Blue Cross Complete of Michigan

What Blue Cross Complete of Michigan does

Blue Cross Complete of Michigan is a state-contracted managed care health plan founded in 2007 that administers Medicaid and Healthy Michigan Plan benefits to eligible beneficiaries across 58 counties in Michigan's Lower Peninsula. Operating as an independent licensee of the Blue Cross and Blue Shield Association and part of the AmeriHealth Caritas family of companies, the plan administers multiple state sub-programs including traditional Medicaid, Healthy Michigan Plan, Children's Special Health Care Services (CSHCS), MIChild, the Flint Waiver, and Freedom to Work. Members are enrolled through the state's MI Bridges portal or the Michigan Enrolls call center, and the plan serves roughly 100,000-300,000+ lives based on 2025 prior authorization volumes of 243,159 standard and a portion of expedited requests.

The company's core product is the Blue Cross Complete Medicaid Health Plan, supported by a suite of wellness, maternity, and chronic-condition programs including Bright Start (maternity), CenteringPregnancy, Doula Services, the Tobacco Quit Program, Special Health Programs for conditions such as asthma, diabetes, sickle cell, and HIV, Integrated Health Care Management (IHCM), and the Override Health Chronic Pain program. The technology platform is a conventional managed care stack: a member-facing BCCMI mobile app on iOS and Android; the NaviNet provider portal for prior authorizations, eligibility, claims status, and care gap reports; an online Formulary Navigator; a Prior Authorization Lookup Tool; and a CMS-0057-F compliant prior authorization reporting system. The plan integrates with PerformRx for pharmacy benefit management, Evolent (formerly NIA) for outpatient imaging prior authorization, CoverMyMeds and SureScripts for electronic prior authorization, ECHO Health and Change Healthcare for provider payments, and Northwood and J&B Medical for durable medical equipment and diabetic supplies.

The business model is capitated managed care: Blue Cross Complete receives per-member-per-month payments from the Michigan Department of Health and Human Services in exchange for delivering a defined benefit package that includes medical, pharmacy, dental, vision, hearing, transportation, and behavioral health services. Beneficiary cost-sharing is minimal or zero across most programs, with MIChild charging a flat $10 per family per month. The plan generates revenue through a single contractual counterparty — the State of Michigan — and derives competitive positioning from the Blue Cross brand, NCQA accreditations (3.5/5 stars in 2025, Health Equity Accreditation, Distinction in Multicultural Health Care), a broad contracted provider network, and community programs such as the Food Pantry Grant Program. The company is headquartered in Southfield, Michigan, employs approximately 200 associates, and is led by Market President Todd Anderson and CMO Dr. Jeremy (Ty) Sullivan.

Name

Blue Cross Complete of Michigan

Legal name

Blue Cross Complete of Michigan LLC

Website

https://mibluecrosscomplete.com

Company type

Private

Founded year

2007

Operating status

Operating

Headcount range

11–50 employees

Short description

Blue Cross Complete of Michigan is a state-contracted managed care health plan that administers Medicaid, Healthy Michigan Plan, and related programs to eligible beneficiaries across 58 Michigan Lower Peninsula counties under a Blue Cross and Blue Shield license.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Health Care and Social Assistance (62), Ambulatory Health Care Services (621)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Specialty Medicaid Managed Care (e.g., HIV/AIDS, SMI/SED) (HLAEAEAG)

Keywords

• Medicaid managed care
• Health plan administration
• Government health programs
• Healthcare benefits management
• Managed care services

Headquarters

HQ city

Southfield

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Others

Revenue model

1. Capitated Medicaid Managed Care Payments: Blue Cross Complete receives capitated (per-member-per-month) payments from the state of Michigan in exchange for providing comprehensive healthcare services to enrolled Medicaid beneficiaries. The company administers benefits for Michigan Medicaid, Healthy Michigan Plan, Children's Special Health Care Services, MIChild, and Flint waiver programs.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels9 records

Core offering

Blue Cross Complete of Michigan is a state-contracted managed care health plan that administers comprehensive medical, pharmacy, dental, vision, hearing, transportation, and integrated care management benefits to eligible Medicaid and Healthy Michigan Plan beneficiaries. The plan also operates Children's Special Health Care Services, MIChild, Flint Waiver, and Freedom to Work programs across 58 counties in Michigan's Lower Peninsula, delivering services through a contracted provider network.

Product overview

Blue Cross Complete of Michigan is a managed care health plan contracted by the state of Michigan serving Medicaid and Healthy Michigan Plan beneficiaries across 58 counties in the Lower Peninsula. The company operates as an independent licensee of the Blue Cross and Blue Shield Association. The core product is the Blue Cross Complete Medicaid Health Plan, which encompasses multiple sub-products including Michigan Medicaid, Healthy Michigan Plan, Children's Special Health Care Services (CSHCS), MIChild, Flint Waiver, and Freedom to Work. The portfolio includes wellness programs such as Bright Start Maternity Program, Tobacco Quit Program, Special Health Programs for chronic conditions, Integrated Health Care Management (IHCM), and the Override Health Chronic Pain Program. Digital services include the Blue Cross Complete Mobile App, Telehealth Services, Keys to Your Care Text Messaging, and Pharmacy Benefits through a preferred drug list. Community programs include the Food Pantry Grant Program. Doula Services and CenteringPregnancy provide maternal support, while My Life My Quit addresses teen tobacco cessation.

Differentiator

Problem solved

Functional benefit

Products and services

• Blue Cross Complete Medicaid Health Plan Managed care health plan contracted by the state of Michigan providing medical services to eligible Medicaid and Healthy Michigan Plan beneficiaries across 58 Michigan counties in the Lower Peninsula.
• Healthy Michigan Plan
• Michigan Medicaid
• Children's Special Health Care Services (CSHCS) State program providing extra support for children and some adults with special health care needs who have qualifying medical conditions, including chronic health problems, specialty services, and home care support.
• MIChild Health care program for uninsured and underinsured children under age 19, providing medical, dental, vision, hearing and prescription coverage for a $10 monthly premium per family.
• Flint Waiver Additional Medicaid services for children up to age 21 and pregnant people who were served by the Flint water system since April 2014, with income eligibility up to 400% of federal poverty level.
• Freedom to Work Michigan program expanding Medicaid eligibility to disabled adults age 16-64 who are employed and below 250% of federal poverty level.
• Bright Start Maternity Program Pregnancy management program promoting healthy behaviors and assisting members with risk factor control during pregnancy through nurse support and care coordination.
• Tobacco Quit Program No-cost telephone-based tobacco cessation support program offering counseling, quit coaches, and coverage for over-the-counter and prescription cessation medications.
• Special Health Programs Disease management programs for chronic conditions including asthma, chronic kidney disease, COPD, diabetes, heart disease, hemophilia, hepatitis C, high blood pressure, HIV, and sickle cell anemia.
• Integrated Health Care Management (IHCM) Program providing specialized services in comprehensive disease management and complex case management for adult and pediatric members.
• Telehealth Services Virtual health care visits and telemedicine appointments for members.
• Override Health Chronic Pain Program Virtual chronic pain management program offering mental and physical exercises with a specialty care team including pain physicians, physical therapists, and psychologists.
• Doula Services Physical, emotional, and educational support during pregnancy, labor, delivery, and postpartum periods with up to 12 total visits plus one birth visit.
• CenteringPregnancy Group prenatal care program where families attend group sessions with other pregnant people having similar due dates.
• My Life My Quit Confidential program helping teens quit smoking and vaping with live text and phone coaching, interactive content, and personalized quit plans.
• Pharmacy Benefits Prescription and over-the-counter medicine coverage through a network pharmacy with Preferred Drug List and prior authorization requirements, administered through PerformRx as pharmacy benefit manager.

Quantifiable outcome

• 65.10% standard prior authorization approval rate with average 5.9 days to decision
• +4 more outcomes

Named customers4 records

Segments5 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration13 records

Feature5 records

Partnerships

Ten partnerships are on record, tiered core, major and minor.

• State of Michigan (Michigan Department of Health and Human Services)coreStrategic or Co-development Partner · 1 January 2007Blue Cross Complete is contracted by the state of Michigan to provide medical services to eligible Medicaid and Healthy Michigan Plan beneficiaries. This is the primary contractual relationship enabling all company operations.
• Blue Cross and Blue Shield AssociationcoreOEM/ Whitelabel/ Licensing Partner · 1 January 2007Blue Cross Complete of Michigan is an independent licensee of the Blue Cross and Blue Shield Association, using the Blue Cross brand under licensing agreement.
• National Committee for Quality Assurance (NCQA)coreStrategic or Co-development PartnerBlue Cross Complete maintains NCQA Health Plan Accreditation, Health Equity Accreditation, and Distinction in Multicultural Health Care through NCQA.
• AmeriHealth CaritascoreChannel Partner/ Reseller/ DistributorBlue Cross Complete encourages job seekers to explore open positions through its affiliate company AmeriHealth Caritas. The company is part of the AmeriHealth Caritas family of companies.
• Blue Cross Blue Shield of MichiganmajorStrategic or Co-development PartnerBlue Cross Complete partnered with Blue Cross Blue Shield of Michigan on the Food Pantry Grant Program investing to support local food pantries across Michigan.
• Blue Cross Blue Shield of Michigan FoundationmajorStrategic or Co-development PartnerBlue Cross Blue Shield of Michigan Foundation is a co-investor in the Food Pantry Grant Program supporting local food pantries.
• United Dairy Industry of MichiganminorStrategic or Co-development PartnerCo-investor in the Food Pantry Grant Program helping food pantries provide nutritious foods including dairy products, fruits, and vegetables.
• PerformRxmajorTechnology or IntegrationPerformRx Pharmacy provides pharmacy benefit management services including MAC pricing administration, pharmacy provider services, and prior authorization support for Blue Cross Complete members.
• NaviNetmajorTechnology or IntegrationNaviNet provider portal provides Blue Cross Complete providers access to prior authorizations, eligibility verification, claims status, care gaps reports, and real-time news alerts.
• March of DimesminorStrategic or Co-development PartnerBlue Cross Complete collaborates with March of Dimes to offer Dismantling Bias in Maternal and Infant Healthcare e-learning provider training with CME credits.

Scale indicators5 records

Recent moves8 records

Expansion highlights6 records

Direct peers

• Meridian Health Plan of Michigan: Michigan-based Medicaid managed care plan serving Medicaid beneficiaries across the state, directly competing with Blue Cross Complete in the same contract regions and beneficiary populations.
• Priority Health Choice: Michigan-based nonprofit health plan operating a Medicaid HMO product (Priority Health Choice) in direct competition with Blue Cross Complete for state contracts and enrollees.
• McLaren Health Plan: Michigan-based health plan offering Medicaid coverage through Michigan's contracted MCO program, competing head-to-head with Blue Cross Complete in regional procurements.
• Molina Healthcare of Michigan: National Medicaid-focused MCO operating a Michigan plan; directly competes with Blue Cross Complete for state Medicaid contracts and member enrollment.
• UnitedHealthcare Community Plan of Michigan: UnitedHealth Group's Medicaid managed care plan in Michigan, offering the same capitated Medicaid benefits as Blue Cross Complete with significantly greater scale and capital backing.
• Aetna Better Health of Michigan: CVS Health-owned Medicaid managed care plan serving Michigan beneficiaries; directly competes for state Medicaid contracts and member auto-assignment.
• HAP Empowered (Health Alliance Plan): Michigan-based HMO offering Medicaid coverage (HAP Empowered) competing directly with Blue Cross Complete for Medicaid beneficiaries and provider network relationships.
• AmeriHealth Caritas: National Medicaid managed care company that is the parent affiliate of Blue Cross Complete of Michigan; operates Medicaid plans in multiple states under a similar capitated PMPM model.

Broad incumbents

• Centene Corporation: Largest US Medicaid managed care insurer with presence across most states; serves Medicaid populations under similar capitated contracts and represents a major competitive and benchmark player for state-contract MCOs.
• Humana Healthy Horizons: National managed care company operating Medicaid plans in multiple states with a similar capitated PMPM revenue model; broad incumbent with overlapping beneficiary focus though not currently dominant in Michigan.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/bcc_mi

Compliance10 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Blue Cross Complete of Michigan