Michigan MIChild
Program
With the implementation of the MIChild program, Michigan has built on lessons learned
in Medicaid to make improvements in the area of service delivery systems. SCHIP Workshop
(July/September 1998) presenter Denise Holmes, of the Michigan Medical Services
Administration, discussed the experiences of the MIChild program as follows.
- MCO Development. The
State used its leverage as the largest purchaser of health care to stimulate the
development of much-needed Medicaid managed care organizations (MCO) in parts of the State
where they previously did not exist. The issuance of an RFP for new and/or expanded
Medicaid MCOs and the decision to no longer accept the fee-for-service (FSS) option
resulted in a significant increase in MCOs throughout the State.
- Prior to the MIChild RFP for MCOs:
- 38 counties had 0 Medicaid plans.
- 37 counties had 1-3 Medicaid plans.
- 8 counties had 4 or more Medicaid plans.
- After the MIChild RFP for MCOs:
- 0 counties have 0 Medicaid plans.
- 1 county has 1-3 Medicaid plans.
- 82 counties have 4 or more Medicaid plans
- Service Delivery Incentives. Service delivery capacity was also addressed through
incentives to physicians and health plans such as:
- Adverse risk supplements for first 7 months.
- Physician rates based on Medicare— these rates are 95 percent above Medicaid, which almost
doubles the physician’s rates.
- Maternity case rate of $4,000.
- Vaccines supplied by the State.
- Hospital Service Delivery Issues. Hospitals in Michigan created a critical
service issue when monopoly hospitals refused to negotiate hospital contracts with health
plans. To address this issue, the State has taken the position that health plans are
agents of Medicaid, and therefore cannot be charged higher prices than the Medicaid
diagnosis-related group (DRG) in absence of a contract.
- Historic Medicaid Providers. HMO’s are encouraged to include historic
Medicaid providers, such as Indian Health Centers (IHCs), Adolescent Health Centers and
Family Planning Clinics, in their network.
- IHCs and Adolescent Health Centers: MIChild to Medicaid comparison
- Family Planning and local
health department: MIChild to Medicaid comparison
- Dental Services. Although there are over 6,000 licensed dentists in Michigan,
only approximately 2,000 have participated in the Medicaid Dental Coverage program in past
years. The MIChild Dental Coverage program has been successful in increasing the total
number of participating dentists to over 4,000 and has instituted access standards to
which participating dentists must adhere. All participating dentists must:
- Accept new patients.
- Provide an appointment within 3 weeks.
- Provide emergency appointments within 24 hours.
Related Questions
What led to this?
Give me an overall context
Show me some lessons learned
Show me more State
strategies
Take me to related
sites
Who presented this material?
|
Benefit Design 
