Evidence status: CURRENT MEDICAID MANAGED-CARE COVERAGE CONDITION. Michigan’s October 1, 2026 Medicaid Health Plan Common Formulary prior-authorization criteria require a signed Pain Medication Agreement with informed consent when a member falls within the chronic-opioid high-MME review and does not meet a listed exception.

The trigger

The current criteria identify high morphine milligram equivalents as more than 90 MME per day. When the high-MME review applies, the provider must satisfy the listed attestation and documentation requirements.

The agreement requirement

Among the required attestations, the provider must attest that a Pain Medication Agreement with informed consent has been reviewed with, completed, and signed by the patient.

This is a coverage condition

The requirement sits inside Michigan Medicaid managed-care prior authorization. It is therefore a program coverage condition, not a statewide rule requiring every Michigan chronic-pain patient to sign the same agreement.

What else accompanies the agreement

The high-MME criteria also require risk assessment, recent MAPS/NarxCare review, medication reconciliation, non-opioid interventions, toxicology screening at appropriate intervals, naloxone counseling, pain-related clinical justification, medication history, and documentation of total daily MME.

Primary source

Michigan Medicaid — Common Formulary Prior Authorization Criteria, effective October 1, 2026

Reviewed: October 5, 2026.

Evidence boundary: The source establishes a Medicaid managed-care coverage condition. It does not establish that every term appearing in a health plan or clinic pain agreement is required by Michigan law.