What NorthCare Network does

NorthCare Network is a Prepaid Inpatient Health Plan (PIHP) operating under contract with the Michigan Department of Health and Human Services (MDHHS) to administer Medicaid-funded behavioral health services across all 15 counties of Michigan's Upper Peninsula. The organization functions as the regional coordinating entity — one of 10 such PIHPs in Michigan — responsible for managing capitation payments, utilization review, and care coordination for specialty mental health services, substance use disorder treatment, and intellectual/developmental disability supports for Medicaid beneficiaries, Healthy Michigan Plan enrollees, and SUD Community Grant recipients. Service delivery is executed through a contracted provider network comprising five Community Mental Health Service Programs (Copper Country CMH, Gogebic CMH, Hiawatha Behavioral Health, Northpointe Behavioral Healthcare Systems, and Pathways Community Mental Health) and eight or more SUD providers, supplemented by NorthCare-direct programs including Behavioral Health Home, SUD Health Home, Veteran Navigators, Independent Facilitation, and 24/7 crisis services.

NorthCare's technology infrastructure centers on FHIR-based Patient Access and Provider Directory APIs operated in partnership with PCE Systems, enabling CMS-compliant health data sharing for beneficiaries and approved third-party applications. The organization maintains HIPAA and 42 CFR Part 2 compliance, a Quality Assessment and Performance Improvement Program (QAPIP), and adherence to evidence-based clinical practice guidelines from APA, SAMHSA, VA/DOJ, and MDHHS. Its proprietary technology footprint is limited to compliance-mandated interoperability tooling rather than differentiated product IP.

The revenue model is straightforward managed-care capitation: NorthCare receives fixed per-member per-month payments from MDHHS and allocates funds across its contracted provider network, retaining an administrative margin for coordination, utilization management, and quality oversight. NorthCare employs approximately 35 full-time and part-time staff at its Marquette headquarters, with clinical care delivered externally through CMHSP and SUD provider staff. Pricing for individual services is not publicly disclosed; beneficiary eligibility and cost-sharing are determined by Medicaid/Healthy Michigan enrollment status and a SUD sliding-fee scale. No external funding rounds, parent company, or private equity ownership is present — NorthCare operates as a regional public behavioral health authority under a state-mandated administrative structure.

Name

NorthCare Network

Legal name

NorthCare Network

Website

https://northcarenetwork.org

Company type

Private

Operating status

Operating

Short description

NorthCare Network is a Michigan-designated Prepaid Inpatient Health Plan that administers Medicaid behavioral health services across 15 Upper Peninsula counties, coordinating specialty mental health, substance use disorder, and developmental disability care through five CMHSPs and eight-plus SUD providers under an MDHHS capitation contract.

Ownership category

akta.pro rank

Product category

Behavioral Health Services / Medicaid Managed Care

NAICS

Outpatient Mental Health and Substance Abuse Centers (621420), Residential Intellectual and Developmental Disability, Mental Health, and Substance Abuse Facilities (6232), Residential Mental Health and Substance Abuse Facilities (623220), Residential Intellectual and Developmental Disability Facilities (623210)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000), Services-Social Services (8300)

akta.pro primary industry

Managed Care Entity Administration for Medicaid (MCO/PHP/PIHP/PAHP) (HLAEAEAJ)

akta.pro secondary industries

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI), Behavioral Health Care Management & Case Management (HLAEAHAE), Behavioral Health Benefit Administration (MBHO Core) (HLAEAHAA)

Keywords

• Behavioral health services
• Medicaid managed care
• Mental health treatment
• Substance use disorder
• Prepaid health plan

Headquarters

HQ city

Marquette

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Revenue model

1. Medicaid Capitation Payments (MDHHS Contract): NorthCare Network is one of Michigan's ten Prepaid Inpatient Health Plans (PIHPs). As the Regional Entity for Michigan's Upper Peninsula, NorthCare receives capitation payments from MDHHS to manage Medicaid Managed Specialty Supports and Services under the 1915(b)/(c) Waiver Program(s), the Healthy Michigan Plan, and SUD Community Grant Programs. Revenue is generated through fixed per-member per-month capitation payments from the state government.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels4 records

Core offering

NorthCare Network is one of Michigan's ten Prepaid Inpatient Health Plans (PIHPs) and serves as the Regional Entity for Michigan's Upper Peninsula, managing specialty mental health, substance use disorder, and intellectual/developmental disability services for Medicaid beneficiaries across 15 counties. Operating under contract with the Michigan Department of Health and Human Services (MDHHS), it coordinates a provider network of five Community Mental Health Service Programs and multiple SUD providers, delivering care through capitation-funded Medicaid Managed Specialty Supports and Services, the Healthy Michigan Plan, and SUD Community Grant Programs.

Product overview

NorthCare Network is one of Michigan's ten Prepaid Inpatient Health Plans (PIHPs) operating as a Regional Entity for Michigan's Upper Peninsula. The organization offers a unified healthcare management platform that integrates specialty mental health services, substance use disorder treatment, and intellectual/developmental disability support programs. The core product portfolio includes Patient Access API and Provider Directory API for health data interoperability, Crisis/Emergency Services, Specialty Mental Health Services (through five Community Mental Health Service Programs), and Substance Use Disorder Services. Additional offerings include Behavioral Health Home and SUD Health Home for intensive care coordination, Veteran Navigators for military community support, Independent Facilitation for person-centered planning, a comprehensive Customer Service Handbook (available in print, PDF, and audio), and PMTO parent training. The Provider Network Directory provides access to qualified providers across 15 Upper Peninsula counties.

Differentiator

Problem solved

Functional benefit

Products and services

• Specialty Mental Health Services

Quantifiable outcome

• Every eligible recipient receives quality specialty mental health and substance use disorder services and supports through responsible management of regional resources.

Named customers1 record

Segments5 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

AI capability2 records

Feature3 records

Partnerships

Seven partnerships are on record, tiered core.

• PCE SystemscoreTechnology or IntegrationNorthCare Network partners with PCE Systems to operate Patient Access API and Provider Directory API systems, enabling secure health data sharing. PCE Systems manages the technical infrastructure for FHIR-based health information exchange, ensuring compliance with Medicare and Medicaid regulations. NorthCare's Patient Access API is available only to approved developers registered through PCE Systems. The Provider Directory API is accessible at fhir.pcesecure.com:9443/PCEFhirServer/NCR/metadata.
• Copper Country Community Mental HealthcoreStrategic or Co-development PartnerOne of five Community Mental Health Service Programs (CMHSPs) contracted by NorthCare Network to deliver specialty mental health services. Serves Baraga, Houghton, Keweenaw, and Ontonagon counties in Michigan's Upper Peninsula.
• Gogebic Community Mental HealthcoreStrategic or Co-development PartnerOne of five CMHSPs contracted by NorthCare Network to deliver specialty mental health services. Serves Gogebic County in Michigan's Upper Peninsula.
• Hiawatha Behavioral HealthcoreStrategic or Co-development PartnerOne of five CMHSPs contracted by NorthCare Network to deliver specialty mental health services. Serves Chippewa, Mackinac, and Schoolcraft counties in Michigan's Upper Peninsula.
• Northpointe Behavioral Healthcare SystemscoreStrategic or Co-development PartnerOne of five CMHSPs contracted by NorthCare Network to deliver specialty mental health services. Serves Dickinson, Iron, and Menominee counties in Michigan's Upper Peninsula.
• Pathways Community Mental HealthcoreStrategic or Co-development PartnerOne of five CMHSPs contracted by NorthCare Network to deliver specialty mental health services. Serves Alger, Delta, Luce, and Marquette counties in Michigan's Upper Peninsula.
• Michigan Department of Health and Human Services (MDHHS)coreOthersMDHHS is the state government agency that contracts with NorthCare Network as a Prepaid Inpatient Health Plan (PIHP). MDHHS awards NorthCare the contract to serve as the PIHP for all Upper Peninsula Medicaid recipients needing mental health, substance abuse, and support services for developmental disabilities. NorthCare manages the 1115 Behavioral Health Demonstration Waiver Program, Healthy Michigan Plan, and SUD Community Grant Programs under MDHHS contract.

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Lakeshore Regional Entity: Fellow Michigan PIHP serving a different region (west/central lower peninsula) under MDHHS contract. Operates the same pre-paid inpatient health plan model, manages the same 1915(b)/(c) waivers, and contracts with local CMHSPs to deliver behavioral health and SUD services.
• Detroit Wayne Integrated Health Network: Michigan PIHP serving Detroit/Wayne County. Operates under the same MDHHS PIHP framework but with a far larger, urban member population—useful peer for understanding how PIHP scale and operational complexity translate as NorthCare grows.
• Mid-State Health Network: One of Michigan's ten PIHPs serving a multi-county region in central Michigan. Provides directly comparable Medicaid managed behavioral health plan administration, including CMHSP contracting, SUD services, and I/DD supports.
• Southwest Michigan Behavioral Health: PIHP for Michigan's southwest region, operating under the same MDHHS contract structure and managing similar specialty mental health, SUD, and I/DD services through county-based CMHSPs.
• NorthWest Michigan Community Health (Northern Michigan Regional Entity): Michigan PIHP serving the northwestern lower peninsula. Most direct geographic and structural parallel to NorthCare—an adjacent PIHP administering Medicaid behavioral health, SUD, and developmental disability services through contracted CMHSPs.

Others

• Community Mental Health Association of Michigan: Statewide association representing Michigan's CMHSPs and PIHPs. Acts as the policy, advocacy, and training infrastructure for the exact system NorthCare participates in, and shapes how NorthCare's contracts and reimbursement evolve.

Regional players

• Macomb County Community Mental Health: Single-county CMHSP providing specialty mental health services in Michigan. Functions both as a NorthCare-equivalent CMHSP in the lower peninsula and an operational peer for the CMHSP-level delivery model that NorthCare contracts with across the UP.

Broad incumbents

• Magellan Health (now part of Carelon): National managed behavioral health organization that administers specialty behavioral health benefits for Medicaid and commercial health plans across many states. Comparable as a scaling example of what a regional PIHP could become operationally if it expanded beyond its current single-region scope.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 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 NorthCare Network