Michigan Acknowledgment Form Requirement

Michigan Acknowledgment Form Requirement

In accordance with the State Medicaid Agency Contract (SMAC), the broker MUST obtain a signed Acknowledgment Form at the time of enrollment from all individuals receiving services from MI Choice or PACE immediately prior to enrollment with the broker and submit it with the HIDE SNP application.

For more details, please consult the MDHHS Acknowledgment Form Resource Guide.

The Acknowledgment Form may be found here on the Molina Agent Center.

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