Michigan Governor Wants Medicaid Benefits for Flint Water Crisis

The requested Medicaid waiver from CMS would help deal with the Flint water crisis. Residents have been affected by lead poisoning after a state-hired emergency manager switched the city's water supply from Lake Huron to the Flint River, without following advice for pretreating the water.

Michigan Governor Rick Snyder has asked CMS to expand specific Medicaid benefits for Flint residents affected by the city’s lead-contaminated water.

Snyder’s sent the formal request for a waiver on Sunday, which his office said would affect approximately 15,000 Flint residents up to age 21 and pregnant women.

The letter seeks funds for case managers to help residents coordinate care with primary care physicians, behavioral health providers and Medicaid plans; provide nutrition support; and boost access to education and social supports as needed. Lead exposure can lead to a host of health problems but is of greatest concern to young children and fetuses, as it can impair brain developing and cause learning disabilities.

Preceding the water crisis, the city of Flint was operating under an emergency manager appointed by the governor, under a unique Michigan law that allows the state to take over administrative functions of cities that are experiencing financial difficulty. Flint had experienced a dramatic loss tax revenue due to the decline of auto manufacturing within the city limits.

For decades, residents of Flint received water through the city of Detroit, sourced from Lake Huron, one of the cleanest sources in the world. The city was scheduled to join a countywide water system that would also use Lake Huron, but at a lower cost than Detroit was charging Flint. To save money in the interim, in April 2014 the emergency manager disconnected Flint from Detroit’s system and instead used water from the Flint River, which for years had been polluted by manufacturing and agricultural uses.

Despite recommendations that the water be pretreated before entering Flint’s aged lead pipes, this advice was not followed. As a result, the river water corroded Flint’s infrastructure, and residents began complaining of brownish, foul-smelling water. Some residents reported rashes and hair loss after bathing in city water.

State officials dismissed complaints for months, but evidence made public in September by a Flint pediatrician, Mona Hanna-Attisha, MD, MPH, FAAP, showed that lead levels in the city’s children had increased following the change in water supply, building a groundswell for state officials to change course.

Her results were published this month in The American Journal of Public Health.1 Hanna-Attisha found that elevated blood lead levels rose from 2.4% to 4.9% (P < .05) after the change, and neighborhoods with the with highest water lead levels saw a 6.6% increase.

According to Snyder’s statement, the waiver appears aimed at ensuring services to those who might all outside the income limits for Medicaid and the Children’s Health Insurance Program. It states, “Individuals with income over 400% of the federal poverty level, which is $47,520 for one person and $97,200 for a family of four, will have the option to buy into the program for full Medicaid benefits.”

There is no end date listed for the waiver.


1. Hanna-Attisha M, LaChance J, Sadler RC, Champney Schnepp A. Elevated blood lead levels in children associated with the Flint drinking water crisis: a spatial analysis of risk and public health response. Am J Public Health. 2016;106(2):283-290.

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