MedicaidCoverageMedium impact
MMP 26-16: Policy Clarification for Enteral Formulas
Michigan Medicaid - MDHHS·MI · Pediatrics, Gastroenterology, Family Medicine·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
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.
Action Required
Before July 1, 2026: Medical suppliers and billing teams must update enteral formula billing procedures to exclude standard infant/toddler formulas unless administered via tube feeding. Review current enteral formula claims to ensure compliance with new non-covered item definitions. Update billing software to flag standard infant/toddler formulas as non-covered except for tube feeding administration.