MDHHS Awards New Medicaid Health Plan Contracts

Earlier this month, the Michigan Department of Health and Human Services (MDHHS) awarded Comprehensive Health Care Program contracts for Michigan’s Medicaid health plans. Health plans administered under Michigan Medicaid provide access to healthcare services to nearly 2 million Michigan residents. In this recent award of health plan contracts, nine health plans submitted proposals. The awarded Medicaid contracts are expected to go into effect in October 2024 and carry terms of five years, with three, one-year optional extensions.

The Medicaid health plan contracts were awarded based on Michigan’s 10 Prosperity Regions as follows:

• Region 1 – Upper Peninsula Prosperity Alliance: Upper Peninsula Health Plan, LLC.
• Region 2 – Northwest Prosperity Region: Blue Cross Complete of Michigan, LLC; McLaren Health Plan, Inc.; Molina Healthcare of Michigan, Inc.; and Priority Health Choice, Inc.
• Region 3 – Northeast Prosperity Region: Blue Cross Complete of Michigan, LLC; McLaren Health Plan, Inc.; Molina Healthcare of Michigan, Inc.; and Priority Health Choice, Inc.
• Region 4 – West Michigan Prosperity Alliance: Blue Cross Complete of Michigan, LLC; McLaren Health Plan, Inc.; Meridian Health Plan of Michigan, Inc.; Molina Healthcare of Michigan, Inc.; Priority Health Choice, Inc.; and United Healthcare Community Plan, Inc.
• Region 5 – East Central Michigan Prosperity Region: Blue Cross Complete of Michigan, LLC; McLaren Health Plan, Inc.; Meridian Health Plan of Michigan, Inc.; and Molina Healthcare of Michigan, Inc.
• Region 6 – East Michigan Prosperity Region: Blue Cross Complete of Michigan, LLC; HAP CareSource, Inc.; McLaren Health Plan, Inc.; Meridian Health Plan of Michigan, Inc.; Molina Healthcare of Michigan, Inc.; and United Healthcare Community Plan, Inc.
• Region 7 – South Central Prosperity Region: Aetna Better Health of Michigan, Inc.; HAP CareSource, Inc.; McLaren Health Plan, Inc.; and United Healthcare Community Plan, Inc.
• Region 8 – Southwest Prosperity Region: Aetna Better Health of Michigan, Inc.; McLaren Health Plan, Inc.; Meridian Health Plan of Michigan, Inc.; and United Healthcare Community Plan, Inc.
• Region 9 – Southeast Prosperity Region: Aetna Better Health of Michigan, Inc.; Blue Cross Complete of Michigan, LLC; HAP CareSource, Inc.; McLaren Health Plan, Inc.; Meridian Health Plan of Michigan, Inc.; and United Healthcare Community Plan, Inc.
• Region 10 – Detroit Metro Prosperity Region: Aetna Better Health of Michigan, Inc.; Blue Cross Complete of Michigan, LLC; HAP CareSource, Inc.; McLaren Health Plan, Inc.; Meridian Health Plan of Michigan, Inc.; Molina Healthcare of Michigan, Inc.; Priority Health Choice, Inc.; and United Healthcare Community Plan, Inc.

MDHHS has instituted certain changes in the new health plan contracts with the goal of strengthening Medicaid services provided to enrollees. Several of these changes seek to address social determinants of health through investment in and engagement with community-based organizations. One notable change is the introduction of “in lieu of services,” which will allow health plans to cover nutrition services that have been shown to improve health. Moreover, as the prior contracts come to an end and health plans look to close out and settle their existing contracts, providers may expect an increase in audit activity by certain health plans in an effort to collect as much money as possible before the new contracts go into effect. Providers should be aware of their rights and options when confronted with an audit, and an experienced healthcare representative can assist a provider in effectively defending against an audit.

For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to Medicaid audits or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.