Michigan Medicaid: Complete In Lieu of Services nutrition prior authorization form

UnitedHealthcare Community Plan of Michigan provides an In Lieu of Services (ILOS) — specifically, nutrition food services — through our 2 programs: Medically Tailored Home Delivered Meals and Produce Prescription. This service is available to our members in select counties who need food assistance.

For a member to receive ILOS, please complete a prior authorization request form in its entirety. Email instructions are included on the form.

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Food service program overview

Medically Tailored Home Delivered Meals: Fresh or frozen home-delivered meals that are medically tailored for a specific disease or condition
Produce Prescription: Manual or electronic vouchers for fruits and vegetables are redeemable at participating food retailers. Eligible items include:
- Women, Infants and Children--approved produce
- Gus Schumacher Nutrition Incentive Program-eligible produce
- Double Up Food Bucks Michigan items