Past Updates

Managed LTSS Program

Michigan Flag

Under §1915(b) and §1915(c) waiver authority, Michigan’s Medicaid Managed Specialty Support & Services Program (MSS&S) provides behavioral health services and LTSS to adults with I/DD or SMI and children with I/DD or SED. LTSS services provided under MSS&S include nursing facility services; ICF/MR; personal care; targeted case management, and HCBS waiver services for persons with DD. Enrollment is mandatory and services are provided at a capitated rate. (Source: CMS and Truven Health Analytics, 7/2012)

On November 25, 2013, the state submitted a request for a six-month MSS&S 1915(b) waiver extension in order to align the waiver’s effective date with Michigan’s duals demonstration project. (Source: Michigan.gov website)

On December 17, 2013, CMS granted the six-month MSS&S 1915(b) waiver extension through September 30, 2014. (Source: Michigan.gov website)
CMS Approval Letter (12/17/2013)

On February 18, 2018, Crain’s Detroit Business reported on ongoing deliberations by the state of Michigan to establish a comprehensive managed long-term services and supports system (MLTSS).  The state currently provides MLTSS via concurrent 1915(b) and 1915(c) waivers that cover adults with I/DD or SMI and children with I/DD or SED. The 2017- 2018 state budget contained a brief instruction for the Department of Health and Human Services (HHS) to explore implementation of an MLTSS system. HSS is due to release an initial review of such a move by July 1, 2018. State officials have indicated that they are interested in carving in the full range of LTSS into MLTSS: nursing facilities, assisted living, and various HCBS programs such as the MI Choice waiver. The move could also include the state’s dual eligible demonstration, MI Health Link, and the PACE program. Michigan currently spends $2.8 billion on LTSS. (Source: Crain's Detroit Business 2/18/2018)

The Michigan Department of Health and Human Services (MDHHS) released a report detailing the feasibility of establishing a Managed Long Term Services and Supports (MLTSS) program. MDHHS collaborated with the Center for Health and Research Transformation, Health Policy Matters, and Public Sector consultants to analyzed Michigan’s current LTSS system and develop solutions for improving and expanding managed LTSS. The report includes a comparison of other states with MLTSS systems and how those models could be adapted and implemented in Michigan, stakeholder feedback on current managed care programs and opportunities for improvement, an analysis of the current LTSS system, and a proposed implementation timeline. (Source: Michigan Medicaid Long-Term Services and Supports Final Report, 3-6-2019)

State Demonstration to Integrate Care for Dual Eligible Individuals

In April 2012, the state submitted to CMS a demonstration proposal to integrate care for dual eligibles. The demonstration proposed a capitated model with opt out enrollment. The demonstration will cover all dual eligibles, including children with disabilities; adults with PD, I/DD, or SMI; and persons age 65 and older. Existing pre-paid inpatient health plans (PIHPs) will remain in place, but if individuals with I/DD opt out, they will not receive the enhanced care coordination envisioned in the demonstration. (Source: CMS and Truven Health Analytics, 7/2012; NASDDDS Managed Care Tracking Report; Demonstration Proposal; NSCLC Dual Eligible State Profiles website)

In September 2013, the state announced it will launch a phased regional enrollment in July 2014 and plans to implement the demonstration in four regions. (Source: Press Release, link no longer available; State of Michigan Department of Community Health, 9/17/2013)

In October 2013, the state submitted a proposed Memorandum of Understanding to CMS. (Source: Stakeholder Forum PowerPoint Presentation, 10/23/2013)
Program Website (link no longer available) 

In April 2014, CMS and the state signed a Memorandum of Understanding for the state’s capitated demonstration model. (Source: NSCLC Dual Eligible State Profiles website, 4/2014; Kaiser Duals Demonstration Proposal Status Map, 4/2014) Opt-in-only enrollment for Regions 1 and 4 will begin no earlier than October 1, 2014, with enrollments effective January 1, 2015. Opt-in-only enrollment for Regions 7 and 9 will begin no earlier than March 1, 2015, with enrollments effective May 1, 2015. (Source: HMA Weekly Roundup, 4/9/2014)
Memorandum of Understanding (4/2014)
Three-Way Contract for Demonstration (9/27/2014)

UnitedHealthcare Group in Michigan will close its Medicare Advantage dual special needs plan on January 1, 2015; UnitedHealthcare Group has also decided to withdraw from participating in a Medicaid-Medicare dual eligible pilot program in metro Detroit.  (Source:  HMA Weekly Roundup, 11/19/2014)   

On November 26, 2014, CMS published updated implementation dates for Michigan’s duals demonstration.  Opt-in enrollment is now scheduled to begin on March 1, 2015 in the Upper Peninsula and Southwest Michigan and May 1, 2015 in Macomb and Wayne Counties; passive enrollment is now scheduled to begin on July 1, 2015 in Macomb and Wayne Counties.  (Source:  CMS Michigan Financial Alignment Demonstration webpage, 11/26/2014)

In February 2015, enrollment began for Phase 1 of MI Health Link, Michigan’s duals demonstration project; and Phase 1 services began on March 1, 2015.  Passive enrollment in Phase 1 will be effective May 1, 2015.  Enrollment for Phase 2 of the project will begin in April, with services starting on May 1, 2015.  Phase 1 includes the entire Upper Peninsula and eight counties in southwest Michigan, including Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, and Van Buren.  Phase 2 includes Macomb and Wayne counties.  (Source: Michigan DCH website)

On May 28, 2015, Atlantic Information Services, Inc. reported that enrollment in Michigan’s duals demonstration has grown to 9,369 individuals. This is in contrast to other states that have seen losses in duals enrollment. (Source: AIS Health, 5/28/2015)

On February 14, 2016, Crain's Detroit Business reported on the current status of Michigan's dual eligible initiative, MI Health Link, which aims to better integrate care for beneficiaries jointly eligible for Medicare and Medicaid. During its first year in operation, MI Health LInk has experienced some challenges other dual demonstrations have faced, including low enrollment and high opt-out rates. Michigan has approximately 110,000 dual eligibles, but as of January, 2016, only 34,800 beneficiaries are enrolled in MI Health Link. A major impediment to enrollment, identified by a study conducted on the Massachusetts duals demonstration and reaffirmed by providers in Michigan, is auto enrolling beneficiaries, which takes away consumer choice and makes them fear losing relationships with trusted providers. Moving forward, one means of improvement is enhancing education for beneficiaries so they better understand and feel comfortable with transitioning into MI Health Link. (Source: Crain's Detroit Business 2/14/2016)

On January 25, 2018, CMS posted the newly re-executed three-way contract between the state, CMS, and the participating health plans for MI Health Link, the state’s dual eligible demonstration. The new contract allowed the state to revise the contract to reflect the 2016 Medicaid managed care regulations, updating provider network and care coordination requirements, and add new definitions, among others. (Source: CMS FAD Site 1/25/2018)

Michigan’s MI Health Link Demonstration Year 1 (Calendar Years 2015-2016) saw improvement in the two evaluated time periods.  All Financial Alignment Demonstrations include a provision to ‘withhold’ a portion of the Medicare-Medicaid Plans’ capitation rate that can be recaptured if the MMPs meet quality measures.  In 2016, six of the seven plans, met 71% or better of performance measures—for a state average of 80%. One plan met 100%. In 2016, the percent of withholding “received” increased to an average of 86% compared to 61% in 2015. Four plans received 100% of withholding in 2016. (Source: CMS Michigan Medicare Medicaid Plan Demo Year 1, 6-19-2018)

CMS released a summary of a quality withhold analysis of Michigan’s Medicare-Medicaid Plans (MMPs) for the second demonstration year (CY 2017) of the Financial Alignment Initiative (FAI). A percentage of both state Medicaid and federal Medicare capitation rates are withheld from the MMPs to ensure quality for dually eligible individuals. MMPs can earn the withheld funds back if Federal, CMS Core, and state-specific quality withhold performance measures were met. MMPs in Michigan met 87 percent of overall quality withhold performance measures, 83 percent of CMS Core measures, and 93 percent of Michigan’s specific state measures.

(Source: Michigan Medicare-Medicaid Plan Quality Withhold Analysis Results; 8-14-2019)

CMS released the first evaluation report for the Michigan MI Health Link demonstration. This demonstration is to improve quality of care and care coordination for dually eligible Medicare and Medicaid beneficiaries. The report includes an analysis of data collected from 2015 to 2017 from key informant interviews, results from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, MMP encounter data, and other sources. The report highlights evaluation results in eligibility and enrollment, care coordination, service utilization, and beneficiary experience.

(Source: FAI Michigan MI Health Link First Evaluation Report; 9-24-2019)

On September 30, 2022, the Michigan Department of Health and Human Services submitted to CMS its transition plan to move its Medicare-Medicaid Plans into an Integrated Special Needs Plan (SNP) model by January 1, 2026: Transition Plan for MI Health Link

Section 1915(i) HCBS State Plan Option

In March 2013, CMS approved the state’s §1915(i) HCBS State Plan Amendment, effective April 2013. (Source: Michigan.gov)
Approved State Plan Amendment (3/26/2013)

Health Homes

As of June 2014, Michigan has not submitted a Health Home State Plan Amendment to CMS. (Source: CMS State Health Home Website, 6/2014)

However, the state’s duals demonstration proposal includes a Health Homes concept established through Prepaid Inpatient Health Plans (PIHPs). PIHPs are the entities currently delivering Medicaid behavioral health and developmental disability benefits in the state; and the state anticipates Health Homes will become part of their services delivery model. For persons with I/DD, SMI or a substance use disorder, the PIHP supports coordinator will be responsible for ensuring integration of participants’ physical and behavioral health care across the delivery system. (Source: Demonstration Proposal)
State Resource on Health Homes

On December 11, 2014, CMS approved Michigan’s Health Home State Plan Amendment to implement Health Homes for individuals with serious and persistent mental health conditions, effective July 1, 2014.  The state will pilot Health Homes in three counties:  Manistee, Grand Traverse, and Washtenaw.  (Source:  Michigan DCH website, 1/2015)
Health Homes State Plan Amendment (Approved 12/11/2014)

On October 21, 2015, the Michigan Department of Health and Human Services announced the MI Care Team health homes pilot program, which will commence in April 2016. The health home initiative will coordinate and manage behavioral and physical health care services for both Medicaid beneficiaries and Healthy Michigan Plan members—who are the newly eligible Medicaid expansion group—that have anxiety, depression, and at least one chronic condition from the following: asthma, heart disease, hypertension, diabetes, or chronic obstructive pulmonary disease. Federally Qualified Health Centers (FQHCs) and Tribal Health Centers (THCs) are eligible to apply to become providers. The pilot program is expected to run for two years. Interested bidders must have submitted all materials by December 8, 2015. (Source: Michigan.gov 10/21/2015;  OpenMinds11/30/2015)

On March 4, 2016, CMS formally approved a second state plan amendment (SPA) for Michigan that will cover beneficiaries with certain chronic conditions, as well as depression and anxiety, that are to be served by federally qualified health centers (FQHCs) and tribal health centers. Qualified providers will receive a one-time start up payment to cover the costs of an initial health assessment and care plan development, and thereafter will receive monthly payments for providing the basic health home services. The new health home program will be effective July 1, 2016. (Source: SPA 3/4/2016; NASHP 3/23/2016)