for publicly funded health care.
The administrative structure of the community health plans varies. Some plans contract with third-party administrators, pharmacy benefit managers, local health maintenance organizations (HMOs) for services including claims processing, member and provider services, and utilization management. Genesee, Saginaw, and Bay County plans contract with HealthPlus of Michigan for member services.
Through improved access to primary care, case management, formulary management and ongoing utilization reviews, community health plans are creating access to basic ambulatory care for persons who otherwise have no reliable source for services.
Genesee Health Plan, Saginaw Health Plan, and Bay Health Plan are non-profit corporations.
The primary goal of the county health plans is to increase access to coverage. At the end of Fiscal Year 2006, based on current funding levels, between 60,000 and 75,000 low-income Michiganians without health insurance had access to at least primary and preventive health care. Those enrolled in Third-Share programs have access to relatively comprehensive health care services.