Medicare: Post-acute care utilization management update

Beginning Jan. 1, 2026, UnitedHealthcare will manage the Medicare utilization management component for some Highly Integrated Dual Eligible (HIDE) or Fully Integrated Dual Eligible (FIDE-AIP) UnitedHealthcare® Medicare Advantage plans in Michigan, Texas and Indiana. Previously, Care Transitions managed the Medicare portion. This is not a new utilization management requirement.

Affected plans

The following plans are the only ones that will be affected by this change in these markets:

• Michigan Dual Complete® (HIDE) H2247-005-000
• Texas Dual Complete® (HIDE) H3868-001-000
• Indiana PathWays for Aging Dual Care (FIDE) H2385-003-000 and H2385-004-000

The process for all other plans in these markets will remain the same.

Prior authorization details

For active prior authorization requests for inpatient services before Jan. 1, 2026, no action is needed from you. Care Transitions will close these requests and UnitedHealthcare will open them under the new HIDE or FIDE-AIP policy on Jan. 1, 2026.

This includes prior authorization and concurrent review, including discharge planning, for the following post-acute levels of care:

• Skilled nursing facilities 
• Acute inpatient rehab 
• Long-term acute care 

Beginning Jan. 1, 2026, prior authorization requests must be submitted through the UnitedHealthcare Provider Portal:

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications

Questions? We’re here to help.

If you have questions, contact your assigned Care Transitions provider relations manager in your state.