Michigan Medicaid Covered Services: What's Covered for Seniors (2026)

Once a senior qualifies for Michigan Medicaid, the program covers far more than doctor visits, from adult dental and hearing aids to transportation, hospice, and long-term care. The full benefit also includes hospital and physician care, prescriptions, vision, therapy, durable medical equipment, and personal care.

This guide lists the services Michigan Medicaid covers for adults 65 and older in 2026, names the three channels that deliver them, and flags the carve-outs (behavioral health and MI Choice waiver services) where a different agency handles part of your care.

How Michigan Medicaid Delivers Covered Services

Michigan Medicaid coverage for seniors runs through three delivery channels:1

1. Medicaid Health Plans (MHPs): the managed care plans that cover most medical care for most seniors, including doctor visits, hospital care, prescriptions, dental, vision, hearing, therapy, and transportation. Michigan's Comprehensive Health Care Program runs through nine MHPs under the contract cycle that took effect October 1, 2024; UPHP serves the Upper Peninsula and is one of the nine. Members choose among the plans available in their county through MI ENROLLS at 1-888-367-6557.2
2. Prepaid Inpatient Health Plans (PIHPs): the regional plans that handle behavioral health, substance use disorder, and developmental disability services. These services are carved out of the MHPs.1
3. Fee-for-Service (FFS) Medicaid: for nursing facility residents, MI Choice Waiver participants, and certain other populations, the state pays providers directly rather than through a plan.

The table below maps each service to the channel that covers it. Service-by-service detail follows.

Federally Mandated Covered Services

The federal Medicaid statute requires every state's program to cover a baseline set of services. Michigan covers all of them:1

• Inpatient and outpatient hospital
• Physician services
• Laboratory and X-ray
• Certified nurse-midwife and nurse practitioner services
• Nursing facility care for adults
• 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 beneficiaries under 21

Michigan Medicaid's Optional Covered Services

On top of the federal floor, Michigan covers an extensive set of optional state-plan services, most of them delivered through the MHPs.1

Prescription Drugs

Outpatient prescriptions are covered through the MHP's pharmacy benefit, subject to the plan's preferred drug list. Some specialty drugs require prior authorization. Dual eligibles (Medicare plus Medicaid) get most prescriptions through Medicare Part D; Medicaid covers a limited set of Part D excluded drugs, such as certain over-the-counter products.

Adult Dental (Expanded April 2023)

Michigan substantially expanded the adult Medicaid dental benefit effective April 1, 2023, and now reimburses dental providers at 100% of the Average Commercial Rate.1 Covered adult dental generally includes diagnostic exams and cleanings, X-rays, fillings, extractions, root canals, crowns, dentures, periodontal care, and oral surgery, with some services requiring prior authorization.

The practical hurdle in Michigan is access, not coverage: historically, many dentists did not accept Medicaid, and the 2023 rate increase was aimed at changing that. To find a participating dentist:

• Call your MHP's member services line and ask for the dental network directory.
• Use an FQHC with a dental program, which accept Medicaid statewide.
• Try a dental school clinic, such as the University of Michigan School of Dentistry in Ann Arbor or the University of Detroit Mercy School of Dentistry in Detroit.

Vision

Adult Medicaid covers routine eye exams, eyeglasses (frames and lenses), medically necessary contact lenses with prior authorization, and cataract surgery and related care.

Hearing and Hearing Aids

Michigan covers diagnostic hearing exams, hearing aids with prior authorization, fittings and repairs, and cochlear implants for qualifying cases.

Therapy Services

Physical therapy, occupational therapy, and speech-language pathology are covered, typically subject to a medical-necessity review and periodic reassessment.

Durable Medical Equipment (DME)

Wheelchairs, walkers, hospital beds, oxygen, CPAP, diabetic supplies, and similar equipment are covered when medically necessary. Most DME requires prior authorization.

Hospice

Michigan covers the full hospice benefit for beneficiaries with a terminal illness and a life expectancy of six months or less, including nursing, aide visits, medications related to the terminal illness, equipment, counseling, and bereavement support.

Non-Emergency Medical Transportation (NEMT)

NEMT covers rides to Medicaid-covered medical appointments. It is arranged through your MHP or, for fee-for-service members, through a state contractor, and is one of the most underused Medicaid benefits. To use it:

Podiatry, Chiropractic, and Other Specialty Services

Michigan covers adult podiatry, chiropractic services, and other 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, administered through MDHHS Adult Services. See the full Home Help guide for eligibility, covered services, and pay rates.

Behavioral Health: The PIHP Carve-Out

Behavioral health services are carved out of the Medicaid Health Plans in Michigan and administered through regional Prepaid Inpatient Health Plans (PIHPs) working with county Community Mental Health Services Programs (CMHSPs).1

PIHP and CMHSP services include:

• Outpatient mental health (psychiatry, therapy, counseling)
• Substance use disorder treatment (outpatient, residential, medication-assisted)
• Crisis intervention and stabilization
• Partial hospitalization and intensive outpatient programs
• Assertive Community Treatment (ACT) for severe mental illness
• Case management for serious mental illness or substance use disorder
• Psychiatric inpatient hospitalization
• Services for people with intellectual and developmental disabilities

In practice, if you are on Medicaid and need mental health or substance use treatment, your MHP refers you to the regional CMHSP. You do not get these services through your MHP's usual network. In a crisis, call the 988 Suicide and Crisis Lifeline.

What Michigan Medicaid Does Not Cover

Michigan Medicaid does not typically cover:

• Cosmetic procedures (unless medically necessary for reconstruction)
• Experimental or investigational treatments
• Most over-the-counter medications (with limited exceptions, such as covered diabetic supplies)
• Private-duty care beyond approved Home Help or MI Choice hours
• Room and board in assisted living, even when MI Choice covers the care services delivered there
• Out-of-state providers, except in emergencies
• Fertility treatments
• Gym memberships and weight-loss programs, unless a plan includes them as a value-added benefit

Value-Added Benefits From Medicaid Health Plans

Each MHP offers value-added benefits on top of the standard Medicaid package. These vary by plan and by year, and common examples include a quarterly over-the-counter (OTC) allowance, a supplemental dental allowance, rideshare benefits for non-medical trips, a gym membership, and a healthy-food card for members with certain chronic conditions. Amounts and availability differ by plan, so call each plan's member services line and ask for its current value-added benefits sheet before you choose.

How Michigan Medicaid Works With Medicare

Most Michigan Medicaid seniors are also on Medicare, and the two programs coordinate:2

• Medicare pays first for acute care, including doctor visits, hospital care, and most prescriptions through Part D.
• Medicaid wraps around it, covering Medicare deductibles and coinsurance through the Medicare Savings Programs, plus services Medicare does not cover, such as long-term care, dental, vision, hearing, and NEMT.
• MI Coordinated Health (MICH) is Michigan's integrated option for full-benefit dual eligibles, combining Medicare and Medicaid in a single plan.2

See the Michigan Medicaid programs hub for the full picture.

Common Misconceptions About Michigan Medicaid Coverage

"Medicaid doesn't cover adult dental." Michigan does, and substantially expanded the benefit on April 1, 2023.1 Finding a participating dentist is the real hurdle, not whether the benefit exists.

"Medicaid only pays for doctor visits and prescriptions." It covers much more: dental, vision, hearing aids, therapy, durable medical equipment, transportation, long-term care, hospice, and personal care. Michigan Medicaid is one of the broader coverage programs a senior can hold.

"My MHP doesn't cover my mental health." Correct, by design. Behavioral health is carved out to the regional PIHP and CMHSP, which work with you directly.1 Call your county CMHSP, or 988 in a crisis.

"If Medicaid covers it, I pay nothing." For full-scope Medicaid seniors, copays are minimal. For dual eligibles, Medicaid covers Medicare cost-sharing through the Qualified Medicare Beneficiary (QMB) program. For MI Choice and nursing-home Medicaid, the beneficiary contributes a patient-pay amount from their own income, but pays nothing beyond that.

"I have to use Medicaid transportation." You do not have to, but NEMT is free for covered appointments, while private rideshare is out of pocket.

Related Terms

• Managed Care Organization (MCO): the umbrella term for a Medicaid Health Plan.
• HCBS waiver: the waiver authority MI Choice operates under.
• Activities of Daily Living (ADLs): the daily tasks used to assess need for many services.

Learn More

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. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.