The Michigan Department of Health and Human Services (MDHHS) is implementing a Medicare-Medicaid capitated financial alignment demonstration program called MI Health Link (MHL). A Memorandum of Understanding was signed on April 3, 2014 and the program began providing services in the first two demonstration regions by January 1, 2015. MHL has now been implemented in four regions of the state, including all counties of the Upper Peninsula, eight counties in southwest Michigan (Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph and Van Buren), Macomb and Wayne counties. There are approximately 100,000 people who are eligible for both Medicare and Medicaid in the demonstration regions.
Michigan is a national leader in administering its Medicaid program through managed care organizations. Nearly 90% of the Michigan Medicaid population eligible for enrollment in managed care are receiving services through one of 13 Medicaid Health Plans. All behavioral health specialty services, including those for persons with intellectual/developmental disabilities and substance use disorders, are provided through a 1915(b)(c) combination waiver using 10 Prepaid Insurance Health Plans (PIHPs). Michigan’s home and community-based services waiver for persons who are elderly or physically disabled, MI Choice, has already transitioned to a capitated service delivery model. Staff members from all these areas of managed care provided expertise to the development and implementation of MI Health Link.
The MHL team includes two Registered Nurses, three contract managers, two quality analysts, four enrollment specialists and a special projects specialist. One of the contract managers is specifically tasked with focusing on the MI Health Link Ombudsman and One on One Counseling programs for contract monitoring and program oversight. MDHHS directors from the Office of Services to the Aging, the Behavioral Health and Developmental Disabilities Administration, and the Medicaid leadership team continue to provide support and guidance when appropriate. The Medicaid Director holds decision-making authority in the MI Health Link governance structure and the team has a direct link to MDHHS Director when department level decisions are required.
The Integrated Care Division (ICD) has responsibility for day-to-day implementation and operational activities of MI Health Link. Pamela Gourwitz is the Division Director responsible for management of the ICD and MHL, with Brian Barrie, Acting Bureau Director for the Medicaid Policy & Health System Innovation, serving as the FAD project sponsor. Mr. Barrie reports directly to the Medicaid Director. As indicated above, expertise and leadership from all pertinent areas of MDHHS (Aging, Behavioral Health, Managed Care, Long Term Supports and Services, and Policy) are available for consultation, and are invited to participate in ICO/PIHP Operations Meetings for MHL.
1. Ombudsman
The MI Health Link Ombudsman Program (MHLO) has been operational since October of 2015. MHLO is organizationally separate from MDHHS administered by an entity external to the State of Michigan and MDHHS to ensure conflict-free assistance for enrollees. This entity has demonstrated capabilities to meet the goals for the Financial Alignment Demonstration and to be responsive to the immediate needs of all Demonstration enrollees in a confidential and person-centered manner.
The program requirements set forth by the State include those identified for the FAD Ombudsman Program, together with requirements for demonstrated credibility with beneficiaries; accessibility; capability to investigate complaints consistent with HIPAA Privacy rules; ability to coordinate with entities such as the Michigan Medicare-Medicaid Assistance Program (Michigan’s State Health Insurance Program), Aging and Disability Resource Collaboratives (ADRCs),state licensing agencies, the Michigan Long Term Care Ombudsman Program (LTCOP), civil legal services, and other
