What types of policy changes does Michigan Medicaid - MDHHS issue?

Michigan Medicaid - MDHHS regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Michigan Medicaid - MDHHS update its policies?

Michigan Medicaid - MDHHS typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Michigan Medicaid - MDHHS policy changes are tracked here?

This page currently tracks 20 documented Michigan Medicaid - MDHHS policy changes. New items are added as they are identified.

What should I do when Michigan Medicaid - MDHHS changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Michigan Medicaid - MDHHS Policy Changes & Prior Auth Updates

We track 20 documented policy changes from Michigan Medicaid - MDHHS across MI. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Michigan Medicaid - MDHHS notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Michigan Medicaid - MDHHS updates automatically.

Medium impact
MMP 26-03: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates
Michigan Medicaid - MDHHS·Identified Jun 16, 2026
Failed to analyze policy change
High impact
MMP 26-02: Update to the Fee-for-Service Prior Authorization Process
Michigan Medicaid - MDHHS·Effective Mar 22, 2026
Michigan Medicaid is implementing new prior authorization timeframes effective March 22, 2026: standard PA decisions within 7 calendar days, expedited PA decisions within 72 hours. Updated PA forms and CHAMPS system fields will be required starting the effective date.
Medium impact
MMP 26-04: Plan First and Medicare-Eligible Beneficiaries
Michigan Medicaid - MDHHS·Effective Mar 1, 2026
This bulletin clarifies payment responsibilities for Plan First beneficiaries who are also Medicare-eligible, effective March 1, 2026. It specifies different billing rules for QMB/Plan First, SLMB/Plan First, and Medicare Part A&B/Plan First beneficiaries, with Plan First only covering family planning services.
Low impact
MMP 26-06: Hospital Rural Access Pool (RAP) Eligibility Criteria
Michigan Medicaid - MDHHS·Identified Jun 16, 2026
Michigan updated eligibility criteria for the Hospital Rural Access Pool (RAP) program, effective state fiscal year 2026. Hospitals must now be located in counties with populations not exceeding 195,000 and within cities/villages/townships with populations not exceeding 15,000, based on 2020 census data.
Medium impact
MMP 26-07: Children’s Home and Community-Based Services Waiver (CWP)
Michigan Medicaid - MDHHS·Effective Oct 1, 2025
Michigan Medicaid updated the Children's Home and Community-Based Services Waiver (CWP) program, eliminating the pre-screen form for priority rating, removing physician approval requirements for Individual Plans of Service (IPOS), and implementing new MichiCANS Decision Support Model criteria for eligibility determination.
Medium impact
MMP 26-08: Updates to the MDHHS Medicaid Provider Manual
Michigan Medicaid - MDHHS·Effective Apr 1, 2026
Michigan Medicaid has updated their provider manual effective April 1, 2026, with changes to terminology (Pharmacy Benefits Manager renamed to Administrator), NICU transfer authorization requirements, behavioral health training requirements, immunization billing clarifications, and hearing aid evaluation timeframes.
Medium impact
MMP 26-10: Electronic Visit Verification (EVV) Compliance
Michigan Medicaid - MDHHS·Effective Apr 1, 2026
Starting April 1, 2026, Michigan Medicaid will enforce Electronic Visit Verification (EVV) compliance for personal care services and home health care services providers, requiring 85% of visits to be recorded electronically without manual edits. Providers failing to meet this threshold face corrective actions including retraining and compliance plans.
Medium impact
MMP 26-11: Nursing Facility Bed Certification Criteria
Michigan Medicaid - MDHHS·Effective Apr 1, 2026
Michigan Medicaid updated nursing facility bed certification criteria and application processes, requiring Medicare certification verification and substantial compliance findings from state agencies. Applications must be submitted during specific quarterly periods with complete documentation including floor plans and census data.
High impact
MMP 26-01: Medicaid Health Plan (MHP) Provider Mental Health Assessment Requirements for Comprehensive Health Care Program (CHCP) Enrollees
Michigan Medicaid - MDHHS·Effective Oct 1, 2025
Michigan Medicaid Health Plans now require standardized mental health assessments (MichiCANS Screener for ages 0-18, LOCUS for 18+) for all enrollees seeking mental health services. Only qualified, trained, and Medicaid-enrolled mental health professionals can perform these assessments, with reassessments required every 12 months or when condition changes.
Low impact
MMP 26-05: Estate Recovery Waivers
Michigan Medicaid - MDHHS·Effective May 1, 2026
Michigan Medicaid clarifies that only MDHHS has authority to approve or deny estate recovery waiver requests. This administrative clarification does not change billing procedures but confirms existing policy authority structure.
Low impact
MMP 26-09: Updates to Home Help Program Policy
Michigan Medicaid - MDHHS·Effective May 1, 2026
Michigan is expanding who can certify medical need for Home Help services to include Clinical Nurse Specialists and adding a new form (MDHHS-6200) as an alternative to the existing DHS-54A form. Home Help agency owners must now monitor and ensure their caregivers maintain active CHAMPS enrollment.
Medium impact
MMP 26-13: Children’s Home and Community-Based Services Waiver (CWP)
Michigan Medicaid - MDHHS·Effective Oct 1, 2025
This correction updates the Children's Home and Community-Based Services Waiver (CWP) eligibility criteria for Michigan Medicaid, removing duplicative communication language and adding missing criterion items for age 6+ assessments. The changes align with CMS waiver amendments effective October 1, 2025.
Medium impact
MMP 26-12: Home and Community Based (HCBS) §1915(i) State Plan Amendment
Michigan Medicaid - MDHHS·Effective Jun 1, 2026
Michigan updated its Home and Community Based Services (HCBS) State Plan Amendment, expanding behavioral health community services through Prepaid Inpatient Health Plans. Key changes include updated assessment tools, revised service definitions, expanded provider qualifications for housing assistance, and separation of supported employment into individual and small group services.
Medium impact
MMP 26-14: §1915(c) Habilitation Supports Waiver
Michigan Medicaid - MDHHS·Effective Oct 1, 2024
Michigan updated its Habilitation Supports Waiver (HSW) for developmental disabilities, adding new services like Vehicle Modification, separating Supported Employment into two services, eliminating Prevocational Services, and expanding eligibility to include TEFRA populations. The changes affect Medicaid billing for developmental disability services through PIHPs and CMHSPs.
Medium impact
MMP 26-15: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates
Michigan Medicaid - MDHHS·Effective Apr 1, 2026
Michigan Medicaid has updated CPT and HCPCS codes effective April 1, 2026, adding new covered codes for various provider types and discontinuing several existing codes. The policy also includes retroactive coverage for some codes back to January 1, 2026.
Medium impact
MMP 26-16: Policy Clarification for Enteral Formulas
Michigan Medicaid - MDHHS·Effective Jul 1, 2026
Michigan Medicaid has clarified that standard infant/toddler formulas are non-covered items, except when administered via tube feeding. The policy defines standard formulas as retail-available products that don't require prescriptions or medical supervision and are not FDA-exempt.
Medium impact
MMP 26-17: Reimbursement of Specialty Behavioral Health Services Based Upon Location of Services
Michigan Medicaid - MDHHS·Effective Jul 1, 2026
Michigan Medicaid policy MMP 26-17 clarifies reimbursement rules for specialty behavioral health services based on service location, affecting mental health, I/DD, and SUD treatment billing. The policy specifies coverage limitations for services in nursing facilities, child caring institutions, and therapeutic group homes, with different rules for children with SED versus I/DD.
Medium impact
MMP 26-20: Expansion of Coverage for Pharmacist-Provided Services
Michigan Medicaid - MDHHS·Effective Jul 1, 2026
Medicaid is expanding coverage for pharmacist-provided services effective July 1, 2026, to include immunizations, laboratory testing, and contraceptive counseling. Pharmacists must enroll as Medicaid providers with specific subspecialty designations and complete required training to provide these services.
Low impact
MMP 26-22: Updates to the MDHHS Medicaid Provider Manual
Michigan Medicaid - MDHHS·Effective Jul 1, 2026
Michigan Medicaid has updated their Provider Manual effective July 1, 2026, with changes to billing procedures for ICF/IID services, hospital transfers, behavioral health services, and peer support programs. Most changes are technical clarifications and administrative updates rather than major billing code or coverage changes.
Medium impact
MMP 26-21: Home Help Audit Forms
Michigan Medicaid - MDHHS·Effective Aug 1, 2026
Michigan MDHHS introduces three new standardized audit forms (HS-2601, HS-2602, HS-2603) for Home Help agency providers effective August 1, 2026. These forms standardize documentation requirements for compliance reviews and random audits, including caregiver lists, submission checklists, and payroll templates for Medicaid and Healthy Michigan Plan services.

Michigan Medicaid - MDHHS in MI Michigan Medicaid - MDHHS: Anesthesiology Michigan Medicaid - MDHHS: Behavioral Health Michigan Medicaid - MDHHS: ENT (Ear, Nose & Throat)Michigan Medicaid - MDHHS: Family Medicine All payers

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Michigan Medicaid - MDHHS Policy Changes 2026 | Prior Auth & Coverage Updates | PolicyChanges.app

MMP 26-03: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

MMP 26-02: Update to the Fee-for-Service Prior Authorization Process

MMP 26-04: Plan First and Medicare-Eligible Beneficiaries

MMP 26-06: Hospital Rural Access Pool (RAP) Eligibility Criteria

MMP 26-07: Children’s Home and Community-Based Services Waiver (CWP)

MMP 26-08: Updates to the MDHHS Medicaid Provider Manual

MMP 26-10: Electronic Visit Verification (EVV) Compliance

MMP 26-11: Nursing Facility Bed Certification Criteria

MMP 26-01: Medicaid Health Plan (MHP) Provider Mental Health Assessment Requirements for Comprehensive Health Care Program (CHCP) Enrollees

MMP 26-05: Estate Recovery Waivers

MMP 26-09: Updates to Home Help Program Policy

MMP 26-13: Children’s Home and Community-Based Services Waiver (CWP)

MMP 26-12: Home and Community Based (HCBS) §1915(i) State Plan Amendment

MMP 26-14: §1915(c) Habilitation Supports Waiver

MMP 26-15: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

MMP 26-16: Policy Clarification for Enteral Formulas

MMP 26-17: Reimbursement of Specialty Behavioral Health Services Based Upon Location of Services

MMP 26-20: Expansion of Coverage for Pharmacist-Provided Services

MMP 26-22: Updates to the MDHHS Medicaid Provider Manual

MMP 26-21: Home Help Audit Forms