Covered Services

CareSource covers the same services as traditional fee-for-service Medicaid. In addition, our members do not have co-payments for services or prescription drugs.

Members can get many services with no referral required from their Primary Care Provider (PCP). They can simply call for an appointment. See our Provider Directory.

Some services require a referral from the Primary Care Provider, Prior Authorization from CareSource, or both.

CareSource members also receive many other benefits. These include a service center, 24-hour nurse triage line, and transportation to medical appointments. For more information about referral procedures, Prior Authorizations, and covered services, please see the Provider Manual.

CareSource covers vision and mental health services, but members must access these through another company.

CareSource does not pay for some services, but our members can still get them. Some services are not covered by CareSource, Michigan Medicaid, or another agency. For more information, please see the Provider Manual.

CareSource uses a Pharmacy Benefits Manager. With pharmacy coordinators on staff to help facilitate services, we pair a clinically sound Preferred Drug List (PDL) with a wide network of participating pharmacies.

For more information, please call Provider Services at 1-800-390-7102.

No referral required

Some health care services provided by specialists do not require a referral from a Primary care Provider. Members may schedule self-referred services from participating providers. PCPs do not need to arrange or approve these services for members as long as any applicable benefit limits have not been exhausted.

These include:

  • Certified Nurse Midwife (CNM) services
  • Chiropractic care (within benefit limits)
  • Services to treat an emergency
  • Family planning services (Planned Parenthood)
  • Laboratory services (must be ordered by a participating provider)
  • Podiatric care
  • Care at public health clinics
  • Care at Federally Qualified Health Centers (FQHCs)
  • Radiology services except for MRI (must be ordered by participating provider)
  • Routine eye exams (at participating vision centers)
  • Hearing services
  • Care from obstetricians and gynecologists
  • Care at urgent care centers after hours

Please note that Members may go to non-participating providers for:

  • Emergency care
  • Family planning services at Qualified Family Planning providers
  • Care at FQHCs

For more information, please call Provider Services at 1-800-390-7102 or see the Provider Manual.

Referral required

CareSource members must get a referral from their Primary Care Provider or specialist to receive some services.

These services include:

  • Specialist services - This includes visits to most participating specialists, such as a cardiologist or a certified nurse midwife. Specialists are listed in the Provider Directory.
  • Medical supplies - These require a prescription. They include diabetic supplies, surgical dressings, splints, casts and other items that cannot be reused. For more information, please see Prior Authorization.
  • Diagnostic services - This includes X-rays and lab work.
  • End-stage renal disease services.
  • Dental surgery in a hospital setting.
  • Laparoscopy, tubal cautery.
  • Sleep studies.
  • Vasectomy.

For more information, please see the Provider Manual.

Additional services

CareSource offers its members many Additional Services and support services. These include:

New Member Kits

Each new member household receives a New Member Kit upon enrollment in CareSource. This kit contains:

  • A Member Handbook that explains plan services and benefits and how to access them
  • A current Provider Directory that lists all participating health care providers and facilities
  • CareSource's Notice of Privacy Practices as required by the Health Insurance Portability and Accountability Act (HIPAA)
  • Other preventive health education materials and information

Member Services

CareSource provides assistance to Members with questions or concerns about services or benefits. Representatives are available Monday through Friday, 8 a.m. to 5:30 p.m., except holidays. Members can reach Member Services at 1-800-390-7102.

CareSource 24

CareSource offers an in-house, 24-hour nurse triage line for Members to call with medical questions and concerns 24 hours a day, 7 days a week. Our nurses can assess a Member's condition and direct the Member to the most appropriate place for care, whether that is the doctor's office, urgent treatment center, or the emergency room. Members can call CareSource 24 at 1-866-206-0488.

Michigan Tobacco Quitline

CareSource offers the Michigan Tobacco Quitline, a free program through the American Cancer Society. The quitline is a telephone coaching service to help tobacco users who are trying to quit that is answered 24 hours a day, seven days a week. Members can call the Michigan Tobacco Quitline at 1-800-784-8669.

Transportation

Transportation can be provided for member medical appointments with participating providers through CareSource's Transportation Services. Members can request transportation by calling 1-866-712-1057.

Case Management

CareSource has nurse case managers who assist members with conditions such as asthma, diabetes, congestive heart failure, obesity and high-risk pregnancy in coordinating appropriate medical and support services. If you know of any CareSource member who may benefit from case management, please call Member Services at 1-800-390-7102.

Interpreter services

CareSource offers sign and language interpreters for members who are hearing impaired, visually impaired, do not speak English, or have limited English-speaking ability. These services are available at no cost to members or health care providers.

As a provider for Medicaid consumers, you are required to identify the need for interpreter services for your CareSource patients and offer assistance to them appropriately. To arrange services, please contact Member Services at 1-800-390-7102.

Vision services

For all vision services including eye exams, CareSource members should contact Vision Services Plan (VSP) at 1-800-877-7195. Services for members under the ate of 21 include:

  • One complete eye exam every two years.
  • One pair of prescription lenses and eyeglass frames every two years. Many frames are covered in full.
  • Replacement glasses. Members who lose or break their glasses may be able to get another pair.

Services for members age 21 and older include:

  • One complete eye exam a year

Glasses and contact lenses for members age 21 and older are not covered by Medicaid or CareSource. CareSource members can get a discount on the purchase of glasses or contacts from VSP. The discounts are:

  • 20% off frames, lenses and lens options
  • 15% off contact lens exam

Mental health services

For all mental health services including routine, urgent and emergency care, CareSource members should call Comprehensive Behavioral Care at 1-800-435-5348. They will be referred to an appropriate mental health care provider.

For more information, please call Member Services at 1-800-390-7102 or see the Provider Manual.

Services outside CareSource

CareSource does not cover some services, but Members can still get them through Michigan Medicaid or another agency.

These services are:

  • Dental care - Call our service center for help.
  • Custodial long-term care in a nursing Certain anti-psychotic and anti-retroviral drugs - These are covered by Michigan's pharmacy benefits manager First Health at the point of sale. Members should present their MiHealth card. WIC services - This is a food and nutrition program for women, infants and children. Call your local health department.
  • Services for people with developmental disabilities - Call your local community mental health agency.
  • Drug and alcohol abuse services - Call your local substance abuse coordinating agency.

For more information, or for help in locating an agency, please call Provider Services at 1-800-390-7102 or see the no referral required from their Primary Care Provider (PCP). They can simply call for an appointment.

Services not covered

The following is a partial list of services excluded or limited by CareSource:

  • Services or items furnished solely for cosmetic purposes, except reconstructive breast surgery or surgery to correct a functional defect that is the result of a congenital and/or acquired disease
  • Services determined to be experimental, investigational or provided primarily for the purpose of research
  • Sex-change operations
  • Reversal of voluntarily induced infertility (sterility)
  • First aid supplies or items used for personal cleanliness and grooming
  • Services, equipment or supplies not performed, provided or prescribe or arranged by the member's PCP or, where required, not authorized in advance by CareSource.
  • Services or items that are usually furnished free of charge
  • Care, services, equipment or supplies not deemed medically necessary
  • Acupuncture

This is a partial list. If you have questions about whether a service is covered, please call Provider Services at 1-800-390-7102.