Issue Background

Healthy Michigan Plan

Nearly 600,000 patients have enrolled in the State of Michigan’s Medicaid expansion program, known as the Healthy Michigan Plan (HMP).  The plan is designed to emphasize patient responsibility while reducing the need for more costly healthcare services through prevention.  Patients are required to share in costs and are provided with incentives for taking steps to improve their health.

The Healthy Michigan Plan is aimed at the working poor – adults between the ages of 19 and 64 whose income is between 100-133 percent of the federal poverty level and who do not qualify for traditional Medicaid but do not have enough income to afford private insurance.  Residents eligible for Medicare are not eligible for the Healthy Michigan Plan.

Eligible patients receive a packet from the state containing their health plan options.  They must complete this packet and return it to the state to enroll in their selected health plan.  Once the state confirms enrollment, the patient will receive an enrollment card from their selected health plan.

What Is Covered?

It is important to note that coverage and reimbursement rates for all enrollees is not the same.  Michigan’s 11 Medicaid health plans are charged with offering dental services on their own or contracting with an insurance company to administer the dental benefit for them.  Some of the dental plans offer only the same benefits as traditional Medicaid and others offer more extensive coverage.  Some reimburse near PPO rates while other reimburse according to the Medicaid fee-for-service fee schedule.  It is important to know which dental plan your patient has their coverage under and to verify benefits on the date of service.

How Do I Participate?

Providers are required to participate with each insurance company in order to accept patients covered by that insurer.  Providers are also able to determine the number of Healthy Michigan Plan patients they wish to treat.  The terms of participation very with each insurance company so dentists are advised to read contracts carefully.  

Additional Information:

A number of resources have been added to the MDA’s website to assist members, including links to the State’s Healthy Michigan Plan website.   

Quick Facts:

  • Residents can enroll online, via telephone or through health departments and other public service agencies that assist with Medicaid enrollment.
  • Eligible patients may have a mihealth card; however, this does not ensure enrollment and coverage.  Patients who have not yet selected a health plan are covered under fee-for-service Medicaid.  Once the patient selects a health plan, they receive an enrollment card from the health plan. This card contains their Medicaid number which you will use to verify eligibility.  Patients who are unsure of their enrollment status should contact Medicaid.
  • 11 health plans administer Medicaid health benefits.  You must be a participating provider with each dental plan to accept patients covered by that plan.
  • Delta Dental PPO and Premier dentists are automatically eligible to treat HMP patients who receive their coverage through Delta Dental.  Services are reimbursed according to the Delta Dental PPO fee schedule. Premier status for other patients does not change.  Premier dentists who do not wish to treat HMP patients must submit an opt-out to Delta Dental in writing.
  • Copays are not collected at the place of service.  You are reimbursed at 100% of the maximum allowable and the state collects copays from the patient. 
  • Prior to rendering services, providers must verify coverage on the date of service.  Coverage can be verified through CHAMPS, the dental plan, or the health plan.
  • It is recommended that you not schedule HMP patients on the first week of the month when eligibility changes may occur.  If you must treat a patient during that time, it is recommended that you verify eligibility directly through CHAMPS or the health plan.
  • Services that are not covered by HMP may be billed to the patient; however, you must inform the patient of these costs and obtain an agreement to pay these fees in writing prior to treatment on the date of service.