Check Eligibility

The Michigan Department of Health and Human Services determines the beneficiary’s eligibility for public assistance.

HAP CareSource™ MI Health Link (Medicare-Medicaid Plan) coverage is based on the following requirements:

  • Michigan adults, ages 21 or over
  • Those who are enrolled in both Medicare and Medicaid
  • Those who are not enrolled in hospice
  • People with Medicaid deductibles are not eligible
  • Nursing home residents are eligible, but must continue to pay patient deductible (if applicable)
  • Medigap policy holders are eligible if other eligibility criteria is met
  • Must disenroll from other products to become eligible
  • Must reside in Macomb County or Wayne County

When can a member enroll?

The state can passively enroll eligible members. Auto assignment and self-selection are key enrollment methods. If eligible for HAP CareSource MI Health Link, the state can disenroll a D-SNP member and enroll them into HAP CareSource MI Health Link. If this occurs, the member would be enrolled into HAP CareSource MI Health Link from the same organization (if available). If they choose, the member can select another plan.

Michigan ENROLLS, the enrollment broker for Michigan Medicaid programs, providers educational material about the Medicaid health plans available in the member’s county. Michigan ENROLLS assists Medicaid members in choosing the health plan of their choice. If the member doesn’t choose a health plan, Michigan ENROLLS will auto assign one to them.

Plans are notified monthly via a data file exchange of the Medicaid members enrolled in their plan.

What if a member loses eligibility?

The member will receive notifications from MDHHS regarding their eligibility status. If it’s under review, all services will continue to be covered until a determination has been made. If the member is no longer eligible, the member will receive a letter from MDHHS and be enrolled back into Medicare.

We recommend that you check member eligibility every time a member presents for services, as member eligibility can fluctuate. Changes in health status such as certain medical conditions may also cause changes in plan eligibility and coverage status.

Providers may use our secure HAP CareSource Provider Portal to check member eligibility. Click “Member Eligibility” on the left. Or call Provider Services at 1-833-230-2159.

Member ID Card

When members select HAP CareSource MI Health Link to provide both their Medicare and Medicaid benefits, they will have a single ID card replacing both their state Medicaid and their Medicare card. These members will require only one card for both plans.

Members are asked to present an ID card each time services are accessed. If you are not familiar with the person seeking care and cannot verify the person as a member of our health plan, please ask to see photo identification.

Member Consent

When you check eligibility on the HAP CareSource Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI). SHI is a subset of protected health information (PHI) which may require consent from the individual in order to be shared with others.

When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS, mental health or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the HAP CareSource Provider Portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information.

Please encourage HAP CareSource MI Health Link members who have not consented to complete the Member Consent/HIPAA Authorization Form so that all providers involved in their care can effectively coordinate their care.

The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf. This designated representative can be a relative, a friend, a physician, an attorney or some other person that the member specifies.