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10. Enter the YEARLY amount of the required Payment Agreement according to the Payment Agreement Guide MSA-0738-B. 10. Enter the Yearly Payment Agreement Amount according to the enclosed Payment Agreement Guide MSA-0738-B even if the amount is 0. Michigan Department of Community Health Children s Special Health Care Services INCOME REVIEW /PAYMENT AGREEMENT Instructions for Completion MSA-0738 The Income Review/Payment Agreement MSA-0738 is used .

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Medicaid (also called Medical Assistance, or MA) is health insurance for people with low income. In Michigan, there is traditional Medicaid (TM) and the Healthy Michigan Plan (HMP).

Your state's Medicaid contact information: Michigan.gov/MIBridges. Your state's Medicaid phone number: 888-367-6557.

Please report any change in phone number, email or address to the Michigan Department of Health and Human Services (MDHHS) if you are a Medicaid beneficiary. You can do this by going to the MIBridges website at .michigan.gov/mibridges. You will need to create an account by choosing Register if you don't have one.

More Information myHealthButton@michigan.gov. Beneficiary Help Line : 800-642-3195. TTY : 866-501-5656.

The Michigan Department of Health and Human Services/Medical Services Administration (MSA) is responsible for the following medical programs in Michigan: Medicaid. Maternity Outpatient Medical Services (MOMS).

Answer general questions you may have about Medicaid benefits. Enroll you in the Medicaid Health Plan you choose. For more information, call Michigan ENROLLS at 1-888-367-6557.

Providers who have questions about the enrollment process or require assistance may contact the MDHHS Provider Enrollment Help Desk at 1 (800) 292-2550.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232