Washtenaw Health Plan Information for Providers

Cancer Screenings

Cancer screenings must be ordered by a WHP primary care physician or a participating specialty clinic to be covered by the Washtenaw Health Plan.

Covered Services

• Colonoscopies
• FIT
• Clinical breast exam
• Mammogram
• Pap test and pelvic exam (can be done at their primary care office, or, if their PCP is unavailable, a specialty care clinic.)
• Radiology, imaging, and labs ordered by a physician
• If needed, cancer-related treatment

Not covered

• ColoGuard
• Genetic testing

Additional Provider Reimbursement Options

If primary care providers want to take steps to receive additional reimbursement for breast and cervical cancer screenings, they may:

• • • Contact Denise Hill of the Michigan Breast and Cervical Cancer Control Navigation Program (BC3NP) at (888) 242-2702
    • Bill MOMS Medicaid if claims have a diagnosis code of pregnancy attached.

Contraception

Contraception methods are covered for members by the Washtenaw Health Plan, MOMS Medicaid, or Patient Assistance Programs.

Most Washtenaw Health Plan members are eligible for MOMS Medicaid during pregnancy and for up to two months after the end of a pregnancy. Washtenaw Health Project can help enroll them.

Covered by Washtenaw Health Plan

• Birth control pills
• Birth control shot (see notes)
• Sterilization procedures for men and women: vasectomy, tubal ligation, and hysterectomy.

Covered by MOMS Medicaid

It is recommended that members use their MOMS Medicaid benefits to access contraception.

• Copper IUD
• Hormonal IUDs
• Arm Implant
• Birth control shot (see notes)
• Patch
• Vaginal ring
• Birth control pills and emergency birth control (with prescription)
• Sterilization procedures for women (tubal ligation and hysterectomy)
• Barrier methods such as diaphragms, the sponge, and cervical caps may be covered.

Hormonal IUDs

The Bayer Foundation Patient Assistance Program covers Skyla, Kyleena, and Mirena IUDs. Medical providers must help members apply.

Free condoms

Free male and female condoms are available from the vending machine in the atrium of the Health Department at 555 Towner Street in Ypsilanti.

NOTES

Birth control shot: It is easiest for members to go to a healthcare provider office with a pharmacy onsite (Packard Health Main or The Corner Health Center). These locations can dispense the shot prescription, perform the required pregnancy test, and administer the shot in the same appointment. Patients up to age 26 can be referred to The Corner Health Center for contraception care without changing their primary care provider.

Breastfeeding is not recommended while using hormonal forms of birth control as the hormones can be transferred to the baby. Breastfeeding is safe while using non-hormonal contraception, such as the copper IUD or a barrier method, or the low-hormone “mini-pill” (also called a “progesterone-only” pill).

Diabetes Management

GLUCOMETERS

Members can receive a Contour Next One or Contour Next Gen glucometer from the manufacturer, Ascensia in two ways, explained below. Contour meters take the same test strips regardless of model.

Pick up a free glucometer at a pharmacy with a prescription
Members can complete this form on Ascensia’s website or get a prescription from their doctor for a Contour Next One glucometer. To get the glucometer for free, a minimum of 50 test strips must be purchased. To cover this cost, providers can prescribe up to 100 Contour Next test strips per 30 days. Members will only be responsible for the $7 brand name prescription copay when they pick these items up from the pharmacy.

Or, call to receive a free glucometer in the mail
Members can call Ascensia at 1-800-348-8100, provide their information, and have a free Contour Next Gen blood glucose meter plus 10 test strips mailed to them. Telephone assistance is available in English and Spanish.

TEST STRIPS AND LANCETS

Test strips and lancets are covered under the pharmacy benefit and must be filled at the pharmacy.

DIABETIC SHOE INSERTS

Diabetic shoe inserts are available for members with a prescription from University of Michigan Health – Michigan Medicine Orthotics and Prosthetics Center at 2850 S. Industrial Hwy. Suite 400 in Ann Arbor (734-973-2400)

DIABETES MEDICATIONS

Washtenaw Health Plan members are covered at most pharmacies in Washtenaw County. Please check our formulary for covered prescriptions.

DIABETES EDUCATION

Washtenaw Health Plan members have access to Diabetes Education classes through Trinity-IHA and Michigan Medicine. See class descriptions and referral procedures for each health system. Members assigned to Packard Health can be referred to the Certified Diabetes Educator on staff for self-management education.

Printable multilingual meal plan guides are available from EthnoMed.

EthnoMed has a library of additional resources on multicultural, multilingual diabetes care and management for providers and patients.

Durable Medical Equipment (DME)

All Washtenaw Health Plan members have a limited yearly benefit of $250 for certain types of medical equipment and supplies. You can send Durable Medical Equipment (DME) requests to local DME providers, and they will contact us for approval. If you have questions, please contact Jean Amador at 734-544-6886.

If a Washtenaw Health Plan member needs DME not covered by the plan or has already used their $250 benefit, please try Washtenaw County loan closets. Certain equipment such as walkers, crutches, and wheelchairs are provided for members by loan closets.

CPAP Machines

Members who need a CPAP machine should take their script and sleep study to Healthcare DME. CPAP machines are approved once every 5 years. Members who need CPAP supplies can use any of the DME providers above where CPAP supplies are listed.

Note on Michigan Medicine CPAP and Ostomy Supplies:

Recently, Michigan Medicine’s associated Oxygen and CPAP groups are no longer operating (to the best of our knowledge). This has created a gap in Oxygen and CPAP machines for WHP members, because the cost for these machines and supplies is greater than $250 per year.

Ostomy supplies are another gap where $250 does not cover it completely. We are currently looking for affordable options here.

Emergency and Outpatient Hospital Services

Providers

• Trinity Health Emergency – Ann Arbor Hospital (formerly St. Joe’s)
  5301 McAuley Dr.
  Ypsilanti, 48197
  
• Chelsea Hospital Emergency
  775 S Main St
  Chelsea, Michigan 48118
  
• University of Michigan Hospital Emergency Room
  1500 E Medical Center Dr
  Ann Arbor, MI 48109
  

Covered Services

• Medically necessary services
• Emergency room visits that do not result in admission
• Surgery
• Radiology, imaging, and labs ordered by a physician

Notes

Ambulance services are not covered by the Washtenaw Health Plan. Members can have ambulance services covered by other programs.

No one can be turned away by emergency rooms, even if they don’t have active insurance.

Immunizations

Providers

• University of Michigan Health – Michigan Medicine (Washtenaw County locations only)
• Trinity Health/IHA (Washtenaw County locations only)
• The Corner Health Center
• Packard Health (children only). Adult Packard Health WHP Members are directed to local pharmacies and the Washtenaw County Health Department Immunizations Clinic.
• Most pharmacies in Washtenaw County
• Washtenaw County Health Department Immunizations Clinic

Covered Immunizations

Immunizations are covered for Washtenaw Health Plan members at their healthcare provider office. Travel immunizations are not covered.

See list of covered pediatric (1-18) immunizations and recommended administration schedule

See list of covered adult immunizations and recommended administration schedule

WHP encourages all members to get their immunizations at their primary care provider’s officer. However, if they cannot get to their primary care provider for an immunization, the following immunizations are available in pharmacies under WHP’s pharmacy benefit:

• Flu
• COVID-19
• Pneumonia (for those who are eligible)
• Shingles (for those who are eligible)

Washtenaw County Health Department Immunization Clinic

Adult Packard Health WHP members are directed to the Washtenaw County Health Department Immunization clinic at 555 Towner Street in Ypsilanti where they can use the sliding-fee scale application to reduce out-of-pocket costs. View the list of available Health Department immunizations here.

Adult Packard Health WHP members may also receive flu, COVID-19, pneumonia, and shingles vaccines at most Washtenaw County pharmacies under WHP’s pharmacy benefit.

Inpatient Hospital Care

Providers

• University of Michigan Health – Michigan Medicine 
• Trinity Health/IHA/St. Joseph Mercy Hospital
• Chelsea Hospital

Covered Services

Medically necessary services only, excluding psychiatric care. Please see the mental health care section for more information.

Mental Health Services

To coordinate mental health care for Washtenaw Health Plan members, please contact Kelly Stupple at 734-544-3079 or stupplek@washtenaw.org. Mental health counseling is available from our partner providers in multiple languages.

Providers

• Amplify Colectivo (counseling only)
• Catholic Social Services (counseling + psychiatric services)
• Corner Health Center (counseling + psychiatric services)
• Jewish Family Services – Thrive Counseling (counseling only)
• Packard Health* (counseling + psychiatric services)
• The Women’s Center of Southeastern Michigan (counseling only)
• Independently contracted licensed therapists (counseling only)
• Michigan Medicine (psychiatric services only)
• Trinity Health (psychiatric services only)

Covered Services

• Intake and counseling for Washtenaw Health Plan members up to 52 sessions per year
• Outpatient psychiatric office visits with participating providers

Covered Elsewhere

Substance use and inpatient psychiatric treatment services are available through Community Mental Health (CMH). Washtenaw Health Project can help members access these services through CMH.

Notes

*Packard Health only provides mental health services to Packard Health primary care patients. Members must first establish primary care at Packard Health if they would like to receive mental health services at Packard Health.

Physical Therapy

Provider

Probility

Covered Services

At Probility, Washtenaw Health Plan members can be seen 2x per week for 4 weeks, at no charge.

Usually this is enough to resolve their physical therapy needs; however, if it is not, directors at each facility have flexibility to approve more visits (likely a reduced visit rate, for 2-3 additional weeks).

Notes

Currently, patients must fill out an MSupport application for Physical Therapy at Michigan Medicine. They can access Physical Therapy, but it is a separate process.

At Probility, Washtenaw Health Plan members may need help scheduling an initial appointment if they do not speak English (where interpreters can be requested). Probility has Spanish-speaking physical therapists at certain locations.

Prescriptions

Washtenaw Health Plan works with all major and local pharmacies in Washtenaw County. Members have prescription coverage with co-pays of $5 (generic) or $7 (brand name).

If a prescription is not covered by the Washtenaw Health Plan formulary, please connect clients with a Prescription Assistance Program (needymeds.org) or search goodrx.com for the pharmacy with the lowest price. Providers may also confirm prescription coverage or request a short-term override with the Ingham Health Plan at 866-291-8691.

Diabetic supplies are available to members for free through the pharmacy benefit. See the diabetes management section for details.

Primary Care

Providers

• University of Michigan Health – Michigan Medicine (Washtenaw County locations only)
• Packard Health
• Trinity Health/IHA (Washtenaw County locations only)
• The Corner Health Center

Covered Services at Primary Care Locations

• Routine physicals and health examinations
• Well-child care
• Diagnostic and treatment services
• Administration of immunizations* per current ACIP guidelines (travel immunizations excluded)
• Administration of therapeutic injections (injectables not included)
• Local treatment of burns
• Destruction of lesions
• Allergy tests & administration of allergy injections (serum not included)
• Pulmonary assessment
• EKG, blood pressure, rhythm strip
• Auditory procedures
• Simple laboratory screens
• Female and male sterilization
• PAP tests (frequency as indicated by physician–can be coordinated with Title XV Breast and Michigan Breast and Cervical Cancer Control Program (BC3NP) )
• Family planning services

Notes: *Packard Health does not currently provide immunizations to adult WHP members. Those are directed to the Washtenaw County Health Department Immunization Clinic at 555 Towner Street in Ypsilanti (734-544-6700) where they have access to a sliding-fee scale. See immunizations section for more information.

Radiology, Imaging, and Labs

Providers

• University of Michigan Health – Michigan Medicine (Washtenaw County locations only)
• Trinity Health/IHA/St. Joseph Mercy Hospital (Washtenaw County locations only)
• Chelsea Hospital

Services Covered

• Medically necessary services
• Laboratory services ordered by a physician
• Chemotherapy, cobalt, isotopes, and radiation therapy
• X-ray services
• EKG services
• CAT, MRI, MRA & PET scans
• Mammograms – See Cancer Screenings for details

Specialty Care

Providers

• University of Michigan Health – Michigan Medicine (Washtenaw County locations only)
• Trinity Health/IHA/St. Joseph Mercy Hospital (Washtenaw County locations only)
• Several Trinity Health-affiliated independent specialists:
  ⋅  Anesthesia Associates of Ann Arbor
  ⋅  Associates in Physical Medicine & Rehabilitation
  ⋅  Catherine McAuley Health System
  ⋅  Chelsea Community Hospital CRNA
  ⋅  EPMG of Michigan (Emergency Physicians Medical Group)
  ⋅  Huron Gastroenterology
  ⋅  Huron Opthamology
  ⋅  Huron River Oncology
  ⋅  Huron Valley Radiology
  ⋅  Michigan Pain Institute
  ⋅  MOSA (Michigan
  ⋅  Otolaryngology Surgery Associates)
  ⋅  Nephrology Associates of Michigan
  ⋅  SJMHS Anesthesia Associates
  ⋅  St. Joseph Mercy CRNA

Covered Services

Medically necessary services.

Urgent Care

Washtenaw Health Plan partners with 5 Washtenaw County IHA urgent care centers. These are the ONLY urgent care centers that participate with the Washtenaw Health Plan. (There are many other urgent care centers in Washtenaw County, but none of them accept the Washtenaw Health Plan.)

• Trinity Health IHA Urgent Care –Domino’s Farms
• Trinity Health IHA Urgent Care –EMU
• Trinity Health IHA Urgent Care –Milan
• Trinity Health IHA Urgent Care –Saline
• Trinity Health IHA Urgent Care –West Arbor

Notes

We recommend that members first call their Primary Care Physician to see if they can be seen the same or next day. 

Covered Elsewhere

The Washtenaw Health Plan does not cover the following services, but members can receive coverage and  financial support for these services through other programs.

Enrollment
Washtenaw Health Project can enroll people in Medicaid for Emergency Services Only (Medicaid-ESO) and MOMS Medicaid or Pregnancy Medicaid to cover some of these services.

AMBULANCE

Medicaid for Emergency Services Only (MA-ESO) — which many Washtenaw Health Plan members are eligible for — will cover ambulance bills within the last 90 days. Huron Valley Ambulance also has charity care. There is also a separate county fund we can access.

DENTAL

Benefits are available for Washtenaw County residents without dental coverage to receive services at Mi Community Dental Center (MCDC) in Ypsilanti. Washtenaw Health Project identifies individuals who would benefit and submits applications for the Dental Fund on a case-by-case basis. Funding for the Dental Fund is limited, and capacity is limited due to limited number of providers. Patients may be eligible to get additional services from MCDC at subsidized levels, depending on their income. Please contact Kelly Stupple at 734-544-3079 or stupplek@washtenaw.org with questions.

DIALYSIS

Individuals on dialysis can receive outpatient treatment covered through Medicaid for Emergency Services Only (MA-ESO).

OUT-OF-COUNTY CARE

Emergency Care outside of Washtenaw County: WHP members with Medicaid for Emergency Services Only (Medicaid-ESO) are covered for emergency room visits and services in truly life-threatening emergencies in any county. MA-ESO does not cover follow-up visits or services.  

Pregnancy Care outside of Washtenaw County: WHP members with Pregnancy Medicaid and MOMS Medicaid can use this health coverage in any county.

Preventative care outside of Washtenaw County: For low-cost preventative care outside of Washtenaw County, such as vaccines, members can visit local Health Departments, nonprofit organizations, or Federally Qualified Health Centers (FQHC). Find a FQHC.

PREGNANCY CARE

Pregnant WHP members have their care covered under Pregnancy Medicaid and MOMS Medicaid. Proof of pregnancy with a due date from a medical provider is required to enroll.

• MOMS Medicaid covers the costs of  pregnancy, including prenatal care, labor and delivery, and 2 months of postpartum care.
• Pregnancy Medicaid is full Medicaid and covers all pregnancy-related care and other health care needs during pregnancy and for 12 months after the end of the pregnancy.

SPEECH AND OCCUPATIONAL THERAPY

Speech and occupational therapy can be covered at Washtenaw County Michigan Medicine locations through the MSupport Charity Care program. Public schools can also provide these services to enrolled students.

SUBSTANCE USE AND INPATIENT MENTAL HEALTH TREATMENT

Services are available through Washtenaw Community Mental Health. Washtenaw Health Project helps Washtenaw Health Plan members through the access process for these services. Service capacity, particularly for Spanish speakers, can be limited.

VISION AND OPTOMETRY

For Adults

Hope Clinic in Ypsilanti provides free vision screenings and free or low-cost glasses through their SIGHT Clinic.

We also send people to America’s Best Eyecare, which offers eye exams and two pairs of glasses for $69.

For Children

Children (age 21 and under) should be referred to Regional Alliance for Healthy Schools (RAHS) for free screenings, eye exams, and new and replacement glasses. RAHS can also arrange free transportation to these appointments.

Free hearing and vision screenings: The Health Department performs free hearing and vision screenings for children entering preschool or kindergarten. Translation service is available.

No Coverage

The Washtenaw Health Plan does not cover the following services, and to our knowledge, these are not covered elsewhere for Washtenaw Health Plan members:

• Chiropractor care
• Dental implants
• Genetic testing
• Hearing aids
• Hospice
• In-home health aids, home health personal care/chore assistance
• Nursing home care
• Private duty nurses
• Surgical weight reduction services