MMP 26-42

Michigan Department of Health and Human Services (MDHHS) issued Bulletin MMP 26-42 on November 2, 2026, directing all Medicaid providers, Medicaid Health Plans (MHPs), and Highly Integrated Dual Eligible Special Needs Plans to implement coverage changes for gender affirmation services. The bulletin responds to a final rule issued by CMS on August 13, 2026 (CMS-2451-F), which prohibits the use of federal Medicaid and CHIP funds for certain gender-affirming procedures for youth, effective October 13, 2026. Effective October 13, 2026, MDHHS will no longer claim Federal Financial Participation (FFP) for puberty blockers and surgery when provided for the purpose of gender affirmation for beneficiaries under 18 years of age in Medicaid and under 19 years of age in CHIP. A narrow, time-limited grandfathering exception permits gender-affirming hormone therapy to remain eligible for FFP through April 13, 2027. To support implementation, gender affirmation services are carved out of MHPs for beneficiaries of all ages effective October 13, 2026. MDHHS will honor MHP-approved prior authorizations (PAs) for affected services occurring on and after October 13, 2026, but MHPs must submit those approved PAs to MDHHS to ensure reimbursement consideration. Providers seeking to modify an existing PA must submit medical documentation to the MDHHS Program Review Division (PRD); new PA requests for affected services on or after October 13, 2026 must be submitted directly to MDHHS PRD. Mental health services provided by Prepaid Inpatient Health Plans (PIHPs) are not affected by this change. Public comment is being accepted concurrently with implementation, and comments are to be directed to the MDHHS contact identified in the bulletin.