Michigan Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

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 available to seniors through Medicaid and include the Home and Community-Based Waiver for 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 criteriacan receive Medicaid-covered services like those provided by nursing homes, but can stay in their own home or another residential setting. The waiver became available in all Michigan counties 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 meetcertain income and asset limits to be eligible for benefits under Medicaid. Michigan has a Special Income Limit (SIL) test for eligibility, meaning the individual applicant cannot make more than $2,205 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 choose to follow the federal standards for Medicaid eligibility for long-term care, and for 2017 that means the community spouse may keep $120,900 in assets (known as the CSRA, or Community Spouse Resource Allowance) and retain a maximum monthly income of $3,022.50 for personal needs and expenses (known as the Maximum Monthly Maintenance Needs Allowance, or MMMNA). These finances are not considered as belonging to the applicant spouse for purposes of meeting the strict financial limits.

Practical Considerations

Michigan does not allow for a Miller Trust, however is a“medically-needy” spenddown state, so the strict Special Income Limit will be hard for most people who earn a monthly income above $2,205 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 for use by the MI Choice program only. 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 having access to 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, an applicant 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 MIChoice Waiver Program are in order before applying so you have the best chance possible.