Medicaid behavioral health

Applies to:

All Priority Health Choice, Inc., members: Medicaid, MIChild, Healthy Michigan Plan

Mild to moderate conditions

Priority Health provides outpatient behavioral health therapy services for Medicaid members with mild to moderate mental health needs. This includes members experiencing or demonstrating mild to moderate psychiatric symptoms or signs of sufficient intensity to cause subjective distress or mildly disordered behavior, with minor or temporary functional limitations or impairments (self-care/daily living skills, social/interpersonal relations, educational/vocational role performance, etc.) and minimal clinical (self/other harm risk) instability.

Severe conditions, substance use disorders, specialized behavioral health services

Medicaid members with severe mental illness (adults), severe emotional disturbance (children), substance use disorders or developmental disabilities, as defined in the Michigan Mental Health Code, should be directed to their local pre-paid inpatient health plan (PIHP) for evaluation and treatment. 

Providers are responsible for referring members to their PIHP if they require specialized behavioral health services. 

Members who are being served through the PIHP system of care are generally not eligible to receive mental health outpatient services through Priority Health.

Find the correct PIHP

Bill the PIHP in the member's county of residence. The list of all PIHPs and regions can be found here:

Coding help

The specific code set to be billed to the proper PIHP can be found by logging into CHAMPS:

  1. Go to the External Links menu located on the 'Provider Portal' page.
  2. Select 'Medicaid Code and Rate Reference' from the dropdown list.

Medicaid resources

Below are links to information on substance use disorders and on acute detoxification:

Medicaid eligibility questions

Questions about Medicaid/Healthy Michigan Plan members' service eligibility should be directed to the Priority Health Behavioral Health Department.

Medicaid authorization and payment questions

The Michigan Department of Community Health has created a chart listing authorization and payment responsibilities by type of service and place of service.

Open the Medicaid Mental Health Substance Use Disorder Authorization and Payment Responsibility Grid.