Michigan program
Help coordinating complex care (hospital case management)
A case manager at an approved complex-care site can help coordinate services for a child who meets the program’s rules.
What it is
A case manager at an approved complex-care site can help coordinate services for a child who meets the program’s rules.
Appointments, referrals and home-care needs can be hard to keep together. This service can support a qualifying child with Medicaid, CHIP or CSHCS through an approved complex-care site. The site checks the clinical criteria and whether this would duplicate existing case management.
Eligibility rules
- Children under 21 can qualify through Medicaid, CHIP, CSHCS alone, or both Medicaid and CSHCS. An approved complex-care site must also confirm the clinical and service-use requirements; cancer alone does not establish eligibility.
- The benefit took effect February 1, 2025. A diagnosis alone does not establish eligibility.
- The site checks for a serious condition affecting three or more body systems, care from at least three specialties, and a recent long hospital stay or ten specialty visits in the past year. A child who already has a case manager elsewhere is excluded. Michigan currently lists Mott’s Partners for Children.
What you get
- A named case manager to help coordinate appointments and referrals.
What the help covers
- The approved site is paid for case management outside Medicaid health-plan capitation; the policy also includes eligible CHIP and CSHCS-only children.
If you decide to apply
- Ask your social worker whether a referral to an approved complex-care site would help. MDHHS currently lists Mott’s Partners for Children.
- Ask the oncology team for a referral if the hospital thinks your child may qualify.
The approved hospital site · Official page ↗
If you decide to apply
- The approved site reviews the referral and assigns a case manager after acceptance.
Good to know
The approved site checks the clinical rules and whether this would duplicate existing case management. A different treating hospital does not by itself settle whether a referral is possible.
Other details
- Your social worker can distinguish this service from support already offered by your clinic.
Official sources
“Does our hospital offer this case-management benefit? Would it add support or duplicate care we have, and could you help with a referral if it fits?”
Why I’m asking: I want to know who can help keep our child’s different services connected.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask at the hospital.
Your social worker
The hospital site enrols the child and assigns the manager.
The care team
The oncology team refers.
- Who decides
- The approved hospital site.
- Ask your social worker
- “Does this hospital run the Children with Medical Complexity case management programme, and can my child be referred?”
How to apply
First step: Ask the oncology social worker whether this hospital runs it.
- Ask the oncology social worker whether your hospital is an approved site.
- Ask what the case manager would take on.
Official application / program page ↗
Where it starts: Ask the oncology social worker at the hospital whether the site runs it.
What to gather
- The hospital and clinic name
How long: No timeline was published.
What a yes looks like
A named case manager at the hospital site.
What a no looks like, and the next move
The approved site explains the clinical or duplication reason. The social worker can check referral access when the treating hospital is not an approved site.
Watch out
- A diagnosis alone is not an automatic entry; more clinical criteria apply.
- It is paid outside health-plan capitation, so the plan is not who to ask.
Dates that change this
2025-02-01: The state names Mott Children’s Hospital, Partners for Children, as an approved site. The full list of counties it serves, the direct phone and the contract date were not published.
Each hospital’s own policy
The federal rule sets the floor; each hospital’s policy sets the actual numbers. “Unknown” means the policy could not be read yet: call the number and ask.
| Hospital | Free care up to | Discounts up to | Insured families | Financial counselor |
|---|---|---|---|---|
| C.S. Mott Children's Hospital · policy | 300% FPL | 300% FPL | yes | 855-855-0863 |
| Children's Hospital of Michigan · policy | unknown | unknown | unknown | 888-730-3989 |
| Helen DeVos Children's Hospital · policy | 250% FPL | 250% FPL | yes | 844-838-3115 |
| Corewell Health William Beaumont University Hospital · policy | 250% FPL | 250% FPL | yes | 877-687-7309 |
| Bronson Children's Hospital · policy | 200% FPL | 350% FPL | yes | 269-341-6120 |
| University of Michigan Health-Sparrow · policy | 300% FPL | 300% FPL | yes | 517-364-6060 |
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Case management at an approved site for clinically eligible children with Medicaid, CHIP or CSHCS.
Covers: Targeted case management for a medically complex child
What it costs the family: The approved site explains how the case-management service is paid under the child’s coverage.
The eligibility facts, as published
- Requirement
- Children under 21 can qualify through Medicaid, CHIP, CSHCS alone, or both Medicaid and CSHCS. An approved complex-care site must also confirm the clinical and service-use requirements; cancer alone does not establish eligibility. The hospital team checks for at least one CSHCS-eligible condition affecting three or more organ systems, functional limitations with technology dependence and/or candidacy for an organ transplant, care from at least three pediatric specialties, and the required recent hospital or specialty-care use. The usual use test is a hospital stay of at least five days or at least ten pediatric specialty visits in the previous 12 months; the policy has a separate infant exception. The policy excludes children in hospice, children who are incarcerated and children already receiving case-management services from another provider. A physician or other qualified practitioner can refer the child with supporting records to an approved site; MDHHS currently lists Mott’s Partners for Children.
- Effective
- 2025-02-01
The trap: A leukaemia diagnosis is not an automatic entry. More clinical criteria apply.
Where I read this
- MDHHS: Children with Medical Complexity Targeted Case Management — MDHHS, read September 10, 2026
- MMP 24-61: CMC Targeted Case Management bulletin — MDHHS, read September 10, 2026
- Michigan Medicine: Partners for Children — University of Michigan Health, read September 10, 2026