Michigan offers long-term care resources to seniors through the Michigan Department of Community Health (MDCH) and the Michigan Department of Health and Human Services, Aging & Adult Services Agency (AASA). AASA manages around $100 million in federal and state (non-Medicaid) funding for home and community-based programs to serve Michigan’s older and vulnerable adults through Michigan’s aging network. Michigan’s aging network is comprised of a partnership between the state of Michigan (AASA), 16 regional area agencies on aging, and more than 1,000 local service providers offering older and vulnerable adult and family caregiver services.

In addition, some programs are available to seniors through Medicaid, including the Home and Community-Based Waiver for the Elderly and Disabled (MI Choice Program) and the Program of All-Inclusive Care for the Elderly (PACE).

Medicaid Waiver Program for Assisted Living and In-Home Care

Michigan Elderly & Disabled Medicaid Waiver (HCBS/ED or MIChoice)

Nursing homes used to be the only choice for older or disabled persons who needed help caring for themselves. Today there may be the choice to stay in your home or a community setting, but you or a family member may need assistance in doing so.

One program run by Michigan Medicaid is the MI Choice Waiver Program. It began in 1992 as the Home and Community-Based Services for the Elderly and Disabled (HCBS/ED) waiver program. It is now known as the MI Choice Waiver Program, or simply “the waiver.”

Through this program, eligible adults who meet income and asset criteria can receive Medicaid-covered services like those provided by nursing homes but can stay in their own homes or another residential setting. The waiver became available in all Michigan counties on October 1, 1998.

Services

Services Included: Community transition services; Community living supports; Nursing services (preventative nursing); Respite services; Adult day health (adult day care); Environmental modifications; Non-medical transportation; Medical supplies and equipment not covered under the Medicaid State Plan; Chore services; Personal emergency response systems; Private duty nursing; Counseling; Home delivered meals; Training in a variety of independent living skills; Supports coordination; Fiscal intermediary; and Goods and services.

Eligibility

  1. Health: Applicants must meet the Nursing Home Level of Care required as determined by a healthcare provider pursuant to the waiver criteria.
  2. Financial: Applicants for the MI Choice waiver must meet certain income and asset limits to qualify for Medicaid benefits. Michigan has a Special Income Limit (SIL) test for eligibility, meaning the individual applicant cannot make more than $2,523 a month in income and must have less than $2,000 in assets ($3,000 in assets if married and both spouses are applying). For the non-applicant spouse (the “community spouse”), Michigan chooses to follow the federal standards for Medicaid eligibility for long-term care, and for 2022 that means the community spouse may keep $137,400 in assets (known as the CSRA, or Community Spouse Resource Allowance) and retain a maximum monthly income of $3,435 for personal needs and expenses (known as the Maximum Monthly Maintenance Needs Allowance, or MMMNA). These finances are not considered to belong to the applicant’s spouse to meet the strict financial limits.

Practical Considerations

Michigan does not allow for a Miller Trust. However, it is a“medically needy” spend-down state, so the strict Special Income Limit will be hard for most people who earn a monthly income above $1,133 unless they are already spending most of their income on medical and remedial expenses.

The Michigan Department of Health and Human Services (MDHHS) specifically formulated a more accurate telephonic evaluation for MI Choice applicants to determine potential program eligibility and waiting list placement. The new telephonic evaluation, the MI Choice Intake Guidelines, is only for use by the MI Choice program. MI Choice Waiver Agencies collect MI Choice Intake Guidelines data electronically online. The online MI Choice Intake Guidelines is the only approved format and is only accessible to MI Choice Waiver Agencies.

Conclusion

Michigan offers a good waiver program for seniors who wish to remain in their community or own home instead of a nursing facility while accessing the same services and types of care. However, given the nature of the program and its strict income limit, without the ability to use a Miller Trust, applicants must already have high medical expenses if they have too much income to meet the limit. However, a Medicaid Planning specialist may be able to assist in applying for the waiver by ensuring that recordkeeping and other requirements for the MI Choice Waiver Program are in order before applying. Hence, you have the best chance possible.

Access all state Medicaid Waiver pages.