MedicaidReimbursementLow impact
MSA 21-32
Michigan Medicaid - MDHHS·MI · Pharmacy·Provider Bulletin
Effective date
Oct 1, 2021
We identified it
Jun 20, 2026
Summary
Michigan Medicaid will implement a new payment methodology for prescriptions dispensed by Tribal 638 facility pharmacies, reimbursing at the Indian Health Services per visit outpatient rate (all-inclusive rate) instead of traditional prescription reimbursement rates. This affects all Medicaid and Healthy Michigan Plan beneficiaries served at these tribal pharmacies.
Action Required
No immediate action required for most practices. Only applies to Tribal 638 facility pharmacies in Michigan. If your practice works with or refers to tribal pharmacies, be aware that they will receive encounter-based reimbursement rather than per-prescription rates for Medicaid patients effective October 1, 2021.