While all states must operate within federal law and guidelines, states are in charge of administering Medicaid, meaning they are responsible for determining eligibility rules, types and scope of services covered, and the dollar amount paid for each medical service (often referred to as “reimbursement rates”). Therefore, as you might imagine, there is incredible variability across state Medicaid programs.

Medicaid eligibility is based on three main factors: income, category (such as being a child, senior, pregnant or disabled person) and residency. Income limits and asset standards vary by state and for different categories of beneficiaries. In general, to qualify for Medicaid in Michigan, you must:

• Be a Michigan resident
• Have income, and in some cases assets, at or below specific limits
• Be a U.S. citizen or lawfully present immigrant

Why Does Medicaid Matter?

Medicaid matters because it provides meaningful health coverage to those who otherwise would be unable to afford medical care. Medicaid, and affordable comprehensive health coverage generally, protects individuals from exorbitant medical expenses and medical debt. Having health insurance fosters timely, consistent care which is important for identifying and treating health conditions early on rather than later after issues worsen and costs tend to increase. Medicaid is a lifeline for rural health facilities and other health systems serving a large percentage of working-class families. 

​Additionally, Medicaid expansion has been pivotal in reducing racial disparities in health coverage, access and outcomes. ​By increasing insurance coverage ​and, as a result​, increased funding from a more widely insured population, expansion has led to measurable improvements in healthcare infrastructure and self-reported health among beneficiaries. ​For example,​ research found that ​Black Michiganders enrolled in the Healthy Michigan Plan experienced the greatest decline ​in poor physical health days of any racial or ethnic group.​ These findings ​align with national trends showing that Medicaid expansion has helped narrow racial gaps in uninsured rates and access to care.^3,4

Medicaid Programs and Health Plans

There are several Medicaid programs that serve specific groups of people, each with its own eligibility criteria and benefits. In Michigan, Medicaid programs include:

• Healthy Kids: A program offering Medicaid coverage to children under 19.
• MIChild: Michigan’s Children’s Health Insurance Program (CHIP) for children in families with higher incomes, but still below a certain threshold.
• Pregnant Women: Medicaid coverage for pregnant women, including prenatal, labor and delivery, and postpartum care.
• ABD (Aged, Blind, and Disabled): Medicaid coverage for seniors, individuals who are blind, and individuals with disabilities.
• Healthy Michigan Plan: Medicaid expansion program that covers low-income adults.
• MOMS (Maternity Outpatient Medical Services): A Medicaid program specifically for outpatient maternity care for pregnant women who may not be eligible for full Medicaid benefits.
• ESO (Emergency Services Only): Medicaid coverage for individuals who are in the U.S. without full legal status but need emergency medical services.

A majority of states leverage managed care to administer their Medicaid programs. Managed care means private health insurance companies contract with a state to provide coverage to at least a portion of Medicaid beneficiaries. Typically, managed care organizations (MCOs) oversee a large percentage of Medicaid beneficiaries, with the remaining covered through “fee-for-service.” Fee-for-service Medicaid beneficiaries are most often individuals with disabilities or those needing long-term care. There are currently nine Medicaid MCOs available in Michigan.

You can find which plans are available in your county here.  

The state also contracts with Delta Dental of Michigan to provide dental coverage for children enrolled in Healthy Kids.

Medicaid is the single largest payer for long-term care, maternity care and mental health care. Covered benefits vary by state and Medicaid program but generally include a wide range of services, such as:

• Preventive Care: Well-child visits, immunizations, screenings, and other preventive services to help detect health issues early and prevent future health problems.
• Women’s and Maternal Healthcare: OBGYN services, prenatal care, labor and delivery care, and postpartum services.
• Hospital and Emergency Services: Inpatient and outpatient care, emergency room visits, and urgent care services.
• Laboratory Tests, X-rays and Medical Supplies: Diagnostic tests, imaging (like X-rays), and medical supplies necessary for treatment.
• Vision, Hearing and Speech Services: Eye exams, glasses, hearing exams, hearing aids, and speech therapy.
• Dental and Oral Healthcare: Preventive dental services, routine exams, cleanings, and necessary dental treatments, such as fillings and extractions.
• Pharmacy: Prescription medications and some over-the-counter drugs.
• Mental or Behavioral Healthcare: Includes services for mental health conditions, therapy, counseling, and substance use disorder treatment.
• Long-term Services and Supports: Includes services like nursing home care and home and community-based services such as programs like MIChoice and Program for All-inclusive Care for the Elderly (PACE).