MedicaidAdministrativeLow impact
MSA 20-69
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Michigan Medicaid introduces new MSA-204 form allowing Home Help agency providers to enroll caregivers in CHAMPS system when caregivers are absent. Caregivers must complete authorization form before enrollment, and cannot provide services until CHAMPS enrollment is approved and associated with agency provider.
Action Required
By January 1, 2021: Home Help agency providers in Michigan must obtain completed MSA-204 authorization forms from caregivers before enrolling them in CHAMPS system. Download fillable forms from www.michigan.gov/homehelp. Retain signed forms for 7 years after caregiver's last service date. Ensure caregivers do not provide services until CHAMPS enrollment approved to avoid payment recoupment.