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MDHHS Rebidding 2025 Comprehensive Health Care Program Contracts For Medicaid Health Care Services Delivery

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Reputable Member
Joined: 4 months ago
Posts: 163
Topic starter  

Medicaid covers approximately 22% of Michiganders:

MDHHS moving forward with MIHealthy Life to provide improved access to care for Medicaid health plan enrollees

Department rebidding contracts that serve 2.2 million Michiganders

LANSING, Mich. – The Michigan Department of Health and Human Services (MDHHS) today provided new information related to the rebidding of contracts for health plans that provide services to 2.2 million Michiganders receiving coverage through Medicaid and Michigan’s Healthy Michigan Plan.

MDHHS is announcing network requirements and minimum qualifications for bidders in its upcoming request for proposals for the Comprehensive Health Care Program contract for Michigan’s Medicaid health plans.

“We want to provide Michiganders served by Medicaid health plans with a more equitable, coordinated and person-centered system of care,” said Elizabeth Hertel, MDHHS director. “Through this rebid process, MDHHS seeks to provide improved affordable health care coverage for Michiganders served by Medicaid health plans.”

The contract is being rebid during fiscal year 2024, which begins Oct. 1, with new contracts beginning in fiscal year 2025. The rebid is part of MIHealthyLife, an initiative to strengthen Medicaid services informed by input from nearly 10,000 enrollees and family members, health care providers, health plans and other community partners.

Consistent with federal standards and input from MIHealthyLife stakeholders, the rebid will include updates to Michigan’s Medicaid Health Plan network adequacy and timely access standards, which can be found at

When determining whether these standards are met, MDHHS will only consider providers with whom bidders have executed contracts at the time of bid submission. MDHHS is releasing its updates to Comprehensive Health Care Program network adequacy and timely access standards in advance of the rebid to provide time for potential bidders to review their provider networks and execute provider contracts necessary to meet the new standards.

MDHHS’s new Medicaid Health plan network adequacy and timely access standards can be found at, along with mandatory minimum requirements Medicaid Health Plans must meet in order to qualify for review under the rebid.

In addition, the request for proposals will incorporate several Comprehensive Health Care Program changes intended to advance the MIHealthyLife pillars. These include:

  • A commitment to health equity demonstrated by plans achieving the NCQA’s Health Equity Accreditation, beginning the process no later than Oct. 1, 2024.
  • A strong emphasis on addressing social determinants of health demonstrated by investment and engagement with community-based organizations.
  • Efforts to increase childhood vaccination rates, including increasing provider participation in the Vaccines for Children Program.
  • Adoption over time of a more person-centered approach to mental health care coverage.

The Medicaid Health Plan request for proposals will be posted to the SIGMA system in Fall 2023, with responses due in January 2024. New contracts resulting from this rebid are scheduled to begin on Oct. 1, 2024. MDHHS reserves the right to change mandatory minimum requirements, dates or any other information deemed necessary.

Go to for more information. Questions about MIHealthyLife can be sent to Procurement-related questions can be sent to

Reputable Member
Joined: 4 months ago
Posts: 163
Topic starter  

Will the rebidding prevent $ 500 million Medicaid frauds like this?

Metro Detroit doctor to pay $6.5M over fraud health care fraud claims
Charles E. Ramirez - August 29, 2023

A Metro Detroit doctor and his three Macomb County pain management clinics have agreed to pay $6.5 million over claims he scammed the federal government, officials said.

Rajendra Bothra and his businesses, the Pain Center USA PLLC and Interventional Pain Center PLLC, agreed to the settlement to resolve allegations that they billed Medicare and Medicaid for unnecessary treatments, drug tests and braces, federal officials announced Monday.

"When healthcare providers manipulate the Medicaid and Medicare systems, it wastes resources meant to help those in need," Devin Kowalski, Acting Special Agent in Charge of the FBI’s Detroit Field Office, said in a statement. "This settlement brings to bear some economic justice by requiring those who orchestrated the fraud scheme to pay for their actions."

The alleged fraud took place between Jan. 1, 2015, and Dec. 31, 2018, said Dawn Ison, U.S. Attorney for the Eastern District of Michigan.

Bothra and federal authorities are not strangers to each other.

In 2018, federal officials indicted Bothra and five other doctors who worked for him at his clinics on charges they cheated Medicare and Medicaid out of almost $500 million by illegally prescribing more than 13 million doses of prescription pain medication.

They also alleged the doctors forced patients to undergo painful, unnecessary or ineligible medical procedures in exchange for illegally receiving pain medication, including OxyContin, Vicodin, hydrocodone and Percocet.

Investigators said the operation was run at the Pain Center USA clinics in Warren and Eastpointe as well as the Interventional Pain Center clinic in Warren.

Bothra, once a renowned surgeon, humanitarian and politician who was given India’s highest civilian honor, maintained his innocence but spent three years in federal prison as the COVID-19 pandemic delayed his trial.

In June 2022, a jury acquitted him and three of his former employees of the charges. Two other doctors who were charged took plea deals.



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