Health Care Programs Eligibility

Health care coverage is available to individuals and families who meet certain eligibility requirements. The goal of these health care programs is to ensure that essential health care services are made available to those who otherwise do not have the financial resources to purchase them. 

It is very important that individuals and families obtain health care coverage. In Michigan, there are many health care programs available to children, adults, and families. Specific coverages may vary depending on the program and the applicant's citizenship status (some non-citizens may be limited to coverage of emergency services only). The Michigan Department of Health and Human Services (MDHHS) determines eligibility for most of the health care programs that are administered by the State of Michigan). 

All of the health care programs in Michigan have an income test, except Children's Special Health Care Services, and some of the programs also have an asset test. These income and asset tests may vary with each program.  For some of the programs, the applicant may have income that is over the income limit and still be able to obtain health care benefits when their medical expenses equal or exceed their deductible (formerly known as spend-down) amount. 

Children  |   Pregnant Women  |   Adults   |   Families 

CHILDREN

U-19 
U-19 is a Medicaid health care program for low-income children under age 19. There is only an income test. There is no monthly premium for this Medicaid program. Most children who are eligible for U-19 Medicaid are enrolled in a Medicaid health plan. This program provides a comprehensive package of health care benefits including vision, dental, and mental health services. Contact the local MDHHS office in your county to apply for this program or apply online at www.michigan.gov/mibridges. 

MIChild 
MIChild is a health care program for children who are under age 19 administered by the Michigan Department of Health and Human Services. It is for the low income uninsured children of Michigan's working families. MIChild has a higher income limit than U-19 Medicaid. There is only an income test. There is a $10 per family monthly premium for MIChild. The $10 monthly premium is for all of the children in one family. The child must be enrolled in a MIChild health and dental plan in order to receive services. Beneficiaries receive a comprehensive package of health care benefits including vision, dental, and mental health services. Contact the local MDHHS office in your county to apply for this program or apply online at www.michigan.gov/mibridges. For more information, visit the MIChild website at www.michigan.gov/michild.

Children's Special Health Care Services (CSHCS) 
Children's Special Health Care Services is a program within the Michigan Department of Health and Human Services that provides certain approved medical service coverage to some children and adults with special health care needs. Children must have a qualifying medical condition and be under 21 years of age. Persons 21 and older with cystic fibrosis or certain blood coagulating disorders may also qualify for services. Click here for more information about Children's Special Health Care Services . 

Under 21   
Medicaid is available to eligible persons under age 21. There is an income test and an asset test for this program. If income is over the income limit, the person is assigned a deductible. Persons may incur medical expenses that equal or exceed the deductible and still qualify for this program.  Beneficiaries receive a comprehensive package of health care benefits including vision, dental, and mental health services. Contact the local MDHHS office in your county to apply for this program or apply online at www.michigan.gov/mibridges. 

Supplemental Security Income (SSI) for Children
SSI is a cash benefit for disabled children whose families have low income. The Social Security Administration (SSA) determines SSI eligibility. The beneficiaries are automatically eligible for Medicaid and they receive the comprehensive package of health benefits including vision, dental, and mental health services. Most beneficiaries are enrolled in a Medicaid health plan. Medicaid may continue even if SSI stops. 

Special Disabled Children 
Medicaid is available to children who received SSI benefits on August 22, 1996, provided the child meets current SSI income and resource standards and the definition of childhood disability in effect before the 1996 revised disability definition. The comprehensive health care package of Medicaid benefits is available. Contact the local MDHHS office in your county to apply for this program. 

Pregnant Women

Pregnant Women

Medicaid is available to an eligible woman while she is pregnant, including the month her pregnancy ends and during the two calendar months following the month her pregnancy ends, regardless of the reason (for example: live birth, miscarriage). There is an income limit for this program. The comprehensive health care package of Medicaid benefits is available. Contact the local MDHHS office in your county to apply for this program or apply online at www.michigan.gov/mibridges. 

Group 2 Pregnant Women 
A woman who has income that exceeds the income limit for Pregnant Women (above), may be eligible for Medicaid under the Group 2 Pregnant Women program. If the income is over the income limit, the pregnant woman is assigned a deductible. Persons may incur medical expenses that equal or exceed the deductible and still qualify for this program.  Contact the local MDHHS office in your county to apply for this program or apply online at www.michigan.gov/mibridges.

Maternity Outpatient Medical Services (MOMS) 

Maternity Outpatient Medical Services (MOMS) is a health coverage program administered by the Michigan Department of Health and Human Services. The MOMS program provides health coverage for pregnant or recently pregnant women who are eligible for Emergency Services Only (ESO) Medicaid. MOMS provides coverage for outpatient prenatal services and pregnancy-related postpartum services for two months after the pregnancy ends. Medicaid ESO covers labor and delivery services. Contact the local MDHHS office in your county to apply for this program or apply online at www.michigan.gov/mibridges.

ADULTS

Healthy Michigan Plan

The Healthy Michigan Plan provides comprehensive health care coverage for a category of eligibility authorized under the Patient Protection and Affordable Care Act and Michigan Public Act 107 of 2013. The Healthy Michigan Plan provides health care coverage for individuals who are 19-64 years of age; have income at or below 133% of the federal poverty level under the Modified Adjusted Gross Income (MAGI) methodology; do not qualify for or are not enrolled in Medicare; do not qualify for or are not enrolled in other Medicaid programs; are not pregnant at the time of application; and are residents of the State of Michigan. All criteria for MAGI eligibility must be met to be eligible for the Healthy Michigan Plan. For more information, visit www.healthymichiganplan.org or www.michigan.gov/mibridges to apply.

Caretaker Relatives 
Medicaid is available to eligible parents and people who act as parents, caring for a dependent child. These people are called caretaker relatives. There is an income test and an asset test for this program. If the income test is over the income limit, persons may incur medical expenses that equal or exceed the deductible and still qualify for this program. Beneficiaries receive a comprehensive package of health care benefits including vision, dental, and mental health services. Contact the local MDHHS office in your county to apply for this program or apply online at www.michigan.gov/mibridges.

Supplemental Security Income (SSI) for Adults
SSI is a cash benefit to low income adults who are aged, disabled, or blind. The Social Security Administration (SSA) determines SSI eligibility. SSI beneficiaries are automatically eligible for Medicaid and the comprehensive package of health care benefits including, vision, dental, and mental health services. Medicaid may continue even if SSI stops. Contact the Social Security Administration to apply for this program. 

Aged, Blind, Disabled (AD Care)
Medicaid is available to persons who are aged, blind, or disabled. There are income and asset tests. If the income is over the income limit, persons may incur medical expenses that equal or exceed the deductible and still qualify for this program. Most beneficiaries are enrolled in a Medicaid health plan and receive a comprehensive package of health care benefits including vision, dental, and mental health services. Contact the local MDHHS office in your county to apply for this program.  

Disabled Adult Children (DAC)
A person who had a disability or blindness that began before age 22 may be eligible to receive Medicaid benefits in his adult years. He must also be receiving DAC benefits from Social Security.  Most beneficiaries are enrolled in a Medicaid health plan and receive a comprehensive package of health care benefits including vision, dental, and mental health services. Contact the local MDHHS office in your county to apply for this program.  

MI Choice 
The MI Choice waiver provides home and community-based health care services for adults aged 65 or older and adults with disabilities. The program's goal is to allow persons, who would otherwise require nursing home care, to receive these services in their home and in the community.  MI Choice beneficiaries are not enrolled in a Medicaid health plan but still receive a comprehensive package of health care benefits including vision, dental, and mental health services. In addition, the waiver may provide other benefits to help the person remain at home. To see if you are eligible for MI Choice and to apply for the program, please contact your local MI Choice waiver agency. 

Medicare Savings Program (MSP) 
The Medicare Savings Program pays for certain Medicare costs. There is an asset test. The Michigan Department of Health and Human Services (MDHHS) may help pay the following, depending on the person’s income: 

•  Medicare premiums 
•  Medicare coinsurance 
•  Medicare deductible

In some cases, the Michigan Department of Health and Human Services (MDHHS) may refund the beneficiary a portion of the Medicare Part B premium on an annual basis. Contact the local MDHHS office in your county to apply for this program. 

Plan First Family Planning

Plan First is a health coverage program administered by the Michigan Department of Health and Human Services. The Plan First program benefit is limited to family planning services such as, contraceptive services and supplies, reproductive health services, and other preventive services. Individuals eligible for the Plan First benefit include those of any age or gender who have income at or below 195% of the Federal Poverty Level (FPL), are residents of the State of Michigan, and meet Medicaid citizenship requirements.  For more information, visit Plan First (michigan.gov).  Contact the local MDHHS office in your county or apply online at www.michigan.gov/mibridges.

FAMILIES  

Many times, the entire family may be eligible for health care benefits:

Low Income Families (LIF) 
Medicaid is available to families under the Low Income Family (LIF) Program. There are income and asset tests. Families that receive cash assistance (Family Independence Program or FIP) are automatically eligible for this program. Other families must apply at the local MDHHS office. Families don't have to apply for FIP in order to receive health care coverage under this program. Most beneficiaries are enrolled in a Medicaid health plan and receive a comprehensive package of health care benefits including vision, dental, and mental health services.  

Special N Support 
Special N Support is available to families that received Low Income Families (LIF) Medicaid or cash assistance (FIP) but are no longer eligible due to income from spousal support payments. Special N Support is available for four months. Most beneficiaries are enrolled in a Medicaid health plan and receive a comprehensive package of health care benefits including vision, dental, and mental health services. Your Family Independence specialist will let you know if you qualify for this program. 

Transitional Medical Assistance (TMA) 
TMA is available to families that have received LIF or cash assistance (FIP) in at least three of the last six months. The family is no longer LIF/FIP eligible because a parent has too much income from employment. TMA is available for up to 12 months and the family does not need to fill out a new application. Most beneficiaries are enrolled in a Medicaid health plan and receive a comprehensive package of health care benefits including vision, dental, and mental health services. Your Family Independence Specialist at the Department of Health and Human Services will let you know if you qualify for this program.