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BAM 402 1 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

POLICY Medicaid (MA) General lists of MA covered services are located at the end of this item; see EXHIBIT I. In this item MA includes MAGI-related and SSI-related beneficiaries. CHOICE OF PROVIDERS The beneficiary is usually free to select a provider or health care plan. However, there are some situations when the recipient may be restricted to certain providers (such as primary care provider, pharmacy, specialist provider). Reimbursement for services rendered is limited to enrolled providers except for emergencies. HEALTH PLANS Health plans provide Medicaid-covered health care services for an enrolled group of beneficiaries in a defined service area. Enrollment Beneficiaries are given an opportunity to select a health plan. If no selection is made, the beneficiary is automatically enrolled by the state’s contracted enrollment broker, Michigan ENROLLS, with a health plan in the beneficiary’s county of residence. Health plan enrollees are identified by program enrollment type (PET) codes which start with MHP-XXXX. Health plan enrollees will also receive an identification card from their health plan. There are beneficiaries who: • Must enroll in a health plan. • May voluntarily enroll in a health plan. • Are excluded from enrollment in a health plan. Persons Who Must Enroll In a Health Plan The following must enroll in a health plan, unless they are Persons Who May Voluntarily Enroll in a Health Plan or Persons Excluded from Enrollment in a Health Plan.

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Official source

BAM 402 1 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

POLICY Medicaid (MA) General lists of MA covered services are located at the end of this item; see EXHIBIT I. In this item MA includes MAGI-related and SSI-related beneficiaries. CHOICE OF PROVIDERS The beneficiary is usually free to select a provider or health care plan. However, there are some situations when the recipient may be restricted to certain providers (such as primary care provider, pharmacy, specialist provider). Reimbursement for services rendered is limited to enrolled providers except for emergencies. HEALTH PLANS Health plans provide Medicaid-covered health care services for an enrolled group of beneficiaries in a defined service area. Enrollment Beneficiaries are given an opportunity to select a health plan. If no selection is made, the beneficiary is automatically enrolled by the state’s contracted enrollment broker, Michigan ENROLLS, with a health plan in the beneficiary’s county of residence. Health plan enrollees are identified by program enrollment type (PET) codes which start with MHP-XXXX. Health plan enrollees will also receive an identification card from their health plan. There are beneficiaries who: • Must enroll in a health plan. • May voluntarily enroll in a health plan. • Are excluded from enrollment in a health plan. Persons Who Must Enroll In a Health Plan The following must enroll in a health plan, unless they are Persons Who May Voluntarily Enroll in a Health Plan or Persons Excluded from Enrollment in a Health Plan.