DCH-1315-Healthy Michigan Assessment-FINAL-PLAN COPY 4 28 14docx-2026

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  1. Click ‘Get Form’ to open the DCH-1315 document in the editor.
  2. Begin by filling out your personal information in the designated fields, including your name, date of birth, and contact details.
  3. Proceed to Section 1, where you will answer initial assessment questions. Check one option for each question regarding your health and lifestyle habits.
  4. In Section 2, provide details about your annual appointment. Specify the month you scheduled it and any topics you wish to discuss with your doctor.
  5. Move to Section 3 and select one or more healthy behaviors you are interested in changing over the next year. Rate your readiness for change using the provided scale.
  6. Leave Section 4 blank for your primary care provider to complete during your appointment. Ensure they sign and date this section after filling it out.
  7. Once completed, save a copy of the form for your records. You can print it directly from our platform or download it as needed.

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The Healthy Michigan Plan Health Risk Assessment (HRA) is a form you fill out every year with your provider. It asks you questions about your health, like how much you exercise and the food you eat. It helps your provider to determine how healthy you are and what you can do to get healthier.
Costs Q: Is there a cost to be in the Healthy Michigan Plan? A: Healthy Michigan Plan participants will have some cost-sharing responsibilities. If you make between 100 and 133% of the federal poverty level, you will need to pay 2% of your annual income.
The Healthy Michigan Plan is a type of Medicaid coverage. Medicaid is a partnership between federal and state governments. They work together to provide coverage. The federal government gives rules and resources.
How often assessments should be performed. Frequency depends on your age, health status, and medical history. For most, an annual health assessment is a reliable benchmark.
Blue Cross Complete Medicaid programs Healthy Michigan Plan is a program for Michigan residents age 19 to 64 who have income at or below 133 percent of the federal poverty level. Approximately, 40 percent of Blue Cross Complete members are enrolled in Healthy Michigan.

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The Healthy Michigan Plan is a Medicaid health care program through the Michigan Department of Health and Human Services (MDHHS).

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