Join the MPCA!

The Michigan Primary Care Association has three (3) membership levels available to suit interested organizations and individuals.

Membership benefits benefits may include training and technical assistance, participation in MPCA-hosted Peer Communications Networks, free or discounted registration to MPCA-hosted trainings and events, online resources, subscription to the weekly MPCA eUpdate and much more.

Provider Membership, which is limited to not-for-profit organizations that operate health centers where they provide comprehensive primary care, and are aligned with the mission of the Association. Provider Members have the right to elect representatives to sit on the MPCA Board of Directors and are the only class of Members that have voting privileges as Members of the Association.

Provider Membership dues are calculated based on the health center’s “Total Accrued Costs” as listed on Table 8A, Line 17 of the Uniform Data System (UDS) Report. Annual dues are capped at $13,500 and may be paid in annual, semi-annual or quarterly installments. (Note: MPCA’s membership year is October 1 – September 30). MPCA is strongest and most effective when we stand together as community health providers and advocates. MPCA is committed to working with any organization that is having trouble paying its member dues to find a solution that supports continued membership. Please contact Phillip Bergquist or Matt Herwaldt for assistance with a member dues arrangement that will assist your organization through a period of financial hardship.

Associate Membership is available to a not-for-profit organization, agency, foundation, association or government entity whose primary business activity is aligned with the purpose and mission of the Association, and meets eligibility requirements established by the Board of Directors. Associate Members do not have voting privileges as Members of the Association.

$2,500 flat rate (annually)

Student Membership is available to any student enrolled in a secondary Michigan education institution. Student members do not have voting privileges as Members of the Association.

$25 flat rate (annually)

If you are interested in joining us, please complete and submit the form below. After clicking the submit button at the bottom of the form, a confirmation webpage should appear. If it does not, that means your application was not received by us and you should email MPCA to let us know.

Membership Type(Required)

Reason for Membership(Required)

APPLICANT ORGANIZATION'S CONTACT INFORMATION:

Organization Name(Required)

Address(Required)

Street Address City State

Phone(Required)

Web URL Address(Required)

ORGANIZATION INFORMATION:

Type of Organization(Required)

330(e), Community Health Center

330(g), Migrant Health Center

330(h), Health Care for the Homeless Center

330(i), Public Housing Health Center

FQHC Look-Alike

Tribal Health/American Indian Health Center

Other (Non-Health Center), Please describe below

Other

Mission Statement(Required)

Consumer Involvement(Required)

Tax Status(Required)

Non-Profit

For-Profit

List Counties Served(Required)

EXECUTIVE STAFF:

Executive Director/CEO Name(Required)

Executive Director/CEO Email(Required)

Medical Director's Name(Required)

Dental Director's Name(Required)

Financial Officer's Name(Required)

Pharmacy Director's Name(Required)

Nurse Manager's Name(Required)

UTILIZATION:

Users Per Year(Required)

Encounters Per Year(Required)

ENCOUNTERS BY INSURANCE TYPE:

Medicaid Encounters (%)(Required)

Uninsured Encounters (%)(Required)

Medicare Encounters (%)(Required)

Private Insurance Encounters (%)(Required)

Provider FTE:

Medical FTE(Required)

Dental FTE(Required)

Behavioral Health FTE(Required)

CONTACT INFORMATION FOR PERSON SUBMITTING APPLICATION:

Name(Required)

Credentials

Email Address(Required)

Join the MPCA!

Physical Address

Mailing Address