Once a senior qualifies for Michigan Medicaid, the next question is always the same: what does it actually pay for? The short answer: a lot, often more than people expect. Michigan has one of the stronger benefit packages in the country for adults over 65, especially after the 2023 adult dental expansion.
This guide walks through every service Michigan Medicaid covers for adults 65+ in 2026, plus the key carve-outs (behavioral health, MI Choice services) where different agencies handle different parts of your care.
The Big Picture
Michigan Medicaid coverage for seniors runs through three payment channels:
- Medicaid Health Plans (MHPs): the nine statewide managed care plans plus Upper Peninsula Health Plan. MHPs cover most medical care for most seniors: doctor visits, hospital, most prescriptions, some dental, vision, hearing, transportation, and pharmacy.
- Prepaid Inpatient Health Plans (PIHPs): the 10 regional PIHPs that handle behavioral health, substance use disorder, and developmental disability services. These services are carved OUT of the MHPs.
- Fee-for-Service Medicaid: for nursing facility residents, MI Choice Waiver participants, and a few other populations, the state pays providers directly rather than through a plan.
The table below summarizes what each channel covers. Details and specific service categories follow.
| Service | Channel |
|---|---|
| Primary care, specialist visits | MHP |
| Hospital inpatient/outpatient | MHP |
| Prescriptions | MHP |
| Dental | MHP (or FFS for waiver members) |
| Vision and hearing aids | MHP |
| Physical/OT/Speech therapy | MHP |
| Non-emergency medical transportation | MHP |
| Behavioral health, substance use disorder | PIHP |
| Mental health medications (certain psychiatric) | PIHP |
| Nursing facility residency | Fee-for-service Medicaid |
| MI Choice Waiver services | Regional Waiver Agency |
| Home Help personal care | MDHHS Adult Services direct |
Federally Mandated Services
The federal Medicaid statute requires every state's program to cover the following, at minimum:
- Inpatient hospital
- Outpatient hospital
- Physician services
- Laboratory and X-ray
- Certified nurse-midwife services
- Nurse practitioner services
- Nursing facility care for adults 21+
- Home health (for people entitled to nursing facility care)
- Federally Qualified Health Center (FQHC) and Rural Health Clinic services
- Family planning services and supplies
- Transportation to medical appointments
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for under 21
Michigan covers all of these.
Michigan's Optional State-Plan Services
On top of the federal floor, Michigan chooses to cover an extensive set of optional services. Most of these are delivered through MHPs.
Prescription Drugs
All outpatient prescriptions are covered through the MHP's pharmacy benefit, subject to the plan's preferred drug list (PDL). Some specialty drugs require prior authorization. Dual-eligibles (Medicare + Medicaid) get most prescriptions through Medicare Part D; Medicaid covers a handful of Part D "excluded" drugs such as certain over-the-counter products.
Dental (Expanded in 2023)
Michigan substantially expanded adult dental coverage starting April 1, 2023. The state invested $85.1 million in higher provider reimbursement (now paid at 100% of the Average Commercial Rate) and $30 million in benefit redesign, bringing adult Medicaid dental near-parity with the Healthy Kids Dental program.
Covered adult dental services now include:
- Diagnostic exams and preventive cleanings (typically 2 per year)
- X-rays on standard dental frequency schedules
- Fillings (composite and amalgam)
- Extractions including surgical
- Root canals with prior authorization
- Crowns with prior authorization
- Dentures (full and partial) with prior authorization
- Periodontal scaling and root planing
- Oral surgery and other specialty dental services
The practical problem in Michigan is not coverage but access: many dentists have not historically accepted Medicaid. The 2023 rate increase was specifically aimed at fixing this. Options for finding a Medicaid-accepting dentist:
- Call your MHP's member services line and ask for the dental network directory.
- Michigan Dental Clinic Program lists Medicaid-accepting safety-net clinics.
- FQHCs with dental programs accept Medicaid statewide.
- Dental school clinics: University of Michigan School of Dentistry (Ann Arbor) and University of Detroit Mercy School of Dentistry (Detroit) have teaching clinics that accept Medicaid.
Vision
Adult Medicaid includes:
- Annual eye exam for most adults
- Frames and lenses every 2 years (basic frames; upgrades are out of pocket)
- Medically necessary contact lenses with prior authorization
- Cataract surgery and related services
Hearing and Hearing Aids
Michigan covers:
- Diagnostic hearing exams for adults
- Hearing aids (one per ear every 5 years in most cases), with prior authorization
- Fitting and repairs
- Cochlear implants for severe cases
Therapy Services
- Physical therapy
- Occupational therapy
- Speech-language pathology
Typically subject to a medical necessity review and periodic reassessment.
Durable Medical Equipment (DME)
Wheelchairs, walkers, hospital beds, oxygen, CPAP, diabetic supplies, and other equipment when medically necessary. Most DME requires prior authorization.
Hospice
Full hospice benefit for terminally ill beneficiaries with a life expectancy of six months or less. Covers nursing, aides, medications related to the terminal illness, equipment, counseling, and bereavement support.
Non-Emergency Medical Transportation (NEMT)
Rides to Medicaid-covered medical appointments. Arranged through your MHP or, for fee-for-service populations, through a state contractor. NEMT is often the single most underused Medicaid benefit. To use it:
- Schedule the appointment.
- Call your MHP's NEMT number at least 3 business days before the appointment.
- Provide pick-up address, appointment time, and destination.
- The MHP arranges the ride (often through a rideshare partnership for ambulatory riders, or a wheelchair-accessible van for those who need it).
Podiatry, Chiropractic, Other Specialty Services
Michigan covers adult podiatry, chiropractic services, and several specialty categories subject to medical necessity and prior authorization.
Personal Care (Home Help)
The Home Help Program is Michigan's state-plan personal care benefit. See the full Home Help guide for eligibility, services, and pay rates.
The PIHP Carve-Out: Behavioral Health and SUD
Behavioral health services are carved OUT of the Medicaid Health Plans in Michigan. They're administered by 10 regional Prepaid Inpatient Health Plans (PIHPs), working with county Community Mental Health Services Programs (CMHSPs). Together these serve approximately 300,000 Michiganders.
PIHP/CMHSP services include:
- Outpatient mental health (psychiatrist, therapist, counseling)
- Substance use disorder treatment (outpatient, residential, medication-assisted)
- Crisis intervention and crisis stabilization
- Partial hospitalization and intensive outpatient programs
- Assertive Community Treatment (ACT) for severe mental illness
- Case management for people with serious mental illness or SUD
- Psychiatric inpatient hospitalization
- Services for people with intellectual and developmental disabilities
What this means in practice: If you're on Medicaid and need mental health or substance use treatment, your MHP will refer you to the regional CMHSP. You don't get these services through your MHP's usual network.
Note: The state's PIHP contracts are up for re-procurement, with a new service start date of October 1, 2026. The names and structure of the regional plans may shift.
What's NOT Covered
Michigan Medicaid does not typically cover:
- Cosmetic procedures (unless medically necessary for reconstruction)
- Experimental or investigational treatments
- Most over-the-counter medications (some exceptions for Medicaid-covered diabetic supplies, etc.)
- Private-duty care beyond approved Home Help or MI Choice hours
- Room and board in assisted living (even when MI Choice covers the services there)
- Services from out-of-state providers (except in emergencies)
- Fertility treatments
- Gym memberships, weight-loss programs (unless specifically included as an MHP value-added benefit)
Value-Added Benefits from MHPs
Each MHP offers "value-added" benefits on top of the standard Medicaid package to attract and retain members. These vary plan to plan and year to year. Common examples in 2026:
- Over-the-counter (OTC) allowance: typically $25 to $75 per quarter for items like pain relievers, cold medicine, first aid supplies.
- Supplemental dental allowance above the base benefit.
- Rideshare benefits for non-medical trips (groceries, pharmacy).
- Gym memberships (some plans partner with SilverSneakers or similar).
- Healthy food cards for members with certain chronic conditions.
- Smartphone or tablet (rare, but some plans offer for telehealth).
Before picking an MHP, call each plan's member services line and ask for their current value-added benefits sheet.
Wondering if Michigan Medicaid will cover a specific service? Chat with Brevy and we'll tell you, plus how to access it.
Coordinating With Medicare
Most Michigan Medicaid seniors are also on Medicare. The two programs coordinate like this:
- Medicare pays first for acute care (doctor visits, hospital, most prescriptions through Part D).
- Medicaid picks up Medicare deductibles, coinsurance, Part B and Part D premiums (via Medicare Savings Programs), and services Medicare doesn't cover (long-term care, dental, vision, hearing, NEMT).
- MI Coordinated Health (MICH) integrates the two into a single plan for full-benefit dual eligibles, replacing the MI Health Link demonstration that ended December 31, 2025.
See the Michigan Medicaid programs hub for the full picture.
Common Misconceptions
"Medicaid doesn't cover adult dental." Michigan does, since April 2023. Coverage is near-parity with Healthy Kids Dental. Access (finding a participating dentist) is the real hurdle, not whether the benefit exists.
"Medicaid only pays for doctor visits and prescriptions." It covers substantially more: dental, vision, hearing aids, therapy, DME, transportation, long-term care, hospice, personal care. The mistake is thinking Medicaid is a narrow benefit when it's actually one of the broadest insurance programs in the country.
"My MHP doesn't cover my mental health." Correct — but that's by design. Behavioral health is carved out to the regional PIHP/CMHSP, which will work with you directly. Call your county CMHSP or 988 in a crisis.
"If Medicaid covers it, I don't pay anything." For full-scope Medicaid seniors with no other coverage, copays are typically $0 to $2. For dual-eligibles, Medicaid covers Medicare cost-sharing through QMB. For MI Choice and nursing home Medicaid, there are patient-pay-amount contributions from the beneficiary's own income, but no out-of-pocket fees beyond that.
"I have to use Medicaid transportation." You don't have to — but you should, because it's free. Private rideshare is out-of-pocket.
Frequently Asked Questions
Yes. Since April 1, 2023, Michigan Medicaid has covered adult dental at near-parity with the Healthy Kids Dental benefit, including diagnostic exams, cleanings, fillings, extractions, root canals, crowns, dentures, and periodontal care. The real challenge is access — not every dentist accepts Medicaid. Call your MHP's dental line or check FQHCs and dental school clinics.
Non-emergency medical transportation (NEMT) is a covered benefit. Call your MHP's NEMT number at least 3 business days before the appointment. Provide pick-up address, appointment time, and destination, and the MHP arranges the ride — often via a rideshare partnership for ambulatory riders, or a wheelchair-accessible van when needed.
Yes. Michigan covers diagnostic hearing exams, hearing aids (one per ear every 5 years in most cases with prior authorization), fitting and repairs, and cochlear implants for severe cases.
Behavioral health, substance use disorder, and intellectual/developmental disability services are carved OUT of the MHPs in Michigan. They're delivered through 10 regional Prepaid Inpatient Health Plans (PIHPs) working with county Community Mental Health Services Programs. Your MHP will refer you to the regional CMHSP for these services.
No. MI Choice Waiver can cover care services (personal care, supports coordination, respite) delivered in an Adult Foster Care home or Home for the Aged, but never room and board. The resident pays room and board from their own income (Social Security, pension), often supplemented by VA Aid & Attendance.
Related Terms
- Managed Care Organization (MCO): The national term for Medicaid Health Plans.
- HCBS waiver: MI Choice is an HCBS waiver; services are carved out of MHPs.
- Activities of Daily Living (ADLs): Used in eligibility determinations for many covered services.
Learn More
- Michigan Medicaid Programs for Seniors (Hub)
- Michigan Medicaid Health Plans: Compare All MCOs
- Michigan Home Help Program
- MI Choice Waiver Program
- Does Michigan Medicaid Cover Dental?
- Michigan Medicaid Nursing Home Coverage
Find personalized help understanding your Michigan Medicaid benefits at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Specific service coverage, prior authorization requirements, and network rules vary by plan and change. Always verify current coverage with your MHP's member services line or MDHHS. Brevy is not a law firm, financial advisor, or healthcare provider.