Case Management Services in Michigan help individuals and families navigate the healthcare and social service systems, ensuring they receive the necessary care and support. These services are primarily funded through Michigan Medicaid, Home and Community-Based Services (HCBS) waivers, and MI Choice Waiver Programs.

1. GOVERNING AGENCIES

Agency: Michigan Department of Health and Human Services (MDHHS)
Role: Administers Medicaid-funded case management through HCBS waivers and MI Choice programs

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for waiver-funded case management services

Agency: Community Mental Health (CMH) Authorities
Role: Coordinate case management services for individuals with mental health needs or developmental disabilities

Agency: Area Agencies on Aging (AAA)
Role: Facilitate case management for seniors and adults with physical disabilities under the MI Choice Waiver

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services involve coordinating comprehensive care and support, including medical, social, and community resources, to enhance the quality of life for individuals with complex needs.

Core Services Include:

• Assessment and Care Planning:
• Conduct initial and ongoing assessments to identify needs and strengths
• Develop and update individualized care plans (ISPs or PCPs)

Service Coordination:

• Arrange healthcare appointments, therapies, and community support
• Coordinate with healthcare providers, therapists, and social services

Referral and Advocacy:

• Connect clients to community resources and Medicaid benefits
• Advocate for client needs within healthcare and social service systems

Monitoring and Follow-Up:

• Regularly review care plans and service effectiveness
• Address changes in client health or service needs

Documentation and Reporting:

• Maintain accurate, HIPAA-compliant case records
• Prepare progress reports and outcome evaluations

Services are person-centered and require a detailed Person-Centered Plan (PCP) or Individual Service Plan (ISP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Michigan Department of Licensing and Regulatory Affairs (LARA)
• Obtain IRS EIN and Type 2 NPI
• Apply for Case Management Provider Enrollment via the CHAMPS system
• Maintain general liability and professional insurance
• Hire or contract qualified case managers (e.g., social workers, nurses)
• Develop a Case Management Policy & Procedure Manual
• Implement HIPAA-compliant data management practices

4. PROVIDER ENROLLMENT PROCESS

Step 1: Register and Obtain Necessary Licenses

• Apply through LARA Licensing Portal:
  LARA Licensing

Step 2: Enroll with Michigan Medicaid

• Complete the process via CHAMPS:
  CHAMPS Login

Step 3: Contract with Community Mental Health (CMH) and AAA

• Work with local CMH and AAA offices to become an approved case management provider

Step 4: Finalize Credentialing and Start Service Delivery

• Complete staff onboarding and compliance checks
• Begin receiving referrals from waiver coordinators and CMH programs

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or business registration
• IRS EIN and NPI confirmations
• Proof of liability and professional insurance

Case Management Policy & Procedure Manual, including:

• Intake and assessment forms
• Service coordination and referral templates
• Client progress tracking logs
• Risk assessment and safety planning forms
• Incident reporting and resolution procedures
• Consent and confidentiality agreements
• Staff training logs and credential verification
• Billing documentation and audit-ready files

6. STAFFING REQUIREMENTS

Role: Case Manager (Social Worker / Nurse)
Requirements: Bachelor’s or Master’s in Social Work, Nursing, or related field, state licensure (if applicable), experience with care coordination, background checks

Role: Program Supervisor / Care Coordinator
Requirements: Experience in healthcare or social services management, oversees case management quality and compliance

Training Requirements for All Staff:

• Person-centered planning and care coordination
• HIPAA and confidentiality practices
• Abuse and neglect prevention (mandatory reporter training)
• Cultural competence and client advocacy
• Safety protocols for in-home visits
• Documentation standards and Medicaid billing practices

7. MEDICAID & HCBS WAIVER PROGRAMS COVERING CASE MANAGEMENT

Case Management Services are reimbursable under:

• MI Choice Waiver Program (for elderly and adults with physical disabilities)
• Habilitation Supports Waiver (HSW) (for individuals with developmental disabilities)
• Children’s Waiver Program (CWP) (for minors with severe disabilities)
• Serious Emotional Disturbance (SED) Waiver (for youth with significant mental health needs)
• Community Mental Health (CMH) Programs (for behavioral health support)

Approved providers may deliver:

• Comprehensive case coordination
• Ongoing monitoring and advocacy
• Crisis intervention and safety planning
• Linkage to community and healthcare resources
• Follow-up and progress evaluations

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup
Timeline: 2–4 weeks

Phase: Medicaid Enrollment and Policy Manual Development
Timeline: 60–90 days

Phase: Staff Hiring and Credential Verification
Timeline: 1 month

Phase: Referral Coordination and Service Delivery
Timeline: Ongoing, based on CMH and AAA caseloads

9. CONTACT INFORMATION

Michigan Medicaid Provider Enrollment (CHAMPS)
https://milogintp.michigan.gov/

Michigan Department of Health and Human Services (MDHHS)
https://www.michigan.gov/mdhhs

Michigan Department of Licensing and Regulatory Affairs (LARA)
https://www.michigan.gov/lara

Community Mental Health (CMH) Services Locator
https://www.michigan.gov/mdhhs

10. SCOPE OF WORK

• Business registration and Medicaid enrollment
• CMH and AAA credentialing support
• Case Management Policy & Procedure Manual creation
• Staff training resources and compliance tools
• Care coordination and referral networking strategies
• Documentation templates for service tracking and reporting
• Billing setup for Medicaid and waiver-funded case management