You can still get care before, during and after an emergency or disaster. People may be eligible for MI Health Link if they: Live in the counties of Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren, Wayne, or any county in the Upper Peninsula Are age 21 or older Have full Medicare and full Medicaid Are not enrolled in hospice Home to an array of public health programs, initiatives and interventions aimed at improving the health and well-being of women, infants, families and communities. 423.120(b)(3). Our migrant program works with a number of organizations to provide services for Michigans migrant and seasonal farmworkers. How will care coordination work with MI Health Link? If you live in a specialized residential setting, the MI Health Link health plan and the PIHP/CMH must work together to ensure that personal care services continue as they are currently being provided. You may file a grievance either orally or in writing, by one of the methods below. Will there be training for providers who participate in MI Health Link? If you disagree with the decision listed in the adverse determination, you can begin the appeal process by filing an internal appeal with your health insurer. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. False Prevention of diseases & conditions such as heart disease, cancer, diabetes and many others. Michigan's Women, Infants & Children program, providing supplemental nutrition, breastfeeding information, and other resources for healthy mothers & babies. 712 0 obj <>stream You must file your grievance within 60 days of the event that gives rise to the grievance. Integrated Care Organizations (ICOs) will give providers information and resources to support care coordination through timely communication across care team members. State and federal law protects your rights. Follow the steps below to file a complaint and grievance with your health plan: Below are links to the complaint forms for Michigans top health plans: You have the right to file a complaint with the Department of Insurance and Financial Services (DIFS) if you have a problem getting the services you need, including quality and affordable health care. endstream endobj startxref Children's Special Health Care Services information and FAQ's. Services will be delivered through one integrated system to enhance communication and care delivery. Michigans stay at home order has been lifted, learn about each phase of theMI Safe Start Plan, Resuming Standard Operations for Case Management and Home and Community Based Services- NEW. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. Low-income Households Water Assistance Program (LIHWAP). Information on Adult Protective Services, Independent Living Services, Adult Community Placement Services, and HIV/AIDS Support Services. MDHHS News, Press Releases, Media toolkit, and Media Inquiries. Licensing information for Adult Foster Care and Homes for the Aged, Child Day Care Facilities, Child Caring Institutions, Children's Foster Care Homes, Child Placing Agencies, Juvenile Court Operated Facilities and Children's or Adult Foster Care Camps. We take pride in the vastly diverse cultures, backgrounds, interests, and expertise of the people who work here. For any other questions, Please call Member Services Coverage is available through Medicaid and the Healthy Michigan Plan, depending on income and other factors. Information about the Michigan law that requires certain information be made available to a woman who is seeking an abortion at least 24 hours prior to the abortion procedure. You will no longer need to wait for a Medicare denial to bill Medicaid. Maintain current provider and level of services at the time of enrollment for 180 days. A list of reports produced by our Department. Information about audits conducted by the Office of Audit. This request is known as a claim. (1-888-746-6456) Information & resources for Community and Faith-Based partners. By Michigan law, each health plan must establish a grievance process. To file a complaint you must first complete your health plans grievance process. Information & resources for Community and Faith-Based partners. If you receive Personal Care services through the home help program, the MI Health Link health plan will provide your personal care services along with any medical and pharmacy services you need. Find Marketplace help near you by visiting LocalHelp.HealthCare.gov. Send us an email at DIFSInfo@michigan.gov, Department of Insurance and Financial Services, Additional Financial and Insurance Services Forms, Go to Licensing - Consumer Finance and Mortgage, Go to Additional Financial and Insurance Services Forms, Go to DIFS Biographies and Public Officials, Life Insurance and Annuity Search Service (LIAS), Financial Education (Banking, Credit Union and Credit Information). Who is eligible for MI Health Link? Resources and information to assist in assuring firearm safety for families in the state of Michigan. Will I still be paid? Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. The health plan will pay your caregiver for personal care services. Information is collected to monitor the general health and well-being of Michigan citizens. If you receive Personal Care services through the home help program, the MI Health Link health plan will provide your personal care services along with any medical and pharmacy services you need. An appeal can be filed when you do not agree with Molina Healthcare's decision to: Those who are eligible for both Medicare and Medicaid and qualify for MI Health Link will be sent enrollment options through a letter from Michigan ENROLLS. 2 Out-of-network nursing facilities must be offered single case agreements to continue to care for the enrollee through the life of the demonstration if the nursing facility does not participate in the ICO's network and the enrollee: Adult & Children's Services collapsed link, Safety & Injury Prevention collapsed link, Emergency Relief: Home, Utilities & Burial, Adult Behavioral Health & Developmental Disability, MI Health Link is a health care option for Michigan adults, age 21 or older, who are enrolled in both Medicare and Medicaid. They will have their own Care Coordinators who will ask them about their health care needs and choices and will work with them to create a personal care plan based on their goals. Information on Safe Sleep for your baby, how to protect your baby's life. The California Chronic Care Coalition (CCCC) launched this website in California and expanded it nationwide to help people who have been denied treatment or medicines, experienced delays or are dissatisfied with the decisions made by their health plan. Study with Quizlet and memorize flashcards containing terms like A consumer may request a State Fair Hearing if his/her grievance is not resolved within 90 days., A consumer may request a State Fair Hearing if his/her is not satisfied with the outcome of the grievance., Consumer with MI Health Link insurance can file grievances: and more. Information on assistance with home repairs, heat and utility bills, relocation, home ownership, burials, home energy, and eligibility requirements. If you cannot afford child care, payment assistance is available. For more information, please read Integrated Care Organization Transition Requirements at Enrollment. DIFS has an on-demand health insurance webinarthat can provide answers to some of the most common health insurance questions. An expedited external appeal is conducted by DIFS within 72 hours. You'll enjoy single plan coverage for: Medical care Behavioral health care Home and community-based services Nursing home care Medications It's for Michigan adults: 21 or over Alliance Health and Life Insurance Company (888) 999-4347 Self-funded / ASO (866) 766-4709 HAP . Behavioral Health Information on the grant awarded for the State Innovation Model Proposal, Offers resources for agencies who operate the Weatherization Assistance Program in the state of Michigan. 1Requirements for all Medicare and Medicaid pharmacy transition will adhere to Medicare Part D pharmacy transition requirements. *Not applicable for enrollees transitioning from the MIChoice HCBS waiver. A variety of reports & statistics for programs and services. Resources and information to assist in assuring firearm safety for families in the state of Michigan. The Michigan Department of Health and Human Services' (MDHHS) Division of Environmental Health (DEH) uses the best available science to reduce, eliminate, or prevent harm from environmental, chemical, and physical hazards. . Adult Behavioral Health & Developmental Disability Services. Don't lose your benefits Don't lose your benefits. MI Health Link is a complete integrated health care program for Michigan residents that meet program requirements and that: MI Health Link offers a broad range of medical and behavioral health services, pharmacy, home and community-based services and nursing home care, all in a single program designed to meet individual needs. Integrated Care Organizations (ICOs) will give providers information and resources to support care coordination through timely communication across care team members and through the use of aninteroperable electronicplatform calledthe Care Bridge. Universal caseload, or task-based processing, is a different way of handling public assistance cases. Information on DHS Applications and Forms grouped by category. Health Care Coverage information and resources. It brings together your services into one plan, one card and one care coordinator. There are certain situations where you may be able to sign up for Medicare during a special enrollment period, for example if you lose employer-provided health insurance. Information on Adult Protective Services, Independent Living Services, Adult Community Placement Services, and HIV/AIDS Support Services. Can I appeal the denial of a health care service that was considered experimental and/or investigational? Need to talk with DIFS? Information on resources in your community and volunteer recruitment and training, and services provided at local DHS offices. We will provide you with help through each step. Information about audits conducted by the Office of Audit. How you file a complaint depends on what your complaint is about. All of our services are free and we keep all beneficiary information confidential. 60 calendar days for a health care service you have already received (a post-service denial). First, contact the grievance cell or helpdesk of your health insurance company regarding your issue. Health Care Coverage information and resources. Please note: PDFs require Adobe Reader to download and read. What is a grievance? HAP Empowered MI Health Link (Medicare Medicaid Plan) has an emergency plan to make sure you are always covered. MI Health Link is a health care option for Michigan adults, age 21 or older, who are enrolled in both Medicare and Medicaid. When you sign up for a health plan and/or if you have problems accessing care through your health plan, it is important to know your rights. There are two ways to file an appeal or grievance (complaint): Call Member Services at 1-877-860-2837. A 90-day supply of drugs when an enrollee requests a refill of a non-Part D drug that is covered by Medicaid. Information on the Family Independence Program, State Disability Assistance, SSI, Refugee, and other cash assistance. Send us an email at DIFSInfo@michigan.gov, Department of Insurance and Financial Services, Additional Financial and Insurance Services Forms, Appealing a Decision Made by Your Health Insurer. endstream endobj 656 0 obj <>/Metadata 165 0 R/Outlines 250 0 R/Pages 653 0 R/StructTreeRoot 258 0 R/Type/Catalog/ViewerPreferences 681 0 R>> endobj 657 0 obj <>/MediaBox[0 0 792 612]/Parent 653 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 658 0 obj <>stream Requires nursing facility care and resides in a retirement community that includes a nursing facility. Please do not share personal health information when you leave your message. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. Information about the Michigan law that requires certain information be made available to a woman who is seeking an abortion at least 24 hours prior to the abortion procedure. A list of reports produced by our Department. MI Health Link aims to reduce the administrativeburden for providersand simplify the navigation of benefits and services for this population. If you enrolled in a health plan that uses a HealthLink network, please contact your plan benefits administrator, identified on your ID card, for questions regarding adverse benefit determinations. Your appeal must include a letter from your treating physician verifying the necessity of an expedited review. Ask your caregiver to contact your MI Health Link health plan to enroll as a provider. What if you could get all the help you need for your health plan all at once? These topics include, but are not limited to, care coordination, service delivery, complaints and grievances, and person-centered planning. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. A federal program which helps persons admitted into the U.S. as refugees to become self-sufficient after their arrival. Useour search toolto find a doctor, dentist or a hearing provider, Michiganders are spending more time at home. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. Information about injury and violence prevention programs in Michigan. MI Health Link is a health care option for Michigan adults, age 21 or older, who are enrolled in both Medicare and Medicaid. TIMEFRAMES Need to talk with DIFS? Go to Licensing - Consumer Finance and Mortgage, Go to Additional Financial and Insurance Services Forms, Go to DIFS Biographies and Public Officials, Health Care Appeals-Request for External Review (online), Health Care Appeals-Request for External Review (PDF), Treating Provider Certification for Experimental/Investigational Denials form, Life Insurance and Annuity Search Service (LIAS), Financial Education (Banking, Credit Union and Credit Information). Information on the Children's Foster Care program and becoming a Foster Parent. Ask your insurer to conduct a full and fair review of its initial decision. hbbd```b``"$dsHf10i f6`5( A`VA`]^ RiHM;!-V$~$ Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Prevention of diseases & conditions such as heart disease, cancer, diabetes and many others. true A grievance must be resolved within: 90 calendar days Consumer with MI Health Link insurance can file grievances: Anytime he/she expresses dissatisfaction Your health plan can request an additional 10 days to obtain necessary medical information, Select: Claims and Accounts > Medical Appeals and Grievances > Member Service Request Form, Fax or mail the completed form to the UnitedHealthcare address listed in the instructions, Request an External Review through the PRIRA, Find more information on the PRIRA process. 30 calendar days for a health care service that has been scheduled but not yet completed (a pre-service denial). A list of reports produced by our Department. The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training. First contact your health plan with your complaint and ask them to provide a written response. Information on communicable & chronic diseases. Resources and information to assist in assuring firearm safety for families in the state of Michigan. Information on the Family Independence Program, State Disability Assistance, SSI, Refugee, and other cash assistance. The MI Health Link Ombudsman (MHLO) serves as an advocate and problem-solver for beneficiaries enrolled in MI Health Link. Connect beneficiaries to other resources. ;sKk3U5uEe 9}C-=%]m#yYcM)i1I q84z t80C _ Prevention of diseases & conditions such as heart disease, cancer, diabetes and many others. They will not pay a deductible or copayment when they receive services from an ICO in-network provider. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. information about the Department's public safety programs. You may be eligible for MI Health Link if you: How do I enroll? We can: We also work with health plans, Pre-Paid Inpatient Health Plans (that offer behavioral health services), the Michigan Department of Health and Human Services, and the federal government to spot issues, identify best practices, and offer solutions that will help make the MI Health Link program work better for beneficiaries. We take pride in the vastly diverse cultures, backgrounds, interests, and expertise of the people who work here. To make sure our office has the information necessary to thoroughly review the issue, please complete all fields and include specific details (physician or facility name, date of service, billed amounts, reason for submitting the form, etc.). We provide most of our assistance to beneficiaries through both a toll-free hotline and through email responses to questions and problems. GetSetup is a free and interactive program for older adults. Talk to your doctor or a qualified healthcare provider about any health or medical questions you may have, and to determine the correct course of action for your individual needs. Howdo I join a provider network? The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Open Enrollment for 2023 health insurance ran between November 1, 2022 and January 15, 2023. When the DIFS external appeal process is completed, both you and the insurer will receive. The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training. If you need one-on-one assistance, please contact the Health Consumer Alliance's Consumer Assistance Program at 1-888-804-3536. Simplified billing will reduce the delay and duplication from working with multiple payment systems. If you have Medicare health or drug coverage from an employer or union sponsored plan, you can leave that coverage and enroll in MI Health Link. CONTACT Information about the health care programs available through Medicaid and how to qualify. Children's Special Health Care Services information and FAQ's. J@a`Y The denial notice you received will tell you the process you must follow, including how long you have to submit the internal appeal to your health insurer. What does that mean? Live in the Michigan counties of Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren, Wayne or any county in the Upper Peninsula. A HAP Medicare Customer Service Representative will return your phone call the next business day. Michigan Complete Health (formerly Fidelis Secure Care), Department of Insurance and Financial Services. If you are still dissatisfied after contacting the health insurer or the agent, contact DIFS' Office of Consumer Services to ask questions or to file a written complaint by completion of this form. We . This is called an external appeal. With MI Health Link, there are no co-pays or deductibles for in-network services or medications. What to consider when deciding to join MI Health Link. If you are interested in a rewarding position helping Michiganders apply today! Molina Medicare wants you to have access to the grievance process. What are the benefits of MI Health Link for enrollees? Information & resources for Community and Faith-Based partners. You can change health plans or leave MI Health Link at any time. If you have any questions about filing a complaint, please call 517-335-7560. What Could Be the Reasons? MDHHS advises review of Actions for Caregivers of Older Adults During COVID-19 and supportingFrequently Asked Questions (FAQ)document. A federal program which helps persons admitted into the U.S. as refugees to become self-sufficient after their arrival. Who is able to file an appeal for a health service denial? MI Health Link MI Health Link. Information on the Food Assistance Program, eligibility requirements, and other food resources. DIFS Prohibition Orders for Consumer Finance and Credit Union. For a list of other state and federal . Expedited external appeals can be requested using either the. If you need care immediately, view the expedited external appeal section. Licensing information for Adult Foster Care and Homes for the Aged, Child Day Care Facilities, Child Caring Institutions, Children's Foster Care Homes, Child Placing Agencies, Juvenile Court Operated Facilities and Children's or Adult Foster Care Camps. Personal Care/Home Help If you are interested in a rewarding position helping Michiganders apply today! Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. Licensing - Consumer Finance and Mortgage. HAP Empowered MI Health Link is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees. Care coordination is a key benefit of MI Health Link. Habilitation Supports Waiver Provider contracts with the ICOs will define specific payment structures and procedures. Medicare is health insurance for people 65 or older. Information on the Food Assistance Program, eligibility requirements, and other food resources. Legislation policy and planning information. Programs for healthy children & families, including immunization, lead poisoning prevention, prenatal smoking cessation, and many others. Information about audits conducted by the Office of Audit. Resides in the nursing facility at the time of enrollment; Has a family member or spouse that resides in the nursing facility; or. If you choose to not participate with an Integrated Care Organization (ICO), you may continue to see your patients who are enrolledonce they have joined MI Health Link for a limited period of time - depending on the type of care or service provided. You will have one plan for all your Medicare and Medicaid benefits including medications. DIFS has an on-demand health insurance webinar that can provide answers to some of the most common health insurance questions. Your letter will describe your options for MI Health Link. Consumer Services then acts as a link between you and your health plan to resolve the complaint. Adult & Children's Services collapsed link, Safety & Injury Prevention collapsed link, Emergency Relief: Home, Utilities & Burial, Adult Behavioral Health & Developmental Disability, MI Health Link Information for People with Medicare and Medicaid. Following are the contact details of some of the leading . Failure to submit your appeal within the timeframe listed in the notice may invalidate your claim. MEMBER GRIEVANCE AND APPEAL FORM HealthLink members have the right to document a grievance or file an appeal by filling out a simple form. Information is collected to monitor the general health and well-being of Michigan citizens. Call your health insurer if you do not understand how to submit an internal appeal. . Programs for healthy children & families, including immunization, lead poisoning prevention, prenatal smoking cessation, and many others. You can "Opt out" and disenroll from MI Health Link by contacting Michigan ENROLLS at 1-800-975-7630, TTY users may call 1-888-263-5897. You will have your own Care Coordinator who will: Work with you to create a personal care plan based on your goals, Answer your questions and make sure that your heath care issues get the attention they deserve, Connect you to supports and services you need to be healthy and live where you want. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. Access the health insurance resources below or contact the Department of Insurance and Financial Services (DIFS) at 877-999-6442 from 8 a.m. to 5 p.m. Monday through Friday. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. Information on child support services for participants and partners. Information on assistance with home repairs, heat and utility bills, relocation, home ownership, burials, home energy, and eligibility requirements. If your claim has been denied and you need care immediately to protect your life, health, or ability to regain maximum function, you may be able to file a DIFS expedited external appeal. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. If you do not agree with your health plans initial response, file a written complaint with the Department of Insurance and Financial Services, Office of Consumer Services. Currently, theseindividuals navigate multiple sets of rules, benefits, insurance cards, and providers in accessing services covered by Medicare Parts A and B, Part D, and Medicaid. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Live in the Michigan counties of Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren, Wayne or any county in the Upper Peninsula. 2002-2023 HealthLink, Inc. All rights reserved.
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