What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, Medicaid will sometimes pay for care in these locations if it can be obtained at a lower cost than in a nursing home. Medicaid does this through state-specific "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
MI Choices allows eligible seniors that require nursing home level care, to receive that care in their homes or in the community, including in certain assisted living residences. Family members can also be paid to provide care.
MI Choice is a Michigan Medicaid Waiver program, formerly referred to as the Home and Community Based Services for the Elderly and Disabled (HCBS/ED) program. This waiver is intended for seniors and disabled individuals who require a level of care consistent with that which is provided in a nursing home, but wish to remain living at home or in the community, such as in an adult foster care home or a home for the aged (similar to assisted living).
Elderly and disabled waiver participants are given the choice of having the state manage their care services or self-directing their own care. This option is referred to as Self Determination in Long-Term Care (LTC), and it is based on the Medicaid Cash and Counseling model. For those who choose to self-direct their own care, they may opt for a representative to direct their care for them. Family members, such as the adult children, can be hired to provide care services. In other words, they can become paid caregivers for their aging parents. However, in most cases, spouses and legal guardians are not eligible to be paid as caregivers for their husbands or wives.
While paying a family member may be the most popular benefit of this program, it is by no means the only benefit. Under the MI Choice waiver, seniors can also receive assistance for home modifications to enable aging in place. This might include the addition of a wheelchair ramp or bathroom safety modifications, such as the replacement of a shower with a walk-in tub.
Did You Know? Michigan seniors can receive free quotes for bath safety modifications. Get started here.
In order to be eligible for the MI Choice Waiver, an individual must be a Michigan resident at least 65 years old (or 18-64 and disabled), qualify for a nursing home level of care, and require one service provided by this waiver on an ongoing basis. (See benefits and services below). In addition, persons must be financially qualified to receive assistance from the Choice Waiver.
Financially speaking, both one’s income and assets are considered. As of 2019, a single individual is allowed up to $2,313 per month in income and up to $2,000 in countable resources. Married couples, in which both spouses are applying for the MI Choice Waiver, are considered as single applicants. Therefore, each spouse is allowed up to $2,313 in monthly income. Unlike income, assets are considered jointly owned. Learn more here. Couples are able to retain as much as $3,000 in countable resources.
Defining "Countable Resources"
Countable resources, countable assets, and non-exempt assets all refer to the resources that Medicaid considers when determining one’s eligibility. (Basically all of the terms are used interchangeably). However, there are several resources that are considered exempt when it comes to Medicaid eligibility. For example, owner-occupied homes are exempt, meaning the real estate value is not included, provided the value of the home does not exceed $585,000. (If the applicant is married and his/her spouse lives in the home, it is also considered exempt, even if the applicant does not live in it.) Primary vehicles, burial plots, and irrevocable funeral trusts are also exempt. In addition, if one partner of a married couple is applying for Medicaid, while the other partner is not, the non-applicant spouse (also known as the community spouse) is able to retain countable resources up to $126,420. (This in Medicaid-speak is called a community spouse resource allowance). This is in addition to the $2,000 in assets the applicant spouse is able to retain.
Options for People Over-Limit
Persons that are over the income and / or asset limits might still gain eligibility for the MI Choice Waiver by working with a financial professional to help them restructure their income and assets in order to meet the limits. There are techniques that can be utilized in order to gain eligibility, while still preserving a family's resources for future generations. If you believe you are over the limits, consider seeking Medicaid planning assistance in order to increase your chances of qualifying for assistance. Learn more.
Benefits and Services
Services are decided on a case-by-case basis and can include the following:
Adult day care in a group environment
Supports Coordination / Case management
Disposable medical supplies and durable medical equipment
Environmental modifications to one's home or car to increase independence
Homemaker services such as laundry, shopping assistance and housekeeping
Personal care services in an assisted living residence or at home
Personal care supervision
Personal emergency response systems (PERS)
Prepared and hot home delivered meals
Private duty nursing on a short-term basis, including respiratory care
Respite care to relieve the primary caregiver (in-home and out-of-home)
Transportation assistance for medical appointments
Non-medical transportation assistance
Transition from a nursing home back into the community
Counseling – family members may participate in these sessions
For individuals who would like to age in place in their private home or the home of a family member, the state of Michigan offers a second option to assist homebound seniors. It is called the Michigan Home Help Program. This program also offers seniors the choice of hiring a family member or a friend to provide their personal care services.
How to Apply / Learn More
The MI Choice Waiver program is operated by the Michigan Department of Community Health’s (MDCH) Medical Services Administration (MSA) and is available statewide across Michigan. There is room in this program to accommodate approximately 18,000 participants. However, there is a waiting list to receive services via this waiver. New applicants can expect approximately a six to twelve month waiting list to begin services.
To apply for the program, one should contact their local Michigan Area Agency on Aging. Some limited information about this program is available on the Michigan Department of Health & Human Services webpage.