New Healthy Michigan Plan HRA form and submission process

Over the past year, the Michigan Department of Health and Human Services (MDHHS) has collaborated with health plans and providers to make the HRA form and submission process more streamlined. Lab values are no longer required, for example.

Effective immediately, begin using the new Healthy Michigan Plan HRA form. The new form is a more condensed version that has removed multiple questions/fields in Section 4 (to be completed by provider), including lab values.

The updated form is not yet available in Spanish and Arabic. MDHHS will continue to accept the original HRA forms through 2018.

New HRA form submission options

In addition to the new form, providers now can submit completed forms by fax directly to MDHHS or online directly to CHAMPS (login required). You also still have the option of faxing the form to us.

You'll receive the $25 incentive per HRA submitted regardless of which submission method you choose.

Find the new form and details on form submission options here in the Provider Center under Plans & benefits > Medicaid programs > Healthy Michigan Plan > HRA form and incentive.