McLaren Health Plan
Medicaid / MIChild

McLaren Health Plan does not cover dental care. You still may be covered because you qualify for Medicaid. Use your Medicaid ID card for these services. Please talk to your local MDHHS office if you have questions.

Yes. MHP covers medications to help you stop using tobacco. These include Nicotine gum, lozenges, patches, inhalers and nasal sprays. Other covered medications are Zyban® and Chantix.® You can get other tobacco cessation benefits, such as counseling services, to help you stop smoking. You also are entitled to a FREE stop smoking program. Call (800) 784-8669 to enroll. Talk to your doctor if you are ready to quit.

We will help you get translation services. These include services for members who are deaf, hard of hearing or have speech problems. Member materials are available in other languages and formats.

The MHP Medicaid provider directory will tell you if a provider speaks another language. It tells you if a doctor has completed cultural and linguistic training (CLAS). This information is listed by the doctor's name. Call Customer Service at (888) 327-0671, TTY 711 if you need help understanding written materials or need translation services.

You should not be asked to pay for any authorized covered services. You do not have a copayment for covered services as an McLaren Health Plan member. Please call Customer Service at (888) 327-0671, TTY 711, if you get a bill for an authorized covered service.

Sometimes no, sometimes yes. A referral is when your Primary Care Physician (PCP) tells you to see a specialist. This process helps your PCP know what is going on with you. There is no paperwork for you to fill out.

An authorization is when your PCP must ask McLaren Health Plan (MHP) for approval for services you need. Some of the time you need a written authorization before you get services. In some cases, you don’t. Your PCP knows when an authorization is needed and when it isn't. You do not need written authorization from your PCP to visit or get services from an in-network specialist.*

You can get a second opinion from an in-network provider. Call us for help if you want a second opinion from an out-of-network provider. Call Customer Service at (888) 327-0671, TTY 711, if you have questions about a health care service that may need a referral or authorization. Any health care that you get must be medically necessary. You should talk to your PCP before seeing any specialist even if you don't need a referral.

*The following in-network service needs an authorization:

Injectable medications given in the office of an in-network specialist

Your Primary Care Physician (PCP) is a big part of your good health. If you decide to change PCPs, you will need to:

• Choose another PCP from the McLaren Health Plan Medicaid list of doctors.
• Use the link on the member information page of our website or call Customer Service at (888) 327-0671, TTY 711, to let them know the PCP you have chosen.

Please call Customer Service if you need help finding a new PCP.

Take your prescription to any pharmacy. McLaren Health Plan (MHP) covers medicines under a "Common Drug Formulary" for MHP members.

MHP worked with the Michigan Department of Health and Human Services to create the Common Drug Formulary. Your doctor knows about it. Ask him or her to use it when prescribing your medicines. Sometimes the medicine your doctor thinks is the best treatment for you is not on the Common Drug Formulary. We have a way to get those medicines for you.

Your doctor can fill out a preauthorization request form for MHP to review. MHP will tell your doctor if the medicine request has been approved. Sometimes MHP will give your doctor another choice of medicine to prescribe for you. Some of your medicines are covered by MHP and will not have a copayment. You may be prescribed some medicines that will be covered by Medicaid. Always take your MHP ID card and your Medicaid ID card with you to the pharmacy.

Call your doctor or Customer Service at (888) 327-0671, TTY 711, if the pharmacy tells you your prescription is not covered.

Call Customer Service at (888) 327-0671, TTY 711, for non-emergency, medically necessary transportation. They can let you know about MHP’s transportation guidelines.

We will need time to set up your ride. We need some important information from you to be able to arrange a ride for you.

There is a special review process if transportation is needed outside of your county.

It is important to remember to call MHP immediately to cancel your transportation if you cancel your doctor's appointment.

Call 911 if you are having a medical emergency and need to go to the hospital.

Visit Michigan.gov for information about the $50,000 Medicaid Auto No Fault-PIP Coverage Option. For specific information, contact your agent, or the DIFS hotline for Auto No Fault inquiries: 833-ASK-DIFS (275-3437).

 

Urgent and emergency care are covered benefits. Emergency rooms are only for serious medical conditions. Call your PCP if you are unsure whether something is an emergency. Call 911 or go to the nearest hospital when you have an emergency or if your health would be in danger if you don’t see a doctor immediately. Authorization is not required for emergency services.

Services covered by McLaren Health Plan Medicaid*

• Ambulance and other emergency transportation when necessary
• Blood lead tests and follow-up
• Breast pumps
• Certified Nurse Midwife
• Certified Pediatric & Family Nurse Practitioner services
• Chiropractic services (up to 18 visits per calendar year, additional visits require preauthorization)
• Diagnostic services (lab, X-ray, other imaging)
• Durable Medical Equipment and supplies
• Emergency services, including transportation
• End Stage Renal Disease services
• Family planning
• **Habilitative services
• Health education
• Hearing and speech
• **Hearing aids
• Home health services
• Hospice services
• Intermittent or short-term restorative or rehabilitative services (in a nursing facility) up to 45 days
• Immunizations (shots)
• Inpatient hospital services
• Long Term Acute Hospital Services (LTACH)
• Maternal infant health program services
• Medically necessary weight reduction
• Mental health care
• Office visits to your doctor
• Orthotic services
• Out-of-state services, when authorized
• Outpatient hospital services
• Parenting and birthing classes
• Pharmacy services
• Podiatry
• Preventive services
• Prosthetic services
• Sexually Transmitted Infection (STI) treatment
• Restorative or rehabilitative services (in a place other than a nursing facility)
• Specialist visits with referrals
• Therapy services (speech, language, physical and occupational)
• Tobacco cessation treatment, including pharmaceutical and behavioral support
• Transplant services
• Transportation
• Vision services
• Well-child visits under age 2
  

*All covered services must be medically necessary.
**These services are not covered for members age 21 and older. These services are covered benefits for children under the age of 21. You can call Customer Service at (888) 327-0671, TTY 711, if you have questions about the above services. If you do not understand the limits, or if you are told something is not covered, please call Customer Service for more information.

Your Primary Care Physician (PCP) is your main doctor. You choose a PCP from our list of doctors when you join McLaren Health Plan (MHP). You can choose a pediatrician, family practice or internal medicine doctor. Female members can choose an OB-GYN as their PCP. The name of your PCP will be on your ID card. It is your responsibility to see your PCP within 60 days of becoming an MHP member, even if you are not sick. It is a good idea to meet with your PCP to talk about your past medical history. When you do get sick, your PCP will know your important health information. Both your PCP and MHP are available by phone 24-hours a day to answer questions about your care. Our toll-free number is (888) 327-0671, TTY 711. Be sure to contact your PCP to find out his or her after-hours number.