Yep you're right re sampling and plan discretion, as you said, data is light and it'll take some time for more to be published publicly. Perhaps you could share your full findings to date for all our benefit and to contribute to? I've come across a few more Tier 2's at quick glance.
State Medicaid often look to other states to try promote uniformity but is subject to budget constraints and demographics, amongst other factors. Further promising considering Michigan seems to be, on average, a low-medium BOT target priority, which is graded by BOT per 'doctors' prescription and reimbursement potential' (screenshot below).
Competition is very high in the health insurance market so it's positive the largest health insurer in the country has classed it as Tier 2 in the above instance. ~73.8 million people are enrolled in US Medicaid as at May 2024.
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