Medicaid Nursing Home Rates by State

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Michigan

Medicaid nursing facility payment · Cost-based · researched October 2026

Michigan’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Cost-based

Case-mix level

None

Classification

None

Rate updates

Once a year

Managed care (LTC)

Short stays only

Quality program

Quality Measure Initiative (QMI)

Paid outside the rate

Large

Bed hold

Hospital and leave

Published rates

Not published

Assisted living

Limited

Personal needs allowance

$60 / month

Overview

• Michigan pays each home a prospective per diem built from its own audited costs, capped by class-wide limits; no statewide or peer-group price.
• Class I (private and nonprofit homes) and Class III (county medical care facilities, hospital long-term care units) rates = plant cost component + variable cost component + small add-ons.
• The variable component (base care costs plus support costs) is the lesser of the home's indexed variable cost per day or its class's 80th-percentile Variable Cost Limit (VCL), plus a legislated Economic Inflationary Update.
• Support costs are also capped by a support-to-base ratio limit at the 80th percentile of four bed-size groups.
• Rates are set each October 1 from the cost report ending in the prior calendar year.
• They are interim until that report is audited, then retroactively settled.
• A large share of pay arrives outside the per diem as monthly lump sums: the Quality Assurance Supplement (QAS, 21.76% of the variable component), the Quality Measure Initiative (QMI) and the direct care worker wage pass-through.

What matters in Michigan

• 21.76% of each home's capped variable cost comes back monthly as the provider-tax-funded QAS, paid outside the posted per diem.
• Posted October 1 rates are interim and later settled to audited costs; settlements can claw back, and Initial Settlement normally pays only 70-80% of an underpayment.
• No case mix: Class I and III homes get one cost-based rate per home, whatever the resident's acuity.
• Variable costs are capped at the class's 80th percentile, weighted by Medicaid days; support costs are also capped by bed size.
• Provider tax FY2026: $36.45 per non-Medicare day, $18.35 for the 50 homes with most Medicaid days, $2.00 under 40 beds.
• Wage pass-through of $3.40/hr for clinical and $0.85/hr for non-clinical staff is reimbursed separately from the per diem.
• Hospital bed hold is paid only when the home is at least 98% occupied, and at a low statewide rate.

Frequently asked

Does a Michigan nursing home's posted Medicaid per diem include the provider-tax supplement it receives?

No. The Quality Assurance Supplement (QAS) is paid as a monthly lump sum outside the per diem: Medicaid days x 21.76% of the lesser of the home's variable cost or its class Variable Cost Limit (MPM appendix s.10.7; 4.19-D s.IV). It is reconciled each year to actual days, audited rates and the fixed pool. Because the variable component is most of the per diem, QAS adds about 18-21% on top of the posted rate, and MI Coordinated Health plans must pay it as a directed payment.

Why do two Michigan homes with very different resident acuity often get similar Medicaid rates?

Because Class I and III homes are paid without case mix: each home gets one cost-based per diem for every Medicaid resident (MPM NF Cost Reporting & Reimbursement Appendix s.10; 4.19-D s.IV). Rates differ by each home's own audited costs, and the variable component is the lesser of the home's indexed cost or its class's 80th-percentile Variable Cost Limit, so higher-cost homes are paid at the same cap. Only the state veterans homes are paid per resident under PDPM.

Can a Michigan nursing home bill Medicaid to hold a bed while a resident is hospitalized?

Only if the home is at least 98% occupied (97.50% rounds up) at midnight on the day the resident leaves for an emergency hospital admission (Medicaid Provider Manual). It can then bill up to 10 days per hospital stay at a single statewide hospital leave rate, equal to the Class I average variable cost x 95% x 66%, well below the home's own per diem. Planned admissions and stays over 10 days are not paid. Therapeutic leave is different: up to 18 days per rolling 365 days at the full per diem.

How much is paid outside the posted rate in Michigan?

Large: QAS lump sums alone equal about 20% of the per diem, plus QMI, wage pass-through and county-home payments.

What does Michigan Medicaid pay on Medicare coinsurance days?

Full Part A coinsurance, not lesser-of, capped so total pay stays within the Medicare-allowed amount.

Does Michigan require a minimum share of spending on care?

No care-spending floor; the wage pass-through must go fully to eligible workers or it is recouped.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Michigan Medicaid uniform nursing facility cost report (state form, 12-month period, due 5 months after year end). Class VII veterans homes file the Medicare SNF cost report instead. A late-file penalty applies from 10/1/2024 (SPA 24-0012). Cost reports are audited by MDHHS's LTC Reimbursement and Audit Division.

Base year and rebasing

Rebased every year: each October 1 rate uses the home's cost report ending in the previous calendar year (or an earlier report covering at least 7 months), indexed to October 1 of the year before the rate year. The rate is interim on filed data until audit, then retroactively settled; Initial Settlement pays 70-80% of an underpayment, raised to 100% for FY21-FY23 by MMP 23-70. Exception: FY2022 and 10/1-12/31/2022 rates did not use COVID-period costs. They took the last pre-COVID-year component plus the average class-wide increase of the previous 5 pre-COVID years. Jan-Sep 2023 interim rates were the FY2022 interim components +4.55% (SPA 23-0017).

Components

Component	Method	Notes
variable cost component (base + support)	VCC = (lesser of facility Variable Rate Base or Class Variable Cost Limit) + Economic Inflationary Update. The VRB is the base cost component plus the support cost component. Base = per-day base costs (nursing, nursing admin, dietary, food, laundry, linen, activities, social services, utilities, workers' comp, agency nursing) x cost index. Support = BCC x the lesser of the facility support-to-base ratio or its bed-size group limit. The Class VCL is the 80th percentile of indexed variable cost per day, with homes ranked low to high and Medicaid days accumulated. VCLs are computed separately for Class I and Class III.	Support-to-base limit: 80th percentile (Medicaid-day weighted) in bed-size groups 0-50, 51-100, 101-150 and 151+. New hospital LTC units (CON on/after 7/1/1990) are held to the Class I VCL. New homes and homes changing class get the class average variable cost for their first two cost-reporting periods.
plant cost component - Class I	Net property tax/interest/lease per day (less a CAV excess-borrowings limit and the DEFRA limit), plus a return on Current Asset Value (CAV): historical asset cost x (update index - obsolescence factor) x a tenure-based rate of return. See capital.	CAV per-bed upper limit = rolling 15-year history of new construction; its increase was capped at 4% for FY2020 (SPA 21-0013). The floor is 30% of the limit.
plant cost component - Class III	Lesser of the facility's per-day plant cost (depreciation, interest, property tax, lease) or the facility plant cost limit.	County medical care facilities and hospital LTC units.
add-ons	Cost-based interim per diem add-ons settled at year end: NATCEP (nurse aide training; interim add-on capped at $1.00/day, settlement not capped); special dietary (religious diets at nonprofit homes, settled outside the VCL).	The DCW wage increase is a separate pass-through, not an add-on (see other_add_ons).

Inflation

Cost index: IHS/Global Insight (S&P) SNF Market Basket without capital, used to index reported costs from cost-report end to October 1 of the year before the rate year. Then the Economic Inflationary Update applies the Economic Inflation Rate (EIR), set by the Legislature each year, to the lesser of VRB or VCL. The 2005 state plan page (TN 05-11) still reads 'The annual economic inflationary rate for Class I and Class III facilities is 0%'; the FY2026/FY2027 EIR was not confirmed.

Verified October 11, 2026

Case mix

System

None

Applied at

None

How it works

Class I and III homes get one cost-based per diem for every Medicaid resident; no acuity measure enters the formula (MPM NF Cost Reporting & Reimbursement Appendix s.10; 4.19-D s.IV).

Classification

none for Class I/III. Class VII state veterans homes only: PDPM since 10/1/2019 (RUG-IV allowed for ARDs before 10/1/2019 until 12/31/2019), paid as a percentage (<=100%) of the Medicare SNF PPS PDPM rate per resident (SPA 19-0005).

Applies to

Not applicable for Class I/III. Veterans homes: the whole per diem, including non-routine therapy.

Acuity measured from

Not applicable.

Updated

Not applicable.

Move to PDPM

Not applicable for Class I/III: Michigan never used RUGs for them, so CMS ending RUG support in Oct 2023 changed nothing. No move to case mix was found in the 10/1/2026 Provider Manual or the 7/1/2026 State Plan. Veterans homes moved from RUG-IV to PDPM on 10/1/2019.

Verified October 11, 2026

Low-acuity residents

None. Michigan has no case mix for Class I/III homes, so no low-acuity group is paid a reduced or flat rate; every Medicaid resident in a home is paid the same per diem. Residents who fail the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD) are not covered at all. Checked: MPM NF Cost Reporting & Reimbursement Appendix s.10 and NF Coverages chapter (10/1/2026); 4.19-D (7/1/2026).

Verified October 11, 2026

Capital

Class I: actual-cost-based plant component = property tax, interest and lease costs per day (net of CAV excess-borrowings and DEFRA limits) + a return on Current Asset Value. CAV = each asset's historical cost x (construction-cost update factor - obsolescence factor), rebased each year from the latest audited/reviewed cost report. It is capped at a per-bed limit from the rolling 15-year history of new construction (floor 30% of the limit). The return rate depends on tenure (full years of continuous Medicaid certification). Lease costs are allowed only with full disclosure of the lessor's costs. Class III: lesser of actual per-day plant cost (depreciation, interest, property tax, lease) or a facility plant cost limit. Plant costs are divided by the greater of actual days or 85% of available bed days. New providers and CHOWs go through Plant Cost Certification. FIDS (Facility Innovative Design Supplemental) adds capital pay for qualifying culture-change construction/renovation, for up to 20 years. Since 10/1/2024, interest on loans over 4 years old is allowable only if principal (at least 0.1% of the balance) is paid down each year (SPA 24-0013).

Verified October 11, 2026

Budget adjustment factor

No standing across-the-board cut. (1) The Economic Inflation Rate on the variable component is set each year by the Legislature; the 2005 plan page says 0%, and current-year values were not confirmed. (2) COVID-era rate setting (SPA 23-0017): FY2022 and Oct-Dec 2022 rates did not use COVID-period costs; prior components were trended by the 5-year pre-COVID class average increase. Jan 1-Sep 30, 2023 interim variable and plant components = the FY2022 interim component +4.55%. Final audited FY22/FY23 rates then reverted to normal formulas using 2022/2023 audited reports. (3) Provider-tax-financed 'rate restorations' are built into rates: 5.85% of variable costs (about $100M), a $23.5M 'dampening' amount and a $26.1M '8.0 rate restoration' (MDHHS QAS calculation methodology). (4) The Rate Relief Program was discontinued 1/1/2025 (SPA 24-0023).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

large

Estimate

About 20-30% of the posted per diem, derived. QAS alone = 21.76% of the capped variable component per Medicaid day, and the variable component is most of the per diem, so QAS is about 18-21% of the posted rate. The DCW pass-through ($3.40/hr clinical + $0.85 non-clinical) adds roughly $10-15/Medicaid day at typical 3-4 nursing hours per resident day (an estimate, not a source figure). QMI and CMCF certified-public-expenditure payments come on top. No official dollar totals were found.

Components

QAS monthly lump sums (21.76% of capped variable cost x Medicaid days; annual $ not published); QMI per-bed payments (pool not published); DCW wage pass-through (not published); CMCFSP CPE payments to about 35 county medical care facilities (not published); FIDS capital supplement.

Source

https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidPro…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

County-owned and -operated County Medical Care Facilities (about 35 CMCFs) can receive CMCFSP special payments covering unreimbursed Medicaid routine costs: full allowable cost before formula limits, minus all Medicaid routine revenue including net QAS/QMI. That effectively lifts them to cost, above the VCL cap private homes face. Class III public homes are paid against their own Class III VCL and get QAS on the lesser of their VCC or the Class I VCL. Counties also run a County Maintenance of Effort revenue program for CMCFs. An older Proportionate Share Pool for local-government homes ($8.2M, SFY2006) remains in the plan.

Funding

Certified public expenditures by the county facilities (42 CFR 433.51), not IGT transfers. No private lease or management arrangement qualifies: the facility must be county-owned and operated.

Source

https://www.mdch.state.mi.us/dch-medicaid/manuals/MichiganSta…

Verified October 11, 2026

Quality program

Active

Yes

Program

Nursing Facility Quality Measure Initiative (QMI), effective 10/1/2017 (SPA 17-0009; 4.19-D s.IV.M; MPM appendix s.10.7.D).

Funding

Provider tax: a separate QMI assessment under the Quality Assurance Assessment Program (QAAP), per non-Medicare day. FY2026 (from 10/1/2025): $3.90 standard, $2.50 for the top 50 homes by Medicaid days, $0.00 for homes under 40 beds. Homes report the QMI assessment as a cost and the QMI payment as revenue; the net gain is removed from the cost report.

Paid as

Lump sum: a monthly gross adjustment outside the per diem.

Measures

Measure	Source	Weight	How points are earned
Average CMS Five-Star quality measure (QM) domain rating	MDS QM via CMS Care Compare (Nursing Home Compare)	Sets the per-bed QMI amount; higher stars = larger per-bed amount (actual per-bed amounts not published; bulletin examples of $1,000 for 1 star to $2,000 for 5 stars are illustrative only)	Average QM star rating July of prior year through June of current year. Below 2.5 stars must file an accepted QMI action plan to be paid.
Resident satisfaction survey data submitted	state (facility-submitted survey and documentation)	Multiplier: 100% if acceptable data submitted, 85% if not (L 26-33 for FY2027)	Submission only; survey content and scores are not graded. For FY2027 the survey must be dated on/after 6/27/2025.

Scoring period

The rate year beginning October 1 uses the average QM star rating from July 1 of the prior year to June 30 of the current year (e.g. FY2027 uses Jul 2025-Jun 2026), so a 3-15 month lag. Medicaid utilization comes from the prior year-end cost report.

Payment formula

Monthly QMI = (per-bed amount for the star rating x Medicaid utilization scale x survey factor x licensed NF beds) / eligible payment months. Utilization scale: Medicaid utilization >63% = 100%; 50-63% = 75%; <50% = the home's utilization rate itself (e.g. 35% -> 35%). Per-bed amounts are set from available funding.

Eligibility

Class I and III Medicaid-certified homes with a 1-5 star QM rating, open, with at least one Medicaid day in the payment year and the prior cost period. Excluded: CMS Special Focus Facilities, prorated if they graduate mid-year, and homes under 2.5 stars without an accepted action plan. After a CHOW, the prior owner's data carry over.

Cadence

Calculated annually at the start of the state fiscal year (October 1); paid monthly.

Scores published

No per-facility QMI payment file found. The QMI page posts methodology, action-plan forms and NHC state average percentages: https://www.michigan.gov/mdhhs/doing-business/providers/provi…

Notes

QMI per-bed amounts are lump-sum payments per licensed bed, not per Medicaid day, so larger homes with high Medicaid share gain most. Unchanged in structure since the FY2019 survey factor was added.

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

$36.45 QAS assessment + $3.90 QMI assessment = $40.35 per non-Medicare day, effective 10/1/2025 (FY2026). FY2025: $36.30 + $3.90. FY2024: $35.90 + $4.15. FY2023: $28.65 + $3.30. FY2027 rates not yet posted on the QAAP page as of 10/11/2026.

Tiers

Who	Test	Amount
Homes with fewer than 40 licensed beds	size	$2.00 QAS assessment + $0.00 QMI per non-Medicare day (FY2026)
The 50 providers with the most Medicaid days (since 10/1/2023; before that, homes with more than 51,000 Medicaid days)	volume	$18.35 QAS + $2.50 QMI per non-Medicare day (FY2026)
Continuing care retirement centers (annual partnership agreement)	ccrc	Special treatment via the CCRC Partnership Agreement; amount not confirmed

Lower for high-Medicaid homes

yes

Returned in the rate

Not in the per diem. Returned as the monthly QAS lump sum (21.76% of the lesser of VRB or Class VCL x Medicaid days) and QMI per-bed payments. Part of the tax also finances rate restorations already built into the variable component (5.85% of variable costs; $23.5M dampening; $26.1M rate restoration).

Source

https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs…

Verified October 11, 2026

Provider tax notes

Quality Assurance Assessment Program (QAAP) tax on nursing homes and hospital LTC units, per non-Medicare day (all inpatient days minus Medicare and Medicare Advantage days). It has two parts: the QAS assessment and a separate QMI assessment. Combined FY2026 rates: standard $40.35/day ($36.45 + $3.90); top 50 Medicaid-day homes $20.85 ($18.35 + $2.50); under 40 beds $2.00 ($2.00 + $0.00). The aggregate is capped at 6% of industry revenue. MDHHS retains 13.2% of the federal funds generated. The tax funds QAS (21.76% of capped variable cost), QMI, the 5.85% rate restoration, hospice QAS pass-through and fixed restorations ($23.5M + $26.1M).

Verified October 11, 2026

Supplemental payments

(1) Quality Assurance Supplement (QAS): provider-tax funded, paid as a monthly gross adjustment = 1/12 of the home's annual Medicaid days (routine + therapeutic leave, 12 months from the prior June) x the home's QAS per day. QAS per day = 21.76% x lesser of VRB or Class VCL; for publicly owned Class III homes, x lesser of their VCC or the Class I VCL; VDC units x the Class I VCL. Reconciled each year to actual days, audited rates and the fixed pool; reduced for uncollected tax. Hospice pays NFs 100% of the QAS add-on for hospice residents. MICH HIDE SNPs pay QAS as a directed payment. (2) QMI per-bed monthly payments (see quality_incentive). (3) County Medical Care Facilities Special Payments (CMCFSP): certified-public-expenditure (CPE) payments to county-owned and operated CMCFs for unreimbursed Medicaid routine costs (allowable cost minus all Medicaid routine revenue, including net QAS/QMI). Paid as quarterly interim payments (Dec/Mar/Jun/Sep) and reconciled twice. (4) FIDS capital supplement for culture-change projects, up to 20 years. (5) DCW wage pass-through (see other_add_ons). (6) A Long Term Care Proportionate Share Pool for local-government homes ($8.2M in SFY2006) remains in the plan text; its current use is unconfirmed. Sources: MPM appendix s.10.7, 10.13.F, 10.14; 4.19-D s.IV.C.6, IV.J, IV.L.

Verified October 11, 2026

Other add-ons

(1) Direct Care Worker (DCW) wage pass-through, separate from the per diem: homes claim monthly or bi-weekly on form MDHHS-5919-A after paying the raise, plus employer FICA, with overtime at 1.5x. FY2026: $3.40/hr for clinical staff (RN, LPN, CNA, respiratory therapist) and $0.85/hr for listed non-clinical staff (housekeeping, maintenance, laundry, dietary, medical records, social services, activities, etc.). History: $2.00 (FY2020) -> $2.25 (3/1/2021) -> $2.35 (FY2022-23) -> $3.20 + $0.85 non-clinical (FY2024) -> $3.40 (FY2025, MMP 24-48). Put in the state plan 10/1/2024 (SPA 24-0014). MMP 24-48 says it covers care to Medicaid and non-Medicaid residents. (2) NATCEP add-on (interim cap $1.00/day). (3) Special dietary add-on for religious diets at nonprofit homes. No ventilator, behavioral, bariatric or dementia add-ons for Class I/III; those residents go to separate classes or negotiated complex-care rates.

Verified October 11, 2026

Units paid separately

Class II (private homes for people with mental illness or intellectual disability): all-inclusive rate negotiated with the State Mental Health Agency, cost-settled to a ceiling, plus an efficiency allowance up to $2.50/day. Class IV (state ICF/IID): Medicare cost principles, cost-settled. Class V ventilator-dependent care units (6 units): prospective unit rate covering all care including Part A/B-type services, set between 15% and 85% of the average inpatient hospital rate for ventilator patients; new units get the statewide average for 24 months. Class VI hospital swing beds: flat statewide weighted average Class I/III rate. Class VII state veterans homes: PDPM-based, % of Medicare SNF PPS, no supplemental payments. Complex care (specially placed residents from acute hospitals): individually negotiated prior-authorized rates. Receivership: rate adjusted for court-approved closure/sale costs for up to two rate periods (SPA 25-0009, eff. 6/1/2025).

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

short_stay

Detail

Medicaid Health Plans pay only the first 45 days in a rolling 12 months of rehab NF care; long-stay custodial care is fee-for-service. Exception: voluntary dual-eligible enrollees in MI Coordinated Health HIDE SNPs (since 1/1/2026; replaced MI Health Link, 2015-2025) in Regions 1, 8, 10 and 12, whose plan pays NF care at negotiated rates.

Verified October 11, 2026

Who pays

mixed, mostly fee-for-service for long stays. Medicaid Health Plans (MHPs, comprehensive managed care) cover restorative/rehab NF care up to 45 days in a rolling 12 months; custodial NF care is carved out of MHP capitation and the resident is disenrolled to fee-for-service (MPM Nursing Facility Coverages s.2; Beneficiary Eligibility chapter). Dual eligibles who voluntarily enroll in MI Coordinated Health (MICH) HIDE SNPs get full NF coverage from the plan in Regions 1 (Upper Peninsula), 8 (Southwest), 10 (Macomb) and 12 (Wayne); MICH replaced MI Health Link on 1/1/2026. MI Choice (HCBS waiver) and PACE are alternatives to NF care, not NF payers.

Verified October 11, 2026

Managed care rate floor

No FFS rate floor found. The MICH chapter says the HIDE SNP 'must negotiate with NFs to establish rates', but QAS must be paid through a 42 CFR 438.6(c) directed payment: HIDE SNP Medicaid NF days x 21.76% of the home's FFS variable cost component (capped at the VCL for private homes). The plan must also pay QAS when hospice pays room and board (MPM, MI Coordinated Health chapter s.2.8, changes 7/1/2026). No floor found for MHP 45-day rehab stays. Source: https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidPro…

Verified October 11, 2026

Included in the daily rate

Included: routine nursing, room and board, routine/maintenance therapy, IV therapy nursing services, supplies and pumps, CLIA-waived lab tests, intermittent oxygen and its administration, non-emergency non-ambulance transport (including to dialysis), and OTC/personal hygiene items. Paid separately: non-routine PT/OT/speech therapy, billed by the facility as ancillary (no prior authorization within 60 days of admission, PA after; changed 10/1/2026); legend drugs and IV pharmaceuticals via pharmacy; non-waived lab and radiology by those providers; daily oxygen of 8+ hours billed by a medical supplier (CMCFs and hospital LTC units bill it themselves); physician, dental, podiatry and vision services. Veterans homes' PDPM rate includes therapy.

Verified October 11, 2026

Bed hold

Hospital stays

Paid only if the home's available-bed occupancy is at least 98% (97.50% rounds up) at midnight on the day the resident leaves, for an emergency hospital admission. Up to 10 days per hospital stay, with no annual cap. Paid at a single statewide hospital leave day rate = Class I average variable cost x 95% (room and board share) x 66% (salary and wage share), well below the home's per diem.

Leave days

Up to 18 days per rolling 365 days, at the home's full per diem, if the plan of care allows visits and the resident returns.

Occupancy rule

98% available-bed occupancy (all licensed beds, excluding beds held for leave) on the day of departure for hospital leave; none for therapeutic leave.

Notes

Planned (non-emergency) admissions and stays over 10 days are not paid; the resident may agree to pay privately to hold the bed. Medicaid hospital leave days are excluded from Medicaid census statistics.

Source

https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidPro…

Verified October 11, 2026

Personal needs allowance

Per month

60

Effective

Current in BEM 546 (version 10-1-2026, BPB 2026-026); the date the $60 amount was set is not stated.

Notes

$90/month for a veteran (or surviving spouse) with the VA Improved Pension. Not COLA-indexed.

Source

https://mdhhs-pres-prod.michigan.gov/olmweb/ex/BP/Public/BEM/…

Verified October 11, 2026

Medicare coinsurance days

Method

full

Rule

MPM NF Coverages s.9.1: 'Medicaid co-insurance payments for Part A are the lower of the co-insurance charge or the current maximum co-insurance rate established under the formula stated in the Social Security Act. The facility's total payments from Medicare, Medicaid and other insurance may be up to, but cannot exceed, the amount established by Medicare as reasonable.' No comparison to the Medicaid per diem. For Medicare Advantage, homes bill Medicaid the MA plan's coinsurance rate x coinsurance days (CARC 2), which may differ from the Part A rate. MICH HIDE SNPs negotiate days 21-100 coinsurance themselves.

Effect

The home usually receives the full Part A daily coinsurance from Medicaid for dual-eligible days 21-100 (or the MA plan's coinsurance), not $0.

Source

https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidPro…

Verified October 11, 2026

Required care spending

Applies

no

Rule

No direct-care spending floor or medical-loss-type rule. Two narrow earmarks: (1) the DCW wage pass-through must go entirely to eligible workers' base wages (plus FICA), cannot replace other raises, and is subject to audit and recoupment; it is reimbursed only after the home pays. (2) QMI homes under 2.5 stars must file an action plan describing how QMI funds will improve quality.

Source

https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidPro…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) Per-day costs for all classes except Class II are divided by the greater of actual resident days or 85% of available (certified) bed days, so homes below 85% occupancy cannot recover their full costs; approved non-available bed plans reduce the bed count. (2) Hospital bed hold is paid only at 98% or higher occupancy. (3) Ventilator units are paid on actual occupancy.

Source

https://www.mdch.state.mi.us/dch-medicaid/manuals/MichiganSta…

Verified October 11, 2026

MDS accuracy penalties

None for rate purposes; Class I/III rates do not use MDS case mix. Audit risk is on cost reports instead: audit adjustments retroactively change interim rates, and a late cost report means 100% withholding of interim payments plus a late-file penalty from 10/1/2024.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

annual

When

October 1 (state fiscal year), with notice at least 30 days ahead, subject to the budget. Mid-year or retroactive revisions come from a newer filed or audited cost report, Plant Cost Certification, NATCEP or dietary add-ons. Late filers' rates take effect no later than January 1. QAS and QMI are set annually and paid monthly.

Verified October 11, 2026

When rates change

October 1 - September 30 state fiscal year. Rates use the cost report ending in the prior calendar year, indexed to October 1 of the year before the rate year (e.g. the FY2027 rate starting 10/1/2026 uses 2025 cost reports indexed to 10/1/2025). Interim rates are settled at Initial and Final Settlement after audit.

Verified October 11, 2026

Posted rates

Home-level rates published

No

Where

No public per-facility Medicaid rate list found on MDHHS's nursing facility pages (https://www.michigan.gov/mdhhs/doing-business/providers/provi…). Each home gets a written rate notice from the LTC Reimbursement and Rate Setting Section. MDHHS posts a cost report status update (10/4/2026), QAAP/QMI tax rate summaries and the DCW wage fee schedule.

Format

none

Cadence

n/a (rate notices are annual, October 1)

History

Tax rate summaries go back to 7/1/2002; no rate history.

Home identifier

n/a

Verified October 11, 2026

Rate build-ups

Published

No

Where

Not posted publicly. The manual says 'an illustration of the timeline and calculations for per diem rate setting is available on the MDHHS website', but it was not found on the current NF pages.

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

limited

Program

MI Choice Waiver (1915(b)/(c) HCBS waiver run through regional waiver agencies). It pays Community Living Supports and other services to residents of assisted living, Adult Foster Care (AFC) and Homes for the Aged (HFA). State Plan Personal Care is also available in AFC/HFA settings. MICH HIDE SNP enrollees get HCBS from their plan.

What is paid

Services only: CLS in residential settings covers only supports beyond what the license already requires, and 'does not include the costs associated with room and board.' The resident pays room and board, e.g. from SSI.

Limits

MI Choice has enrollment slots and waiting lists by waiver agency.

Source

https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidPro…

Verified October 11, 2026

Sources

1. Michigan Medicaid Provider Manual (version Oct 1, 2026): Nursing Facility Coverages chapter; Nursing Facility Cost Reporting & Reimbursement Appendix; MI Coordinated Health chapter; Billing & Reimbursement for Institutional Providers; MI Choice Waiver · agency page
2. Michigan Medicaid State Plan, Attachment 4.19-D (July 1, 2026 version, Transmittal 143) · state plan
3. MDHHS Long Term Care Nursing Provider Quality Assurance Assessment Tax Rate Summary (through 10/1/2025) · rate file
4. MDHHS Quality Measure Initiative Assurance Assessment Tax Rate Summary (through 10/1/2025) · rate file
5. MDHHS Nursing Facility Quality Assurance Assessment page (incl. QAS Assessment Calculation methodology, CCRC agreement) · agency page
6. Long Term Care Nursing Provider Quality Assurance Tax Calculation Methodology (QAS_Assessment_Calculation.doc, updated 2016) · agency page
7. MDHHS Nursing Facility Quality Measure Initiative page · agency page
8. L 26-33 Nursing Facility QMI Resident Satisfaction Survey Data (May 27, 2026; FY2027) · agency page
9. Skilled Nursing Facility DCW Wage Increase Medicaid Fee Schedule (FY2020-FY2026) · rate file
10. Bulletin MMP 24-48 Direct Care Worker Wage Increase (Oct 3, 2024) · agency page
11. Bulletin MMP 23-70 Change in Interim Settlement for Nursing Facilities (Nov 29, 2023) · agency page
12. Michigan SPA 24-0023 (CMS approval Dec 13, 2024): discontinue the Rate Relief Program, eff. 1/1/2025 · state plan
13. MDHHS Nursing Facilities billing & reimbursement page and Cost Reporting and Reimbursement Information page · agency page
14. Bridges Eligibility Manual BEM 546 Post-Eligibility Patient-Pay Amounts (10-1-2026) · regulation
15. MACPAC States' Medicaid Fee-for-Service Nursing Facility Payment Policies (2019 baseline, Michigan tab) · secondary

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