Michigan Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Michigan's plan contracts, statutes and notices. For 13 of 21 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 13of 21
- Plans on record
- 11
- Directed payments
- 8
- Capitation cells
- 32$1.53–$3,472.98 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 28,494 | State wraparound guaranteeState sets the plan rate |
| Radiology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 9,050 | State wraparound guarantee |
| Pharmacy | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 6,121 | State wraparound guaranteePaid by the state, outside plans |
| Lab & pathology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 5,467 | State wraparound guarantee |
| Hospice | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 2,864 | |
| Equipment & supplies | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 2,376 | State wraparound guaranteeState sets the plan rate |
| Dental | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 940 | State wraparound guaranteePlans must pay at least this |
| Hospital outpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 529 | |
| Behavioral health | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 409 | State wraparound guaranteeState sets the plan rate |
| Hospital inpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 376 | |
| Therapy (PT/OT/speech) | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 263 | State wraparound guaranteeState sets the plan rate |
| Vision & hearing | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 198 | |
| Other | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 99 | State-directed paymentState wraparound guarantee |
| Transportation | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 40 | |
| Other home & community services | State sets the plan rateThe state sets the rate plans pay | 37 | Plans negotiate; applies out of networkPaid by the state, outside plans |
| Private duty nursing | Paid by the state, outside plansPaid directly by the state, outside managed care | 11 | State sets the plan rate |
| Home health | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 10 | |
| ABA / autism services | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 7 | |
| Clinics (FQHC/RHC) | State wraparound guaranteeThe state guarantees the encounter rate on top of plan payment | 7 | Suggested schedule for plansPlans negotiate; applies out of network |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 4 | State sets the plan ratePlans negotiate; applies out of network |
| Nursing facility | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 4 | Paid by the state, outside plans |
State-directed payments
Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.
| Program | Amount | Effective |
|---|---|---|
| MI Health Link state directed payments (42 CFR 438.6(c)) | $3.40 | 2026-01-01 |
| MI Health Link state directed payments (42 CFR 438.6(c)) | $0.44 | 2026-01-01 |
| MI Health Link state directed payments (42 CFR 438.6(c)) | 78.59% | 2026-01-01 |
| MI Health Link state directed payments (42 CFR 438.6(c)) | 21.41% | 2026-01-01 |
| MI Health Link state directed payments (42 CFR 438.6(c)) | 100% | 2026-01-01 |
| MI Health Link state directed payments (42 CFR 438.6(c)) | 85.81% | 2026-01-01 |
| MI Health Link state directed payments (42 CFR 438.6(c)) | 14.19% | 2026-01-01 |
| MI Health Link state directed payments (42 CFR 438.6(c)) | 100% | 2026-01-01 |
Frequently asked questions
Do Michigan Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Radiology, Pharmacy, Lab & pathology, Equipment & supplies, Dental, Behavioral health, Therapy (PT/OT/speech), Other, Other home & community services, Private duty nursing, Clinics (FQHC/RHC), Personal care & attendant. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Michigan's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.