Michiganders are no strangers to the need for community health organizations and community health workers (CHWs). These frontline workers are the bridge that connects residents to essential care, resources, and support, from food and transportation to medical care.
Nearly 1 in 5 Michiganders live in rural communities, where a lack of nearby grocery stores, limited transportation options, and workforce shortages can make it difficult for families to access basic health services and food. Meanwhile, social drivers of health, such as housing instability, unsafe water, and environmental health hazards in cities like Flint and Detroit, are understood nationally, thanks to media coverage.
For years, CHWs have been the ones who step up in communities across Michigan to connect families to the health and social services they need. While Michigan’s CHWs are familiar with the work, they are newer to the practice of reimbursing CHWs for services delivered to eligible Medicaid recipients. Only as recently as January 1, 2024, the Michigan Department of Health and Human Services (MDHHS) formally expanded Medicaid coverage to include Community Health Worker (CHW) services.
Below is a quick guide to help community-based organizations (CBOs) and CHWs navigate Medicaid requirements and reimbursement in Michigan.
Key takeaways
- As of January 1, 2024, certified Michigan CHWs can get reimbursed for services delivered to eligible Medicaid members.
- Michigan CHWs must complete a training or work experience pathway and be registered with the Michigan Community Health Worker Alliance (MiCHWA).
- Community-based organizations with CHWs and individual CHWs can bill CHW services through the state’s fee-for-service Medicaid program.
- CHW services must be recommended by a supervising provider.
- Michigan CHWs use CPT codes 98960, 98961, and 98962 to bill Medicaid for qualified services.
- Care navigation and billing software can help CBOs and CHWs meet Michigan’s documentation requirements for Medicaid billing.
How do you become a community health worker in Michigan?
Michigan has a straightforward path for becoming a CHW. The basic process requires CHWs to be 18 years or older, hold a high school diploma or equivalent, and meet the training criteria.
Assuming the first criterion is met, aspiring CHWs can complete training with a Michigan Department of Health and Human Services (MDHHS) approved provider, such as Michigan Community Health Worker Association (MiCHWA).
Programs may vary, but MiCHWA divides its 166-hour requirement into components, including 25 hours of independent study and 40 hours of internship experience with a local agency. CHWs who are already employed may complete internship hours at their current workplace.
This training equips CHWs to provide culturally responsive, whole-person care.
Once certified, CHWs pay a $50 fee to become official MiCHWA members and apply to join the MI Medicaid CHW Registry. CHWs must earn six continuing education units (CEUs) annually to maintain certification.
How do CHWs and CBOs work with Medicaid in Michigan?
CHWs and CBOs in Michigan can receive Medicaid reimbursement through the state’s fee-for-service Medicaid program when services meet Medicaid reimbursement requirements.
Michigan allows certified CHWs to bill the state Medicaid program, administered by the Michigan Department of Health and Human Services, as well as through contracts with Managed Care Plans (MCPs), similar to states like California.
Billing requirements for CHW services
Michigan’s path to CHW reimbursement eligibility is pretty straightforward. CHWs must:
- Complete a CHW training program.
- Obtain an individual (Type 1) National Provider Identifier (NPI) as a rendering/servicing-only provider.
- Join the MI Medicaid CHW Registry.
- Enroll and gain access to the Community Health Automated Medicaid Processing System (CHAMPS) as a Medicaid provider.
While CHWs do not require clinical supervision, Medicaid-covered CHW services must be recommended by an eligible licensed provider to establish medical necessity for reimbursement. CHWs can request a standing order from a provider on a client’s care team following an SDOH screening, or the provider may recommend one as a result of a medical visit.
Approved clinical supervisors include:
- Physician
- Physician Assistant
- Advanced Practice Registered Nurse
- Registered Nurse
- Licensed Master Social Worker
- Dentist
- Psychiatrist or Psychologist
The supervising provider does not need to be present during service delivery.
CHW services that are reimbursable
Michigan’s Department of Health and Human Services (MDHHS) has identified specific goals for CHW programs, including increasing awareness of social drivers of health, improving trust and satisfaction with healthcare systems, serving rural populations, supporting behavioral health, and helping manage chronic conditions.
While CHWs meet these goals in many ways, only certain services are eligible for Medicaid reimbursement. According to Michigan Medicaid policy, reimbursable services include:
- Health system navigation and resource coordination
- Health promotion and education
- Screening and assessment
System navigation services might include helping beneficiaries:
- Adhere to preventative care practices and follow-up care plans.
- Find and receive Medicaid services and relevant community services.
- Self-manage chronic conditions
- Arrange transportation to Medicaid-covered services.
- Stay educated on telehealth technology.
CHWs may also provide health promotion and education sessions that include coaching and goal-setting to improve a beneficiary’s health or self-management capacity. Covered health education topics include, but are not limited to:
- Preventing injury
- Addressing family violence/inter-partner violence
- Controlling health conditions like asthma and high blood pressure
- Dementia
- Preventing and managing diabetes
- Self-managing chronic pain and chronic disease
- Family planning
- Preventing oral disease
- Improving safety and the environmental health of housing to mitigate asthma risk, risk of injury from unsafe housing, lead exposure, etc.
- Improving nutrition and physical fitness
- Occupational health and safety
- Improving mental health outcomes
- Preventing fetal alcohol syndrome/neonatal abstinence syndrome
- Reduction in the misuse of alcohol or drugs
- Tobacco cessation
- Promoting preventative services like cancer screenings and immunizations
Unlike states like California, which include case management as a billable service, the following services are not covered under Michigan’s Medicaid reimbursement policies:
- Case management
- Transportation services
- Personal care services/home help, including shopping and cooking meals.
- Companion services
- Employment services
- Helping a beneficiary enroll in government or other assistance programs that are not related to improving their health as part of a provider’s recommendation.
- Delivery of medication, medical equipment, or medical supplies
- Respite care
- Services that require a license
- Services that duplicate another covered Medicaid service already being provided to the beneficiary
- Discharge planning
- Community transition services
- Support services covered under behavioral health services programs by certified peer support specialists (CPSS) or certified peer recovery coaches (CPRC)
Medicaid Michigan fees schedule and rate for reimbursable services
Eligible CHW services fall under Michigan’s Medicaid fee schedule using the following CPT codes for education and training:
| CPT code | Description | Rate for one 15-minute unit |
|---|---|---|
| 98960 | Education and training for patient self-management; individual client | $10.26 |
| 98961 | Education and training for patient self-management; 2–4 clients | $5.23 |
| 98962 | Education and training for patient self-management; 5–8 (max) clients | $4.21 |
CHWs may bill up to 128 units per beneficiary per month. Providers may exceed this limit with prior authorization from a licensed healthcare provider.
While per-unit rates are modest, many CHW workflows combine education, navigation, and follow-up to bill multiple units per member per month and sustainably support care delivery.
Documentation requirements
In Michigan, documentation is especially important, as all services must be tied to a chronic health condition, social need, pregnancy, or other eligibility criteria. Detailed guidance is outlined in MDHHS Bulletin Number MMP 23-74.
Documentation must include:
- Proof of Medicaid eligibility at the time of service
- Provider recommendation/referral
- Service type and duration (15-minute units)
- Link to health education or self-management goals
- Date, location, and CHW rendering the service.
How does Medicaid billing software support Michigan CHWs?
Given the need for detailed documentation, a care navigation and billing software like Pear Suite equips CHWs with the tools needed to meet these requirements, including capturing information about encounters in real time, tracking social drivers of health, and generating the reports needed for compliant Medicaid billing and quality metrics.
Instead of spending hours on paperwork or struggling to prove the value of their work, CHWs can focus on what they do best: meeting people where they are and connecting them to care. For example, a CHW who helps clients arrange transportation to dialysis appointments can use Pear Suite to log each interaction, set reminders for follow-ups, and capture the data needed to submit a claim for Medicaid reimbursement. Similarly, software that centralizes care plans, monitors closed-loop referrals, and allows CHWs to easily assign billing codes to services provided can help CHWs scale their community impact and build out their Medicaid reimbursement pathways.
With Medicaid reimbursement in place, Michigan CHWs and the organizations that support them have a chance to secure sustainability for their work. Care navigation software empowers CHWs to expand their reach, demonstrate their impact, and continue advancing health equity.
Whether you’re a Michigan CBO preparing to enroll CHWs, a health system building referral pathways, or a CHW navigating documentation and billing for the first time, Pear Suite helps Michigan teams operationalize Medicaid reimbursement with confidence.
