Michigan
MI Health Link
MI Health Link is a capitated duals demonstration program for adults eligible for both Medicare and Medicaid. It operates in ten counties in the Lower Peninsula and the entire Upper Peninsula. Enrollment began in 2015.
Capitation rates are determined by region of the state, age group (working ages versus elderly), LTSS utilization, and residential setting. There are two tiers for nursing home residents, with a lower rate for privately owned facilities and a higher rate for publicly owned facilities. These rates take effect only after the first three months of institutionalization; the rate assigned prior to institutionalization is used until then. There are two rates for community residents, one for those with a nursing home level of care need and the other for everyone else. For people transitioning out of a nursing home after a stay of three months or longer, a supplemental capitation payment is made during the third month following transition.
More information
Program documents
Contract with managed care organizations:
Supplemental quality reporting requirements:
Quality Withold Analysis Results Year 1 (2015-2016):
Memorandum of Understanding with CMS:
Demonstration proposal to CMS:
1915(c) Waiver Amendment Application:
Assessment instrument for level of care determination:
MI Health Link Capitation Rates: