Region 10 PIHP

What Region 10 PIHP does

Region 10 PIHP (Region 10 Prepaid Inpatient Health Plan) is a Michigan-designated Prepaid Inpatient Health Plan established under contract with the Michigan Department of Community Health effective January 1, 2014. It serves as the single regional entry point for Medicaid specialty behavioral health services across four counties — Genesee, Lapeer, Sanilac, and St. Clair — managing mental health, substance use disorder (SUD), and intellectual/developmental disability services on behalf of Medicaid beneficiaries. The organization functions primarily as a contracting and utilization management layer rather than a direct service provider: it contracts with four county Community Mental Health Services Programs (Genesee Health System, Lapeer CMH, Sanilac CMH, and St. Clair CMH) and a regional SUD provider network to deliver care, while providing administrative oversight, utilization management, quality improvement (QAPIP), and compliance functions centrally. The central administrative staff is small (11-50 employees) under CEO Kelly L. VanWormer and a C-suite including Chief Clinical Officer Thomas Seilheimer, PhD, and CFO Richard Carpenter, with a 15-member Board of Directors providing community governance.

Core service programs include Mental Health Services, SUD Prevention/Treatment/Recovery, Home and Community Based Services (HCBS) under CMS waivers, Veterans Navigation Services with county-level Veteran Navigators, Utilization Management, a Certified Peer Support Specialist Warmline, and 24/7 crisis intervention lines. The technology backbone consists of PCE Care Management Version 9.4 for care management, CareConnect 360 for health information exchange, and ONC 2015 Edition Cures Update-compliant public-facing APIs (Patient Access API and Provider Directory API) that enable third-party applications and patients to query claims, clinical data, encounter details, and provider directory information via FHIR standards with token-based authentication. Additional resources include a Customer Handbook with county-specific inserts and a Provider Network Directory available in PDF and JSON formats.

The business model is a state-regulated Medicaid managed care arrangement: the PIHP receives capitation payments from Michigan Medicaid (MDHHS) and disburses funds to contracted CMHSPs and SUD providers under negotiated service rates. No commercial revenue, employer-sponsored coverage, or non-Medicaid government contracts are evident in the source material, making MDHHS the single de facto payer. Sliding fee scales are available for SUD services based on ability to pay, but pricing is not publicly disclosed. Revenue figures, budget, and capitation rates are not available in the disclosed information, though the organization is described as operating continuously since contract signing.

Name

Region 10 PIHP

Legal name

Region 10 Prepaid Inpatient Health Plan

Website

https://region10pihp.org

Company type

Private

Founded year

2013

Operating status

Operating

Headcount range

11–50 employees

Short description

Region 10 PIHP is a Michigan-designated Prepaid Inpatient Health Plan managing Medicaid specialty behavioral health services — mental health, substance use disorder, and developmental disability — across Genesee, Lapeer, Sanilac, and St. Clair counties via contracted Community Mental Health organizations and SUD providers.

Ownership category

akta.pro rank

Product category

Medicaid Managed Behavioral Health

NAICS

Residential Mental Health and Substance Abuse Facilities (623220), Nursing and Residential Care Facilities (623)

SIC

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

Mental Health Parity (MHPAEA) Compliance & Reporting (HLAEAHAG), Community Mental Health Centers (CMHCs) & Public Behavioral Health Providers (HLAFACAI)

Keywords

• Medicaid managed care
• Behavioral health services
• Substance use treatment
• Mental health services
• Developmental disability services

Headquarters

HQ city

Port Huron

HQ country

United States

HQ region

North America

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Distribution channels4 records

Marketing channels5 records

Core offering

Region 10 PIHP is a contracted Michigan Prepaid Inpatient Health Plan that manages and coordinates Medicaid-funded specialty behavioral health services — mental health, substance use disorder treatment and recovery, intellectual/developmental disability supports, home and community based waiver services, veterans navigation, and a Certified Peer Support Specialist Warmline — for residents of Genesee, Lapeer, Sanilac, and St. Clair counties. The organization functions as the single regional entry point, providing utilization management, administrative oversight, and quality assurance through a contracted network of county Community Mental Health organizations and SUD providers.

Product overview

Region 10 PIHP is a Prepaid Inpatient Health Plan that serves as a single integrated entity managing Medicaid specialty services and supports for mental health, substance use disorders (SUD), and intellectual/developmental disability services across Genesee, Lapeer, Sanilac, and St. Clair counties in Michigan. The organization operates as a coordinating entity that contracts with Community Mental Health organizations and SUD providers in each county, providing administrative oversight, utilization management, and quality assurance. Core service programs include Mental Health Services, SUD Prevention/Treatment/Recovery, Home and Community Based Services (HCBS), Children's Waiver Program, Habilitation Supports Waiver, Veterans Navigation Services, and a Certified Peer Support Specialist Warmline. Technology offerings include Patient Access API and Provider Directory API for healthcare data interoperability, enabling third-party developers and patients to access claims, clinical data, and provider information. Additional resources include a Customer Handbook with county-specific inserts, Provider Network Directory, and various forms for providers.

Differentiator

Problem solved

Functional benefit

Products and services

• Prepaid Inpatient Health Plan (PIHP) Regional Prepaid Inpatient Health Plan that manages Medicaid specialty services and supports across Genesee, Lapeer, Sanilac, and St. Clair counties in Michigan, providing public mental health, substance use disorder, and intellectual/developmental disability services. Targeted at Medicaid beneficiaries in those counties.
• Veterans Services Mental health services, navigation assistance, and community resources for veterans and their families; Veteran Navigators are available in each county (Genesee, Lapeer, Sanilac, St. Clair) to help access VA systems and mental health services.
• Substance Use Disorder (SUD) Services Coordinated network of community-based services for substance use disorder prevention, treatment, and recovery, including outpatient, residential, detox, and women's specialty services. Targeted at individuals with SUD across the four-county region.
• Home and Community Based Services (HCBS) Medicaid waiver program services designed to improve individual experience by enhancing access to the community, promoting services in integrated settings, and expanding person-centered planning per CMS rules. Targeted at individuals with intellectual/developmental disabilities and other HCBS-eligible Medicaid beneficiaries.
• Utilization Management Utilization management program ensuring the right service is provided at the right time in the right amount, including a UM Service Grid, service authorization denial reporting, and provider training resources. Targeted at contracted provider organizations and PIHP oversight.
• Certified Peer Support Specialist Warmline A warmline operated by Certified Peer Support Specialists providing wellness supports and listening services to individuals with mental health conditions, established by the Michigan Department of Health and Human Services. Targeted at individuals with mental health conditions across the region.
• Medicaid Health Plan Pharmacy Benefit Information and access to drug and supply coverage through Michigan Medicaid Health Plans, directing members and providers to state pharmacy benefit resources. Targeted at Medicaid beneficiaries and their prescribing providers.
• Patient Access API (Healthcare Data API) ONC 2015 Edition Cures Update compliant API enabling patients and approved third-party applications to access healthcare data including claims, clinical data, and encounter details. Targeted at patients served by Region 10 PIHP and approved third-party developers.
• Provider Directory API Public-facing API exposing endpoints that allow third-party applications and websites to retrieve designated provider directory data from the payer system. Targeted at third-party application developers and patients seeking provider information.

Quantifiable outcome

• Tobacco cessation program for adults with serious mental illness highlighted by CMS as a successful model
• +1 more outcomes

Segments4 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Recent moves8 records

Expansion highlights5 records

Broad incumbents

• Centene Corporation: Largest Medicaid managed care organization in the U.S., operating multiple Michigan Medicaid health plans. Overlaps with Region 10 in serving Medicaid beneficiaries but at national scale with broader portfolios including physical health and pharmacy.
• Magellan Health: National managed behavioral health and specialty healthcare company. Comparable to Region 10 in managed behavioral health service delivery for Medicaid populations, though operating across multiple states and product lines.
• Optum Behavioral Health: Managed behavioral health arm of UnitedHealth Group serving Medicaid and commercial populations nationally. Comparable to Region 10 in administering behavioral health benefits at scale, but with integrated physical health and technology platforms.
• Carelon Behavioral Health: National managed behavioral health organization (formerly Anthem/Beacon Health Options). Comparable to Region 10 as a behavioral health managed care entity but operates across many states with commercial, Medicaid, and Medicare lines.

Direct peers

• Network180: Kent County Community Mental Health Authority and designated PIHP for Kent County, Michigan. Operates the same Prepaid Inpatient Health Plan model under Michigan Medicaid with county-based access and a community provider network.
• NorthCare Network: PIHP for Michigan's Upper Peninsula under the same state Medicaid contract, providing behavioral health and I/DD services with a comparable governance model and provider network structure.
• Lakeshore Regional Entity: Michigan PIHP covering Allegan, Kent, Lake, Mason, Muskegon, Oceana, and Ottawa counties. Functions as an identical regional managed care entity for Medicaid behavioral health services under the same state contract.
• Mid-State Health Network (MSHN): PIHP serving 21 central Michigan counties, operating under the same Michigan Medicaid specialty behavioral health and I/DD managed care model with overlapping service populations and contract structure.
• Detroit Wayne Integrated Health Network (DWIHN): Designated PIHP for Detroit and Wayne County under Michigan Medicaid, managing specialty behavioral health and I/DD services for the largest urban Medicaid population in the state under an identical governance and contract structure.
• Macomb County Community Mental Health Authority: PIHP for Macomb County, Michigan operating the same specialty behavioral health managed care framework for Medicaid beneficiaries, with the same MDHHS contract and reporting requirements.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights5 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Profiles21 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 Region 10 PIHP