MedicaidAdministrativeMedium impact
MMP 26-08: Updates to the MDHHS Medicaid Provider Manual
Michigan Medicaid - MDHHS·MI · Pediatrics, Family Medicine, Internal Medicine +2 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 16, 2026
Summary
Michigan Medicaid has updated their provider manual effective April 1, 2026, with changes to terminology (Pharmacy Benefits Manager renamed to Administrator), NICU transfer authorization requirements, behavioral health training requirements, immunization billing clarifications, and hearing aid evaluation timeframes.
Action Required
By April 1, 2026: Billing and clinical teams must update documentation and processes - (1) Replace all references to 'Pharmacy Benefits Manager' or 'PBM' with 'Pharmacy Benefits Administrator' in systems and forms, (2) For NICU transfers: ensure Prior Authorization Certification Evaluation Review (PACER) is obtained through MDHHS PRD for all elective hospital transfers with neonatologist written orders, (3) Verify behavioral health staff complete required 24 training hours annually per Michigan Administrative Code, (4) For VFC immunizations: ensure administration fees don't exceed charges to private-pay patients, (5) Schedule hearing aid conformity evaluations within 90 days of dispensing date. Access updated manual at www.michigan.gov/medicaidproviders.