- As of July 1, 2011, there were 1,818,312 beneficiaries enrolled in the state’s Medicaid program, 1,606,688 of whom were enrolled in some form of managed care.
- The state has 14 Medicaid-only MCOs that provide physical health and outpatient mental health services. Additional behavioral health services are provided to 1,606,688 beneficiaries through 18 Prepaid Inpatient Health Plans.
- Dental services are provided to 312,918 beneficiaries through a Prepaid Ambulatory Health Plan known as Health Kids Dental.
- Michigan also has a home and community-based services waiver for children with serious emotional disturbances.
Michigan relies on the federal medical necessity definition for EPSDT, and does not have a general state-level medical necessity definition for Medicaid services.
Michigan’s Medicaid State Plan does contain a medical necessity definition for specific Medicaid services, such as the definition used for physical therapy services and psychological, counseling and social work:
“Medically necessary services are health care, diagnostic services, treatments and other measures to correct or ameliorate any disability and/or chronic condition.”
|Initiatives to Improve Access
|Reporting & Data Collection||
The Michigan Department of Community Health publishes Statewide Aggregate Reports of Medicaid health plan performance on HEDIS measures. These measures include metrics in a child and adolescent care domain, including:
The department also collects high-level data into a Health Plans Quality Checkup document for consumers. Medicaid health plans are given “below average,” “average,” or “above average” ratings on five key indicators. A Keeping Kids Healthy indicator measures how well “children in the plan get regular checkups and important shots that help protect them against serious illness.”
Local Community Mental Health Services Programs coordinate delivery of public behavioral health benefits in Michigan. Prepaid Inpatient Health Plans cover behavioral health services for children with serious emotional disturbance.
The state also has a Children with Serious Emotional Disturbances Waiver that provides behavioral health services to children in community settings.
|Support to Providers and Families||
Support to Families
The Michigan Department of Community Health produces a Healthy Kids brochure informing families about eligibility and services covered by the benefit. Multi-lingual brochure for families about well-child visits.
Medicaid managed care plans are required to reach out to families when children are overdue for a well-child visit.
Support to Providers
The Michigan Department of Community Health website hosts a page for providers consolidating Medicaid policy bulletins, provider manuals, forms, billing information, and training opportunities.
Managed care plans in Michigan provide case management services for enrollees needing “extended use of resources and help navigating the system of care.” Medicaid plans are also required to work with and coordinate service delivery with a variety of community-based providers, such as:
Medicaid primary care providers serving children with special health care needs are expected to have experience coordinating care for children who receive care from multiple providers.
Michigan’s Medicaid program also participates in a multi-payer patient-centered medical home initiative known as the Michigan Primary Care Transformation Project. The project is working to coordinate care and build linkages across settings and services. Managed care contracts require health plans to make per member per month payments to medical homes serving children with special health care needs.
Oral health services for children are provided by a Prepaid Ambulatory Health Plan (PAHP), Delta Dental. The PAHP provides beneficiaries with information on eligibility and covered services, as well as a Member Handbook.
The state also lists Medicaid professionals who have received fluoride varnish certificates.