Michigan Medicaid

Medicaid, also called Medical Assistance (MA) in Michigan, is a government health insurance program that helps people with low income get health care services at a lower cost. There are several different Medicaid programs in Michigan, each serving a different group of people. This includes people who are older (age 65+), blind, or living with a disability.

What does Michigan Medicaid cover?

Michigan Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Michigan Medicaid may also cover services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

Since the program serves those with limited income and resources, people with Michigan Medicaid pay few to no out-of-pocket costs. To get coverage once you are enrolled, you must go to health care providers that take part in the Medicaid program.

Michigan Medicaid is administered by the Michigan Department of Health & Human Services (MDHHS). Call the Michigan Health Care Helpline at 1-855-789-5610 to learn more about the coverages provided.

How do I know if I qualify for Medicaid in Michigan?

Michigan Medicaid covers people with limited income and resources. In general, to be eligible, you must:

• Be a Michigan resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income limit for your category

Also, if you receive Supplemental Security Income (SSI), you should automatically qualify for Michigan Medicaid without having to file a separate application.

If you need help with your health care coverage and costs, you should apply for Michigan Medicaid even if you think you are over the income limit or your assets are too high. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance.
• If you are over the income limit, but you have very high medical costs, you may be able to qualify for AD Care Medicaid through the Spend-Down Program.

What are the different Medicaid programs in Michigan?

You may be able to get health coverage if you fall into one of the following categories.

Traditional Medicaid

This program is for people with very low income, including children, pregnant women, older adults (age 65+), and those with disabilities.

Nursing Home Medicaid

Nursing Home Medicaid covers health care and support services in a nursing home or other medical facility. You can get these services if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis.

Michigan Choice Waiver Program

This program gives you health care and support services so that you can stay in your own home and avoid having to move into a nursing home. You may take part in this program if you are age 65 or older or you have a disability and are 18 years of age or older. You must have limited income and resources and you must need help caring for yourself on a daily basis.

Michigan Freedom to Work Medicaid Buy-In Program

If you're a worker who has a disability and limited income and resources, the Michigan Freedom to Work Medicaid Buy-In program can provide you with health care benefits. This program lets you work, keep more in your savings, and still get health care coverage. You can take part in this program if you are a paid worker (part-time or full-time) between the ages of 16 and 64. 

Healthy Michigan Plan

The Healthy Michigan Plan provides low-cost health insurance for people who cannot get coverage through regular Medicaid or private insurance. You may be able to get help from this program if you live in this state, have limited income, and are between 19 and 64 years of age.

Medically Needy Program (Medicaid Spend-Down)

The Medically Needy Program lets you get Medicaid benefits even if your income is higher than program guidelines. It works by letting you spend down your income so that you meet Medicaid’s income limits. The spend-down amount is the amount of income that is over the Michigan Medicaid limit. This amount is different for each person.

To get Michigan Medicaid benefits, you must submit current paid or unpaid medical bills equal to or greater than your monthly spend-down amount. Once your medical bills reach this amount, you will get coverage for the rest of the spend-down period.

Some examples of medical expenses you can use to spend down your income include:

• Unpaid medical bills (that have not been used to spend down your income before)
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

How do Medicare and Medicaid work together?

Medicaid pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from Medicaid. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for Michigan Medicaid, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. It will also cover your Part A (Hospital Insurance) premiums if you have to pay a premium for that coverage. Your share of Medicare costs, like deductibles, coinsurance, and copayments, will also be covered.

If you have both Medicare and Michigan Medicaid, you should show both cards to your health care provider each time you receive services.

In addition, if you are dual-eligible for Medicare and Michigan Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You can get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Michigan Medicaid?

When you apply for Michigan Medicaid, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• A Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements
• Documentation of medical expenses

How do I apply for Medicaid in Michigan?

There are a few different ways you can apply for Michigan Medicaid. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for Medicaid in Michigan is online through the MIBridges portal. All your personal information is kept 100% confidential and protected by special security technology.

Apply through MIBridges Portal

Once there, you will click othe "Apply for Benefits" button. You can then login or begin your application as a guest. 

Note: If applying as a guest user, you will not be able to review the status of your application, save your application and complete later, or manage your benefits or report changes. 

To apply by mail, you can download and print a paper Medicaid application, complete it, and mail it to:

Michigan Department of Health and Human Services
Health Insurance Affordability Program 
P.O. Box 8123
Royal Oak, MI  48068-9985

To apply over the phone, call 1-855-789-5610 and an agent will complete the application with you.

How can I get help with my application?

• Call the Michigan Health Care Helpline at1-855-789-5610.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559.