Healthy Michigan Plan information for providers
Priority Health, in accordance with the regulations of the State of Michigan, offers the health care benefits of the Healthy Michigan Plan. Learn more about the Healthy Michigan Plan on michigan.gov.
Participation in the Healthy Michigan Plan
If your practice is in one of our approved counties and you are not currently contracted with our Medicaid product (which includes the Healthy Michigan Plan), contact your provider account representative to become a participating provider. If you are participating but your practice is closed, consider opening to new members.
To open to new Medicaid/Healthy Michigan Plan members, complete the Provider information form. We will open your practice effective on the date we receive your request.
Eligibility and enrollment
Note that not all Healthy Michigan members will be new to your practice. Your current patients may find that they are eligible for the Healthy Michigan Plan.
Per state regulation, the Healthy Michigan Plan will cover people who are:
- Ages 19-64
- Earning up to 133% of the Federal Poverty Level, approximately $15,000 for single person or $34,000 for a family of four
- Residents of Michigan
- Not currently eligible for Medicaid
- Not eligible for or enrolled in Medicare
- Not pregnant when applying for the Healthy Michigan Plan
Enrollment period: Eligible members will join this plan every month. There is no set enrollment period.
Effective date: The member's effective date will always be on the first of a month.
Healthy Michigan Plan work requirements
On Jan. 1, 2020, the Michigan Department of Health and Human Services (MDHHS) implemented new work requirements for Healthy Michigan Plan beneficiaries age 19-62. Beneficiaries must complete and report 80 hours of work activity per calendar month to remain eligible for the plan. Some individuals may be exempt from the new work requirements if they meet certain criteria.
As a provider, you do not need to change your process for seeing Healthy Michigan Plan patients because of these requirements. However, due to the requirement, more beneficiaries may be moving in and out of eligibility more frequently. You should continue to confirm your patients' Healthy Michigan Plan eligibility using CHAMPS and/or our Member Inquiry tool.
More information about the Healthy Michigan Plan work requirements is available on the MDHHS website.
Identifying members of Healthy Michigan Plan vs. Medicaid
ID cards: The State of Michigan does not allow us to indicate "Healthy Michigan Plan" on member ID cards. Therefore, Priority Health ID cards will show the plan as Priority Health Choice HMI.
Member Inquiry: These members share the Medicaid group number 10001. We identify them in the Member Inquiry tool as Healthy Michigan Plan/Priority Health Choice HMI members.
The goal of the Healthy Michigan Plan is to help members get healthy and stay healthy. Therefore, members are encouraged to contact their PCP to schedule an "annual visit." The purpose of the annual visit is to review and complete a health risk assessment (HRA) with provider, and assist the member in selecting a healthy behavior.
- The PCP can be either a physician or a mid-level primary care provider (NP/PA).
- Members may be eligible for an incentive if they complete the visit and health risk assessment.
We have made it easier for you to submit HRA forms. To learn more about the Healthy Michigan Plan incentive and form submission methods, visit the Healthy Michigan Plan form submission and incentive page.
Healthy Michigan Plan copayments
Providers do not collect copays. You'll see copayment amounts on the member's ID card and in the Member Inquiry tool, but Priority Health is responsible for collecting from the member.BUT you must notify patients of their copay at the time of service.
- Every provider is required to provide this notice
- Every visit
- Every service - office visits, X-rays, labs, prescription pickup, etc.
Print the copay notification form
To fulfill this requirement, CMS requires that you give Healthy Michigan Plan members a copy of the copay notification form found on the michigan.gov website at time of service. Print these forms to distribute to your Healthy Michigan Plan members at each visit. DO NOT COLLECT THE COPAYS LISTED IN THIS DOCUMENT.
Direct your questions regarding this letter to 800.292.2550 or ProviderSupport@michigan.gov.