Medical Subsidy Eligibility And Covered Services

Prior to the PCA 320 Order Placing Child being signed by the court, the child’s adoption case manager must submit a DHS-1341, Adoption Assistance and/or Medical Subsidy Application and supporting documentation to AGAO.

After the PCA 320 or PCA 321 Order of Adoption has been signed by the court, the adoptive parent(s)/guardian(s) must submit a DHS-1341-A, Parent Application for Adoption Medical Subsidy for An Adopted Child and supporting documentation to AGAO.

Supporting documentation must identify the condition and explain how the condition, or its cause, existed prior to adoption. It must also be signed by an appropriate diagnosing professional. These specific guidelines can be found on the last page of the application form.

Once the eligibility unit has approved adding a condition, a new medical subsidy agreement with the condition added will be sent to you for signatures and then need to be returned to AGAO for processing. The agreement must have final signature from AGAO program manager or designee to be eligible.

Example: Your child is having difficulty with academics at school. You would like assistance in paying for tutoring. Your child MUST have a related condition added to their medical subsidy (if you do not already have a related condition) before a prior authorization for tutoring can be requested. Examples of related conditions could be learning disability, ADHD, Autism, etc. The DHS-1341-A would need to be completed and submitted to the eligibility unit for an eligibility determination to be made to have a related condition that impacts learning added to your medical subsidy agreement.

Example: You are informed that your child will require orthodontic work. Your child MUST have orthodontics added to their medical subsidy to be eligible for payment of services/reimbursement. The DHS-1341-A would need to be completed and submitted to the eligibility unit to have orthodontics added as a condition and must then be approved by the eligibility unit and added to your medical subsidy agreement.

Conditions may be added to your child’s medical subsidy agreement before appointment of the guardianship and after.

Prior to appointment of the guardianship, the child's foster care caseworker must submit a DHS-3310, Juvenile Guardianship Assistance Application and supporting documentation to AGAO.

After the appointment of the guardianship, the legal guardian(s) must submit a DHS-1084, Guardian's Application for Medical Subsidy and supporting documentation to AGAO.

Supporting documentation must identify the condition and explain how the condition, or its cause, existed prior to guardianship. It must also be signed by an appropriate diagnosing professional. These specific guidelines can be found on the last page of the application form.

Once the eligibility unit has approved adding a condition, a new medical subsidy agreement with the condition added will be sent to you for signatures and then need to be returned to AGAO for processing. The agreement must have final signature from AGAO program manager or designee to be eligible.

Example: Your child is having difficulty with academics at school. You would like assistance in paying for tutoring. Your child MUST have a related condition added to their medical subsidy (if you do not already have a related condition) before a prior authorization for tutoring can be requested. Examples of related conditions could be learning disability, ADHD, Autism, etc. The DHS-1341-A would need to be completed and submitted to the eligibility unit for an eligibility determination to be made to have a related condition that impacts learning added to your medical subsidy agreement.

Example: You are informed that your child will require orthodontic work. Your child MUST have orthodontics added to their medical subsidy to be eligible for payment of services/reimbursement. The DHS-1341-A would need to be completed and submitted to the eligibility unit to have orthodontics added as a condition and must then be approved by the eligibility unit and added to your medical subsidy agreement.

Once a condition is certified by AGAO and added to your medical subsidy agreement, then many services (except for orthodontics, glasses/contacts, hearing aids, dental, medical, medical supplies, prescriptions, camp, and respite) require a prior authorization for the specific service/service provider. If your child does not have a related condition on their medical subsidy and you request prior authorization for a service, your prior authorization request will be denied.

Prior authorization requests can be emailed, mailed or faxed to AGAO. Emailed prior authorization requests can be sent to MDHHS-MedicalSubsidyClaims@michigan.gov.

You must complete the general information section of the prior authorization form, along with the section for the service you are requesting AND provide ALL the required documentation indicated on the form. Your ongoing analyst will review the prior authorization request. If you are missing required information needed to process your request, you will be notified and allotted 45 days to provide the missing information. If you do not submit the information within 45 days, your request will be denied.

If approved, you will receive an authorization letter from your analyst with the approved dates of service and maximum payment rate.

MDHHS-6178 Medical Subsidy Prior Approval Application

Example: Your child is having difficulty with academics at school. You would like assistance in paying for tutoring. You already have an approved learning related condition on your child’s medical subsidy. You now need to request a prior authorization by completing the general information section on the MDHHS-6178 and the section for tutoring including all required documentation listed for tutoring. This should be submitted to your ongoing analyst.

Example: You are informed that your child will require orthodontic work. You already have orthodontics approved on your child’s medical subsidy. Orthodontics is one of the services that does not require a prior authorization. A prior authorization request is not needed. AGAO will pay for services on or after the date of certification for orthodontics on your child’s medical subsidy.

Medical subsidy payments are made in response to specific bills submitted to AGAO by the adoptive parent(s)/guardian(s) or the service provider. Payments are made at rates approved by AGAO and issued directly to the service provider or adoptive parent(s)/guardian(s).

To request a payment or reimbursement for a medical subsidy service, an Adoption Medical Subsidy Services Billing Statement must be completed. Requests for reimbursement to the adoptive parent/guardian must include proof of payment. Billing statements must be submitted within six months after the date of service or within six months after receiving a decision of payment by the child’s insurance. AGAO cannot pay for services that occurred prior to the effective date of the condition on the medical subsidy agreement. Please allow 30 days for medical subsidy claims to be processed by your analyst before following up. Prior authorization must be approved by AGAO for services requiring an authorization before payment can be processed through the medical subsidy program.

Billing documents can be emailed, faxed, or mailed to AGAO on or after the date of service. Emailed billing documents can be sent to MDHHS-MedicalSubsidyClaims@michigan.gov.

Medical Subsidy Billing Statement
General Medical Subsidy Billing Procedures
Ortho Medical Subsidy Billing Procedures
Respite Billing Procedures & Tracker