Answers to Frequently Asked Questions
To be used in conjunction with MIChild Manual Click the following links to see questions pertaining to:
Marketing and Recruiting
Billing, Payment and Reimbursement
Questions pertaining to families
Questions pertaining to other insurance
- What if the parents are divorced, who can apply for MIChild?
If the parents have joint custody, the parent the child lives with the majority of the time should apply. The income of the parent the child is living with when the application is filed will be used to determine eligibility. The other parent's income information is not used to determine MIChild or Healthy Kids eligibility.
If one parent has full custody of a child, that parent should apply. The income of the non-custodial parent will not be considered. Support paid will be budgeted as income.
- Can an absent parent use MIChild as court ordered medical insurance? No.
- With the "no wrong door' policy in mind, why doesn't the MIChild application allow families to apply for other programs, such as day care, WIC, cash assistance, or food stamps?
The "no wrong door" policy applies to the Medicaid program only. Requests for applications for other programs should continue to be through DHS or local public health agencies.
- Will DHS pursue child support for Healthy Kids?
Yes. DHS will pursue child support, as well as parental support and spousal support.
- Who pays for the medical transportation for a Healthy Kids case?
DHS will approve the transportation needs until the child is enrolled in a Medicaid managed care agency.
- Will the health plans be able to offer transportation for families in MIChild?
No, only emergency transportation by ambulance is a MIChild-covered service and is the responsibility of the health plan.
- Does MIChild cover pre-existing conditions?
Yes, but MIChild does not cover previous medical bills.
- Does MIChild cover Long Term Care?
No. MIChild covers 120 days per admission for skilled care in a skilled nursing or extended care facility while convalescing from general conditions and pulmonary tuberculosis.
- Will clients be given a MIChild card?
They will be given whatever identification is supplied by the health plan or dental plan.
- Do we have to change providers when receiving specialty care?
Enrollees should try to select a health plan in which their specialist is participating. Otherwise, participants will need to choose a specialist from within their health plan network.
- Is there any prior authorization requirement by the provider?
Prior authorization policies for non-emergency services are decided by each health plan.
- Are the benefits for MIChild equivalent to those of Healthy Kids?
They are similar, but there are some differences.
- Will the health plans provide dental services?
No. Dental coverage is through a separate MIChild participating dental plan.
- Is the $1,500 dental limit per child or per family?
Per child, per year.
- How is the coordination of dental/medical benefits decided?
They are separate insurance plans and separate cards.
- Are there co-payments for prescriptions?
- Are the participants required to have a written referral from primary-care physicians for vision, hearing and/or elective surgery?
The individual health plans make their own referral policies.
- Is HAP (Health Alliance Plan) a health plan participating in the program?
- What if I quit my job?
You can submit a MIChild/Healthy Kids application to see if your children qualify.
- Are computer printouts that verify a person's SSN acceptable as proof of their SSN, or do they need to wait until the card arrives?
Applicants must list their SSN on the application. A copy of the card is only needed if the number is questionable.
- What if the child does not have a Social Security Number?
The applicant should complete an SS-5, Social Security Number Application (available online), or be directed to the local Social Security Administration for assistance.
- Will the program cover children detained in youth home facilities?
If a child is living in a youth home facility, they may be eligible for MIChild or for Healthy Kids. Children who have been criminally adjudicated and are in a correctional facility, including a detention home or training school such as JW Maxey, Shawano Center, or Adrian Training Facility are not eligible.
- Are there caps on regular medical care (well visits, sick visits, etc.)?
Medical care is comprehensive and modeled after the state employee health plan. There are no caps on medical coverage. There is however, a cap on the dental benefit of $1,500 per child per year.
- I had heard that if a working parent/guardian refused to participate in an employer's insurance plan (for whatever reason) they would NOT BE ELIGIBLE for MIChild. Is this true?
No. There is no penalty for refusing employer-based insurance. However, families who voluntarily drop employer-based comprehensive insurance must wait six months.
- How long is the residency requirement?
The requirement is that you are currently living in and intend to live in Michigan or that the applicant is a child of a migrant worker family.
- If a person is found to be eligible, how can that person receive services prior to the MIChild effective date? What if that child has an emergency? Who will pay?
MIChild is not retroactive. The family is responsible for covering medical/dental bills incurred prior to effective date of enrollment.
- Does the web page have a Spanish version available yet?
- How do persons request a Spanish-speaking operator?
When you contact MIChild, 1-888-988-6300, you will be given the option to select Spanish as your language of choice.
Questions pertaining to pregnant applicants
- Can MIChild be a secondary insurance?
No, MIChild cannot be a secondary insurance. MIChild is denied if other comprehensive insurance is in effect at the time of application. MIChild will be terminated if enrollment in other comprehensive insurance is obtained or discovered after the MIChild becomes effective. MIChild termination will take effect the month after discovery of the beneficiary's enrollment in other comprehensive insurance. You will be notified by letter of the disenrollment.
- Will other insurance coverage be verified?
Yes, there will be periodic cross-data checks with insurance plans.
- Is health coverage through the Indian Health Center considered comprehensive health insurance?
- Is CHAMPUS (now TRICARE) considered a comprehensive health plan if there is no military base in the state? If the family is having difficulty receiving reimbursement from TRICARE, can they apply for MIChild instead?
TRICARE is considered a comprehensive insurance. Therefore, the child would not be eligible for MIChild even if the family is not getting reimbursed by TRICARE. The family should contact TRICARE for payment.
- Can people drop expensive coverage to enroll?
Families who voluntarily drop employer-based comprehensive insurance must wait six months. If families drop private insurance, they may immediately enroll in MIChild.
- When does the 6-month penalty begin if employer-based insurance is dropped?
The six-month penalty begins the month insurance was stopped.
- Will a family that was MIChild eligible and paid $120 for one year of premiums be sent a prorated refund if the family obtained insurance through a new employer?
Yes, if the family wants to drop MIChild coverage, the family would need to notify Maximus and request a disenrollment from the MIChild Program. The family would only be refunded for months NOT enrolled in MIChild.
Questions pertaining to income
- How many days do pregnant women have to choose a health plan?
Pregnant women who are eligible for Healthy Kids Medicaid will receive a packet from Michigan ENROLLS. Their packet will advise of the timeframe in which they have to choose their plan. If MIChild eligible, the plan is chose during the application process.
- What is MOMS?
MOMS (Maternity Outpatient Medical Services) program provides immediate prenatal care coverage for pregnant women. The MOMS program provides a Guarantee of Payment letter while Medicaid is pending. You may apply online through your local health department or other participating clinic.
- Does MOMS cover pregnancy-related medical care for non-citizens?
Yes. MOMS is available to non-citizens throughout the pregnancy and up to two-months after the pregnancy ends.
- Will a child who is eligible for MIChild becomes pregnant and turns 19 before the baby is born remain eligible for MIChild?
MIChild will end the month that she turns 19 years old and will be referred to Healthy Kids for Pregnant Women.
- Is a pregnant woman counted as two people in the MIChild program?
Yes. MIChild and Healthy Kids group sizes are determined the same way.
- Is there a $10.00 monthly fee for pregnant women?
Yes. If the pregnant woman is eligible for MIChild.
- Is there a three-month retroactive coverage for a pregnant woman?
MIChild is not retroactive. Retroactive coverage is limited to Medicaid.
- Will MIChild cover voluntary terminations of pregnancy?
Questions pertaining to non-citizens
- What is a fiscal group?
The fiscal group for a child includes the child being considered for eligibility as well as the biological or adoptive parent(s) living with the child.
- If a family operates an adult foster care home, is the income received by the foster care clients included on the application?
No. However, the family must include the money they receive for managing the foster care home as income.
- If the absent parent does not pay consistent child support, is this considered income?
If the custodial parent received child support during the month the application was filed, it is considered income. Arrearage payments for child support are not considered income and should not be included on the application. An average amount of child support paid per month is determined from current payments.
- Is a child who receives an adoption support subsidy considered part of the fiscal group?
Yes, the child is included in the fiscal group. Adoption support subsidy, however, is disregarded.
- How do we determine if the income of a Native American is to be considered?
Earned and unearned income received by a Native American is countable unless it is listed as exempt by one of the Public Acts. A list of Public Acts is included in the MIChild policy manual.
- Are payments from a trust to a child considered income?
Yes. These payments are considered unearned income.
- Is it true that the MIChild application allows families to self-declare their income and that pay stubs or income tax forms are not required at application, unless the information provided is unclear?
Yes. Eligibility is based on the statements regarding income which the applicants provide on the application. The applications will be audited for accuracy. The families chosen for audit will be asked to provide written documentation regarding their income, such as pay stubs, tax records, or a letter from their employer.
- What should be used as verification of income for self-employed persons who have asked for extensions on their taxes?
Income for this program is self-declared on the application. The most recent income tax returns will be used for verification.
- What is the proper disregard to use for Medicaid applicants who have received FIP or LIF in one of the last four months?
The $30 and 1/3 of income disregard should be used when determining eligibility.
- If a family has received FIP in the last four months, and the $30 and 1/3 disregard is used, does it apply to each person receiving earned income or do you apply it only once regardless of the number of people in the fiscal group with earned income?
The disregard is applied for each child's budget, regardless of the number of people in the fiscal group with earned income.
- Can a child living in a home not his/her own (e.g. he/she ran away from home and is living with a friend), be eligible for MIChild or Healthy Kids?
An application may be submitted for the child. DHS and MIChild will review the application using only the child's income. Since the child is not living with the parents, their income will not be used to determine financial eligibility. Depending on the age of the child, parental support may be pursued by DHS.
- Is a legal guardian's income counted when determining MIChild eligibility?
- If a grandparent in the home is receiving Social Security income, is his/her income counted?
No. The grandparents are not financially responsible for their grandchildren.
- Will a child remain covered when family income rises above eligibility allowance for that family?
Yes. Once eligible, children are enrolled for one year. At the end of the year, they will be asked to reapply. If they do not qualify, they will not be enrolled for the next year.
- Will a child's own income count toward the eligibility, (for example, a 16-year-old student who works part time after school)?
A student's earned income is not used in determining eligibility; but the responsible parent's income is used to determine eligibility. Unearned income, such as child support is considered the child's income and is used in determining eligibility, as is any RSDI received by a child would be budgeted as income for the child.
- Does Family Support Subsidy count as income? And if a family takes advantage of a flex-spending plan for childcare, how does that affect eligibility?
No, the Family Support Subsidy would not be considered income and part of a child-care payment may be considered a deduction from income, when eligibility is determined.
- Regarding the monthly income requirements, are the figures based on gross or net pay? Is child support a family pays out figured into the equation? Is there a formula if people are denied? Is there an appeals process?
The family reports the gross monthly, income on the application. There is a formula which allows certain deductions and expenses to be considered when determining the countable, or adjusted gross income. The adjusted gross income must be at or above 150% and below 200% of the federal poverty level. For children under 1 year of age, the adjusted gross income must be above 185% and at or below 200% of the federal poverty level. Paid child support is considered a deduction. When someone is denied, the notification of eligibility includes the family's right to appeal and the Request for Department Review form.
- If a parent is working, are transportation and childcare taken into consideration?
Childcare costs are taken into consideration when determining eligibility.
- What if parents meet income levels, have insurance available from employment, but parents cannot afford the high premiums?
If a family meets the income levels and does not currently have employer-based insurance coverage, they may qualify for MIChild. Availability is irrelevant. NOTE: Children who are eligible for health insurance based on a family member's active permanent employment by a state, county, or city government agency in Michigan, are not eligible for MIChild. School employees are not considered government employees.
Questions pertaining to eligibility
- What sources may be used to determine MIChild eligibility for aliens?
At this time, the only documentation that DHS and MIChild will accept is a copy of both sides of the I-94 (Arrival/Departure record) or the I-551 (Green Card).
- If a child's parent is an illegal alien or does not have a green card, will the child qualify for MIChild? What will happen to the parent?
If the child is a citizen, they may qualify. The parent's legal status is not considered in determining the child's legal status. Information on MIChild applications regarding parent's status is not passed on to other agencies.
- Will non-citizens be evaluated for Medicaid ESO (Emergency Services Only) and will pregnant non-citizens be referred to the Maternity Outpatient Medical Services (MOMS) program?
Yes, non-citizens are evaluated for Medicaid ESO. If MOMS is needed, application should be made through the local health department or authorized participating clinic.
- Are all of the Migrant Health Clinics approved as MIChild health providers?
Only if the clinics are in an approved health plan's network.
- Are children who are eligible for emergency Medicaid only, because of citizenship status, eligible for MIChild?
Questions pertaining to enrollment
- Why don't public health agencies determine initial eligibility?
Public health agencies do not have the ability to enroll a child in health or dental plans. Also, public health agencies cannot ensure that coverage will begin on the date the application is approved.
- If a child is independent, or married and is 19 years or less and between 185% and 200% of poverty, is he or she then eligible for MIChild?
Yes, if under age 19. Eligibility ends the month the child turns 19.
- How is MIChild eligibility determined when the child has been previously eligible for Healthy Kids? (185% poverty level and below)?
When determined eligible for either MIChild or Healthy Kids programs, the child is eligible for a year. The application must be renewed annually. You will be referred / enrolled to the appropriate program based on your circumstances at the time of application.
- The public health agency was told that they must meet a quota to keep their grant funding for MIChild?
There is no quota that a public health agency must meet to retain grant funding for MIChild.
- If a child is enrolled today, when does MIChild coverage begin?
Coverage begins on the first of the month, following acceptance into the MIChild program. If approval occurs in the last five working days of the month, coverage begins on the first of the following month. For example, a May 27 approval would result in a July 1 enrollment date.
- What is the effective date for Healthy Kids?
Usually, the effective date will be the date DHS receives the signed application. The family may request retroactive coverage for Healthy Kids for the past three months if there are unpaid medical bills. Services will be reimbursed on a fee-for-service basis until the family has chosen or has been assigned to a health plan.
- Will Maximus send notification of the eligibility determination back to the public health agency?
- Who is included in the economic unit (i.e., household members, significant others)?
This is complex eligibility issue. It is best to send in the application with accurate information listing everyone who lives in the home. Eligibility will be reviewed and determined, and the family will be notified in writing.
- How would you cover a six month-old-infant whose parents are over the 185% range, but within the 200% poverty range?
The infant would likely be eligible for MIChild.
- What about the disappointment of enrollees expecting MIChild who get Medicaid (especially dental access)?
MIChild and Medicaid both cover dental access for children under 21 years of age.
- Who determines eligibility and how long does it take?
MIChild will review completed applications within 10 days from the date a complete application is received, and make a recommendation of eligibility to Michigan Department of Community Health.
- If a person is from another country and has been in this country less than a year, will they be eligible for insurance?
No. Not during their first five years in the U.S., unless they are the dependent child of a qualified military alien or Native American who was residing in Canada.
- When someone has other health insurance does that automatically disqualify them for MIChild?
No. Health insurance is not always comprehensive and may not disqualify individuals from eligibility for MIChild.
Questions about marketing and recruiting
- When did MIChild start enrolling?
Statewide - September 1, 1998.
- Is there automatic enrollment in Medicaid if a child is not eligible for MIChild?
No. The child is automatically referred to Healthy Kids Medicaid if the income level is at or below 150% of the poverty level. The child is enrolled in Healthy Kids Medicaid if all other eligibility requirements are met.
- Can an applicant select a new health plan each month?
No, after 30 days they are "locked" into their chosen plan for the remainder of their year's eligibility.
- How will children be assigned to different plans?
The family will select a participating plan from those available in their county during the application process. If not chosen at the time of application, MIChild will assign a plan to a family. All the children in a family should be in the same plan, unless the children are covered by different programs, such as Medicaid or Children's Special Health Care Services. If a plan is assigned, you may change it within the first 30 days of the plan's effective date.
- If a family is disenrolled after services have been rendered to a member, will those services be honored?
Yes, if they were enrolled when services were rendered.
- Under what program would children born to MIChild enrollees be covered?
It is likely that they would qualify for Healthy Kids.
- Are there certain times when people can apply for MIChild or Healthy Kids?
Applications may be made anytime.
- How will MIChild monitor changes in family status?
MIChild won't be monitoring changes in family status.
Questions pertaining to application processing
- What are the concerns about recruiting enrollees?
At this time, health plans are prohibited from directly marketing their plan to potential enrollees.
- Are MIChild brochures available?
For brochures and posters, contact: Maximus 1-888-988-6300.
For agencies requesting materials, fax Materials Request form to Presort Services (517) 394-5976, or mail to Presort Services, P.O. Box 24096 Lansing, MI 48909-4096.
- How do we target small businesses?
Small businesses may be approached with MIChild information through local community organizations, chambers of commerce, small business organizations, etc.
- What are the promotional programs for MIChild?
Several times a year, television and radio stations promote MIChild.
Questions pertaining to billing/payments/reimbursement
- Why is there a question about the Family Independence Program (FIP) and Low Income Families (LIF) in the MIChild Application?
The application is also used to determine Medicaid eligibility. Persons who recently received FIP or LIF may qualify for further income deductions.
- Why is there a question on the MIChild application about whether the children's father is living at home?
In order to help determine whether the father's income should be considered when deciding if the child is eligible for MIChild or Healthy Kids. If the child is eligible for Healthy Kids, a referral to the child support staff may be made.
- What happens if an application is mailed to the health insurance company directly?
The health plan will forward the application to MIChild.
- Do the families have to complete the whole application each year, or is renewal simplified?
Yes. MIChild will send out a renewal applications before the end of the year. The completed renewal form is signed, dated, and returned to MIChild for review.
- If DHS receives an application for MIChild/Healthy Kids (DCH-0373) and determines that an individual is not eligible for Healthy Kids, will DHS be able to forward the application and all verification to MIChild, or will the applicant have to resubmit?
DHS will forward applications and related materials to MIChild.
- What is the biggest problem with incomplete MIChild applications?
Incomplete applications delay processing of the application thereby delaying access to care for children. Some of the reasons that an application is considered incomplete are relationship of all household members, especially parent/child, income information of household members, lack of signature on the paper application.
- When an application is sent in with incomplete information, how does MIChild or MDCH contact the client and how long do they have to return the documents?
They are contacted by both mail and telephone. They have 10 days to provide the information or clarification. After that, their application is denied.
- What is MIChild's role in screening applicants?
MIChild will conduct preliminary eligibility screening and will make recommendations to DCH for final determination.
- If a job is terminated or someone quits, must they still wait six months to apply?
- If health insurance is no longer carried due to a job change is there still a six-month waiting period or is the family expected to exercise COBRA law?
- Is there a gender bias on form?
- Will this application be used for those who are eligible for Emergency Services Only Medicaid?
- What is the time involved in applying for MIChild?
The time involved in applying for MIChild is approximately 20-30 minutes. The family can apply online at http://healthcare4mi.com, or by mailing in a paper application. The online application informs the applicant, upon completion of the application, if the child appears to be eligible for either MIChild or Healthy Kids Medicaid. The paper application is processed within 10 days of receipt by MIChild.
- What will happen to those families that aren't able to fill out the application and mail in information as required?
Families may call the call center (1-888-988-6300) and receive help filling out the application. They may also go to their local health department, DHS Office, CMHSP, or to a participating Health Plan and receive help in completing the application.
Questions pertaining to mental health
- Can the Guarantee of Payment Letter be used by the local health agencies to assure providers of payment for their services?
When a Guarantee of Payment letter for the MOMS program is issued, it can be used at any provider that accepts Medicaid. Application for MOMS program can be made at the local health department and authorized participating clinics.
- If a beneficiary is on an electronic tether, who is responsible for reimbursement of covered services?
Since the beneficiary is not incarcerated in an institution, the judicial system is not responsible for covered services. Therefore, if determined MIChild eligible, MIChild is responsible for reimbursement.
- Is reimbursement equivalent to Medicaid?
Reimbursement from Medicaid and MIChild to health plans is made on a capitated basis each month. The capitated rates of the two programs differ depending upon region, age, and gender.
- How are premiums paid and what happens if they lapse?
MIChild will handle the collection of premiums. Payments can be made by check or money order. Families are asked to not send in cash. Families can pay monthly, or pay for the whole year. Payments are due the 10th of the month for the following month's coverage. The premium payments for the 1st and 2nd month's premium are paid at the time eligibility is determined. If premiums are late, MI Child will send a letter advising you of the balance due and the deadline to receive the payment. If payment is not received, MIChild will end. MIChild will send you a letter if you are disenrolled.
- If a customer fails to pay the premium by the 10th of the month, what happens to the medical bills incurred from the 1st through the 10th of the month? Are these bills subject to be paid by MIChild, or is the customer liable?
The customer is not liable for bills incurred for covered services during the time the child is enrolled in MIChild. Medical bills for covered services incurred prior to termination of coverage are the responsibility of the health plan in which the child is enrolled. Medical services received after the disenrollment are the responsibility of the family.
- Will the premiums be accepted if paid by money order?
- Is provider reimbursement at Medicaid or Blue Cross fee levels?
Providers are paid based on their contract with the health plan in which the eligible child is enrolled.
- Is there a specific contact at Blue Cross/Blue Shield and Delta Dental?
Blue Cross/Blue Shield Provider number for area codes: 248, 313, 517, 734, and 810: 800-482-5141; 616: 800-531-2583 906: 800 -517-4441. Delta Dental number is: 800-482-8915
- Have there been problems with people paying by check and the check being returned for non-sufficient funds by the bank? If so, how is this being handled?
When MIChild has a check that is returned non-sufficient funds. MIChild will contact the family and ask that they send in a new check immediately.
- What is the plan for Community Mental Health to be able to provide this service?
Community Mental Health Service Programs (CMHSPs) will be providing the mental health benefit (and substance abuse benefit will be provided by Coordinating Agencies [CAs]). The mental health benefits are comprehensive carve outs. There are no mental health benefits included in the health plans. The mental health PEPM (Per Enrolled Per Month) will be paid to the CMHSP for each child enrolled, living in that service area.
- Will CMHSP be required to authorize mental health related inpatient treatment?
- What about health plans that have mental health services within their system? Does the child still get mental health services through community mental health?
Yes. MIChild and Healthy Kids enrollees receive mental health services through community mental health (CMHSPs). The MIChild and Healthy Kids programs contract separately with CMHSPs, although Medicaid (Healthy Kids) health plans (QHPs) are contracted to provide up to 20 outpatient mental health visits.
- Can people use mental health benefits under MIChild anywhere outside Community Mental Health, like private non-profit clinics?
No, mental health benefits are obtained through CMHSPs.
- For Blue Cross/Blue Shield which plan is covered?
P.P.O. (Preferred Provider) only.
- If the size of the population does not meet HEDIS reporting requirements, what other quality reporting is required?
Plans will report their commercial HEDIS data, but it will not be MIChild-specific.
- Is MIChild a time-limited program i.e., a life of one, two, three years, etc.?
No. The program will continue as long as funding is available.