Medicaid rebid impacts on providers in Northern and Southwest Michigan
The first Medicaid rebid since 2015 was just finalized, and the results will impact your work with Priority Health Medicaid members if you’re a provider in Northern or Southwest Michigan. The changes take effect on October 1.
What's the Medicaid rebid?
The Medicaid rebid is a competitive process run by the Michigan Department of Health and Human Services (MDHHS) which determines where health plans can offer their Medicaid products in Michigan. Michigan is divided into 10 “Prosperity Regions,” each of which allows one or more health plans to serve the Medicaid members living there.
The rebid changes take effect on Oct. 1, 2024. They'll be in effect until the next rebid, which will not occur until at least 2029.
Members will be receiving an MDHHS letter with information if their current plan is exiting the region they live in. They’ll then be given a chance to choose a new plan online by September 17, or they’ll be automatically assigned to one of the new plans entering the region.
What’s changing for Priority Health?
As a result of the rebid, Priority Health maintained access to Regions 4 (West Michigan) and 10 (Detroit Metro), gained access to Regions 2 and 3 (Northern Michigan) and lost access to Region 8 (Southwest Michigan). See below for a list of the counties in the regions that we’re entering and leaving and what you need to know if you’re a provider in these regions.
Regions 2 and 3 (Northern Michigan)
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Welcome to our Medicaid network. If you’ve been in the health care industry since 2015, you’ll remember that we’ve served Medicaid members in your region before, and we’re excited to be back.
If you’re not yet in our network, please join. If you’d like to begin serving Medicaid members and haven’t yet been credentialed to do so, please visit MDHHS’s Community Health Automated Medicaid Process System (CHAMPS) page.
As long as you’re in our network, you can continue to see the Medicaid members you’ve been seeing if they transition to our plan. If you’re the member’s PCP, encourage them to name you as their assigned PCP during the transition period or to use their member portal after October 1 to select you as their PCP.
If you have patients choosing a plan, we encourage you to share this informative MDHHS guide to Michigan Medicaid health plans, which provides quality ratings in a variety of categories for each Michigan Medicaid health plan and shows Priority Health as the highest ranked plan in the lower peninsula. For more information about Priority Health Medicaid specifically, you can direct your patients to our Michigan Medicaid page.
We have several resources in our provider manual for you to refer to and bookmark as you work with our Medicaid members:
- Priority Health Medicaid program info
- Medicaid patient treatment requirements
- Priority Health’s downloadable Medicaid Provider Manual
You can also find general information about being a Medicaid provider in Michigan on MDHHS’s site for Medicaid providers.
Region 8 (Southwest Michigan)
- Berrien
- Branch
- Calhoun
- Cass
- Kalamazoo
- St. Joseph
- Van Buren
Thank you so much for having served our Medicaid members so well these past several years.
Encourage your members to refer to their MDHHS letter for information about changing plans. If they don’t pick a new plan by September 17, they’ll be automatically assigned to one of the new plans in the region. Neither you nor the member need to do anything to end their Priority Health Medicaid coverage on October 1.
Still have questions?
See our provider FAQs for more details about the rebid and its impacts.