Michigan Health Homes

Program Location: 
Lansing, MI
Payer Type: 

Michigan currently has three health home models. The first State Plan Amendment created a SMI health home model in two counties in 2014. In 2016, a second State Plan Amendment created a chronic conditions health home model in 21 counties. The third State Plan Amendment was approved in 2018 and it creates an opioid treatment health home (OHH) model in 21 counties. 

The OHH will provide comprehensive care management and coordination services to Medicaid beneficiaries with opioid use disorder who also have or are at risk of developing another chronic condition. For enrolled beneficiaries, the OHH will function as the central point of contact for directing patient-centered care across the broader health care system. Beneficiaries will work with an interdisciplinary team of providers to develop an individualized recovery care plan to best manage their care. The model will also elevate the role and importance of peer recovery coaches and community health workers to foster direct empathy and connection to improve overall health and wellness. In doing so, this will attend to a beneficiary's complete health and social needs. Participation is voluntary, and enrolled beneficiaries may opt out at any time.

Opioid health home receives reimbursement for providing the following federally mandated core services:

  • Comprehensive care management
  • Care coordination and health promotion
  • Comprehensive transitional care
  • Patient and family support
  • Referral to community and support services
Payment Model: 
  • MDHHS will pay the PIHP a case rate based on attributed lives
  • The PIHP will pay OHH providers based on approved encounters for enrolled beneficiaries
    • Payment will be in the form of a monthly case rate—one payment per month per beneficiary:
      • Recovery Action Plan Rate (enhanced first month rate to account for longer encounter)
      • Ongoing Care Management Rate
  • The PIHP will submit encounters to MDHHS
  • MDHHS will reconcile periodically based on submitted and approved encounters
Last updated March 2019
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