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Act No. 45
Public Acts of 2025
Approved by the Governor
December 23, 2025
Filed with the Secretary of State
December 23, 2025
EFFECTIVE DATE: December 23, 2025
STATE OF MICHIGAN
103RD LEGISLATURE
REGULAR SESSION OF 2025
Introduced by Reps. Bierlein, Borton, Frisbie and Martin
ENROLLED HOUSE BILL No. 4726
AN ACT to amend 1939 PA 280, entitled “An act to protect the welfare of the people of this state; to provide
general assistance, hospitalization, infirmary and medical care to poor or unfortunate persons; to provide for
compliance by this state with the social security act; to provide protection, welfare and services to aged perso ns,
dependent children, the blind, and the permanently and totally disabled; to administer programs and services for
the prevention and treatment of delinquency, dependency and neglect of children; to create a state department of
social services; to prescribe the powers and duties of the department; to provide for the interstate and intercounty
transfer of dependents; to create county and district departments of social services; to create within certain county
departments, bureaus of social aid and certain divisions and offices thereunder; to prescribe the powers and duties
of the departments, bureaus and officers; to provide for appeals in certain cases; to prescribe the powers and
duties of the state department with respect to county and district departmen ts; to prescribe certain duties of
certain other state departments, officers, and agencies; to make an appropriation; to prescribe penalties for the
violation of the provisions of this act; and to repeal certain parts of this act on specific dates, ” by amending
section 109 (MCL 400.109), as amended by 2024 PA 248.
The People of the State of Michigan enact:
Sec. 109. (1) An eligible individual may receive the following medical services under this act:
(a) Hospital services that an eligible individual may receive consist of medical, surgical, or obstetrical care,
together with necessary drugs, X-rays, physical therapy, prosthesis, transportation, and nursing care incident to
the medical, surgical, or obs tetrical care. The period of inpatient hospital service must be the minimum period
necessary in this type of facility for the proper care and treatment of the individual. Necessary hospitalization to
provide dental care must be provided if certified by the attending dentist with the approval of the department.
An individual who is receiving medical treatment as an inpatient because of a diagnosis of mental disease may
receive service under this section, notwithstanding the mental health code, 1974 PA 258, M CL 330.1001 to
330.2106. The department must pay for hospital services according to the state plan for medical assistance
adopted under section 10 and approved by the United States Department of Health and Human Services.
(b) Physician services authorized by the department. The services may be furnished in the physician ’s office,
the eligible individual’s home, a medical institution, or elsewhere in case of emergency. A physician must be paid
a reasonable charge for the service rendered. The department must determine reasonable charges. Reasonable
charges must not be more than those paid in this state for services rendered under title XVIII.
(c) Nursing home services in a state licensed nursing home, a medical care facility, or other facility or
identifiable unit of that facility, certified by the appropriate authority as meeting established standards for a
nursing home under the laws and rule s of this state and the United States Department of Health and Human
Services, to the extent found necessary by the attending physician, dentist, or certified Christian Science
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practitioner. An eligible individual may receive nursing home services in an extended care services program
established under section 22210 of the public health code, 1978 PA 368, MCL 333.22210, to the extent found
necessary by the attending physician when the combined length of stay in the acute care bed and short -term
nursing care bed exceeds the average length of stay for Medicaid hospital diagnostic related group reimbursement.
The department shall not make a final payment under title XIX for benefits a vailable under title XVIII without
documentation that title XVIII claims have been filed and denied. The department must pay for nursing home
services according to the state plan for medical assistance adopted according to section 10 and approved by the
United States Department of Health and Human Services. A county must reimburse a county maintenance of
effort rate determined on an annual basis for each patient day of Medicaid nursing home services provided to
eligible individuals in long-term care facilities owned by the county and licensed to provide nursing home services.
For purposes of determining rates and costs described in this subdivision, all of the following apply:
(i) For county-owned facilities with per patient day updated variable costs exceeding the variable cost limit for
the county facility, county maintenance of effort rate means 45% of the difference between per patient day updated
variable cost and the concomit ant nursing home -class variable cost limit, the quantity offset by the difference
between per patient day updated variable cost and the concomitant variable cost limit for the county facility. The
county rate must not be less than zero.
(ii) For county -owned facilities with per patient day updated variable costs not exceeding the variable cost
limit for the county facility, county maintenance of effort rate means 45% of the difference between per patient
day updated variable cost and the concomitant nursing home class variable cost limit.
(iii) For county -owned facilities with per patient day updated variable costs not exceeding the concomitant
nursing home class variable cost limit, the county maintenance of effort rate must equal zero.
(iv) For the purposes of this section: “per patient day updated variable costs and the variable cost limit for the
county facility” must be determined according to the state plan for medical assistance; for freestanding county
facilities the “nursing home class variable cost limit” must be determined according to the state plan for medical
assistance and for hospital attached county facilities the “nursing class variable cost limit ” must be determined
according to the state plan for medical assistance plus $5.00 per patient day; and “freestanding” and “hospital
attached” must be determined according to the federal regulations.
(v) If the county maintenance of effort rate computed under this section exceeds the county maintenance of
effort rate in effect as of September 30, 1984, the rate in effect as of September 30, 1984 must remain in effect
until a time that the rate computed u nder this section is less than the September 30, 1984 rate. This limitation
remains in effect until December 31, 2030 or until a new reimbursement system determined by the department
replaces the current system, whichever is sooner. For each subsequent c ounty fiscal year, the maintenance of
effort rate may not increase by more than $1.00 per patient day each year.
(vi) For county-owned facilities, reimbursement for plant costs must continue to be based on interest expense
and depreciation allowance unless otherwise provided by law.
(d) Pharmaceutical services from a licensed pharmacist of the individual ’s choice as prescribed by a licensed
physician or dentist and approved by the department. In an emergency, but not routinely, the individual may
receive pharmaceutical services rendered personally by a licensed physician or dentist on the same basis as
approved for pharmacists.
(e) Other medical and health services as authorized by the department.
(f) Psychiatric care provided according to the guidelines established by the department to the extent of
appropriations made available by the legislature for the fiscal year.
(g) Screening, laboratory services, diagnostic services, early intervention services, and treatment for chronic
kidney disease under guidelines established by the department. A clinical laboratory performing a creatinine test
on an eligible individual unde r this subdivision must include in the lab report the glomerular filtration rate
(eGFR) of the individual and must report it as a percentage of kidney function remaining.
(h) Medically necessary acute medical detoxification for opioid use disorder, medically necessary inpatient care
at an approved facility, or care in an appropriately licensed substance use disorder residential treatment facility.
(i) Mental health screenings during the postpartum period as described in section 9137 of the public health
code, 1978 PA 368, MCL 333.9137.
(2) The director must provide notice to the public, according to applicable federal regulations, and must obtain
the approval of the committees on appropriations of the house of representatives and senate of the state
legislature, of a proposed change in the statewide method or level of reimbursement for a service, if the proposed
change is expected to increase or decrease payments for that service by 1% or more during the 12 months after
the effective date of the change.
(3) As used in this act:
(a) “Title XVIII” means title XVIII of the social security act, 42 USC 1395 to 1395lll.
(b) “Title XIX” means title XIX of the social security act, 42 USC 1396 to 1396w-7.
(c) “Title XX” means title XX of the social security act, 42 USC 1397 to 1397n-13.
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This act is ordered to take immediate effect.
Clerk of the House of Representatives
Secretary of the Senate
Approved___________________________________________
____________________________________________________
Governor