MedicaidAdministrativeHigh impact
MSA 19-18
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Michigan Medicaid requires Home Help agency providers to sign MSA-4676 agreements for every client before delivering services and submit monthly MSA-1904 invoices instead of DHS-721 forms for payment verification, effective October 1, 2019.
Action Required
By October 1, 2019: Home Help agency providers must obtain signed MSA-4676 agreements for all new clients before service delivery and for existing clients before their next case review. Replace DHS-721 form submissions with monthly MSA-1904 Home Help Agency Invoice submissions to local county MDHHS offices. Retain signed agreements for seven years after service ends. Payment will not be released without proper MSA-1904 invoice submission and verification.