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MMP 25-47: Implementation of MI Coordinated Health (MICH) Program
Effective date
Jan 1, 2026
Identified
Jun 20, 2026
Summary
Effective January 1, 2026, the MI Health Link program transitioned to a Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP) program called MI Coordinated Health (MICH). A HIDE SNP is a Medicare Advantage plan for people who are dually eligible for Medicare and Medicaid, and it provides most Medicaid benefits under a capitated contract, excluding certain behavioral health services but including long-term services and supports. The HIDE SNP program operates in limited regions of Michigan and is expected to extend to the entire State on January 1, 2027, contingent upon budget approval.
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What to do
Action · 16 steps
01Already effective January 1, 2026: For MICH enrollees, verify eligibility at every appointment before providing dental services, because dental services provided to an ineligible enrollee will not be reimbursed.
02Dental services must be received from a participating provider to be covered.
03Direct questions about eligibility, prior authorization or the provider network to the enrollee's HIDE SNP.
04FQHC providers must obtain prior authorization from the HIDE SNP.
05Emergency screening and stabilization services and family planning services do not require HIDE SNP prior authorization.
06Non-contracted hospitals must make post-stabilization authorization requests by telephone to the HIDE SNP before providing any treatment after stabilization, and may not wait until the next business day to call.
07Out-of-network providers with an established prior relationship can be reimbursed retroactively for services provided without an approved continuity of care request if they submit the request for payment within 30 days of the first date of service.
08Do not hold enrollees liable for coinsurance, copayments, deductibles or financial penalties, other than any patient pay toward nursing facility care.
09Nursing facilities collect the Patient Pay Amount from enrollees, and the HIDE SNP reduces its reimbursement to the facility by that amount each month.
10Nursing facility admission requires a physician-written order, a completed Level of Care Determination (LOCD) and a completed DCH-3877 Pre-Admission Screening/Annual Resident Review form.
11For enrollees with inborn errors of metabolism who use metabolic formulas (HCPCS B4157 and B4162), Medicaid services are paid through the Medicaid FFS Program.
12When a MICH enrollee elects hospice in a nursing facility, the hospice agency bills Medicare for hospice services and bills the HIDE SNP for room and board.
13Enrollees cannot receive personal care services or Expanded Community Living Supports while at an Adult Day Program facility.
14Providers record and report personal care minutes using the MDHHS Reasonable Time and Task table, and personal care, respite and ECLS are subject to Electronic Visit Verification.
15Private duty nursing must be ordered by a physician, physician assistant, clinical nurse specialist or nurse practitioner.
16Non-contracted providers must comply with the HIDE SNP's authorization and uniform billing requirements, and are paid Medicaid FFS rates for properly authorized, medically necessary services with a clean claim.
Codes mentioned
B4157B4162
Original notice
MMP 25-47: Implementation of MI Coordinated Health (MICH) Program
michigan.gov · Always check the source before changing claims.
Related changes
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