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Michigan - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Michigan Department of Health and Human Services (MDHHS) funds case management and supports coordination through specific carve-outs like the MI Choice Waiver and Targeted Case Management (TCM) for Recently Incarcerated Beneficiaries. Approval to bill for these services requires navigating a closed-network system where independent agencies cannot directly enroll as standalone waiver case managers without first securing a subcontract from a designated regional waiver agency.

Prospective providers must first register in the SIGMA Vendor Self-Service system before applying through the Community Health Automated Medicaid Processing System (CHAMPS). The state delegates the direct credentialing, rate-setting, and authorization of waiver supports coordination to regional Area Agencies on Aging (AAAs) and other designated waiver agencies, meaning an applicant's primary approval relationship is with the regional entity rather than the state Medicaid office.

1. Service Definition and Scope

In Michigan, case management is primarily delivered as Supports Coordination under the MI Choice Waiver or as Targeted Case Management (TCM) for specific populations. The service encompasses comprehensive assessment, person-centered service planning, referral, and ongoing monitoring of the beneficiary's health, safety, and service package.

The state utilizes these services to reduce unnecessary emergency room visits, reduce recidivism for justice-involved populations, and allow elderly or disabled individuals to live independently while receiving nursing facility level of care in their home or community.

2. Regulatory and Oversight Agencies

MDHHS oversees all Medicaid case management services through its Behavioral and Physical Health and Aging Services Administration (BPHASA). Regional waiver agencies act as the direct oversight bodies for MI Choice providers, conducting monitoring reviews and managing subcontracts.

Provider enrollment and claims adjudication are managed centrally through the state's Medicaid Management Information System, known as CHAMPS.

3. Gatekeeping Prerequisites: Who Can Even Apply

Michigan does not allow open enrollment for independent MI Choice Supports Coordination providers. Agencies must secure a subcontract with a designated regional MI Choice Waiver Agency, which controls network access based on regional need.

Before an application can even be started in the Medicaid portal, the agency must be fully registered and validated in the state's financial system, SIGMA.

4. Licensure and Certification Requirements

Michigan does not issue a distinct Case Management Agency license. Instead, the state relies on the professional licensure of the individual staff members and the agency's Medicaid enrollment and waiver agency certification.

Agencies must pass a provider monitoring review conducted by the regional waiver agency or MDHHS to ensure compliance with waiver standards and the CMS HCBS Final Rule.

5. Medicaid Provider Enrollment

Providers must enroll in the Community Health Automated Medicaid Processing System (CHAMPS) as an Atypical Agency or standard agency depending on their exact medical billing status. The application requires a MiLogin account and prior SIGMA registration.

The enrollment process requires detailed disclosures of ownership and controlling interest, including Social Security Numbers and Dates of Birth for all managing employees and board members.

6. Staffing, Training and Background Checks

Agencies must maintain an adequate number of trained staff to meet the needs of their contracted beneficiary population. MI Choice Supports Coordinators are typically required to be licensed professionals.

All staff providing direct services must undergo criminal history background checks and cannot be listed on state or federal exclusion lists.

7. Documentation, Policies and Records

Providers must maintain comprehensive case records that document the assessment, person-centered service plan, and all monitoring activities. MDHHS and waiver agencies conduct annual or biennial quality assurance reviews of these records.

The state uses a quality assurance review process to meet CMS requirements, randomly selecting a statistically significant sample of waiver case records to review for compliance.

8. Billing, Rates and Claims

Payments for waiver services are processed through CHAMPS, Michigan's approved Medicaid Management Information System (MMIS). For MI Choice, the regional waiver agencies pay subcontracted providers based on negotiated rates.

The waiver is considered a funding source of last resort, meaning providers must exhaust and bill other liable third parties before billing Medicaid.

9. Approval Sequence and Timeline

The process begins with SIGMA registration, followed by CHAMPS enrollment, and culminates in contracting with a regional waiver agency or MDHHS. Providers must track their application status directly within the CHAMPS portal.

Because MI Choice relies on regional waiver agencies, the timeline for final approval to bill depends entirely on the procurement schedule of the local Area Agency on Aging.

10. Common Denials and Survey Findings

Enrollment applications are frequently delayed due to data mismatches between SIGMA and CHAMPS. Attempting to enroll in CHAMPS before the SIGMA processing window completes will result in validation errors.

During monitoring reviews, documentation errors such as missing signatures or incomplete person-centered service plans are the most common findings.

11. Key Contacts and Resources

MDHHS provides several resources for provider enrollment and waiver program information. The Provider Support Helpline is the primary contact for CHAMPS issues.

For financial registration issues, providers must contact the SIGMA Vendor Support Call Center.

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