Michigan MI Choice Waiver Program

As the Baby Boomers continue to march into their golden years, more and more people will need nursing home-level care at some point in their lives—perhaps for years. But getting that care in a long-term care facility is not the only option. For many people, the Michigan MI Choice Waiver program will enable them to get the care and support they need without moving to a nursing home. 

What is the MI Choice Waiver Program?

Established in 1992, the program was originally known as Home and Community-Based Services for the Elderly and Disabled. It allows adults over 18 who meet medical and financial requirements to live in the community and receive services like those they would get in a nursing home, covered by Medicaid. In addition to the basic services covered by Michigan Medicaid, MI Choice participants may receive other services, including:

• Adult daycare
• Case management (supports coordination)
• Community health worker visits
• Community living supports
• Counseling
• Fiscal intermediary to help administer benefits
• Goods and services
• Home meal delivery
• Home modifications (environmental accessibility adaptations)
• Household chore services
• Independent living skills training
• Medical equipment and supplies
• Medical and non-medical transportation
• Nursing services
• Personal emergency response systems (medical alert systems)
• Respiratory care
• Respite services to allow primary caregivers to take a break

The MI Choice Waiver program has been available in all Michigan counties for 25 years—since October 1, 1998. The services listed above are provided by Area Agencies on Aging (AAAs) or other agencies, collectively known as Waiver Agencies. Michigan’s 20 Waiver Agencies serve clients in every corner of the state.

The program allows participants to remain in their homes, or in the home of a family member, adult foster care home, or even an assisted living facility. The program does not cover the cost of room and board in adult foster care or a home for the aged. In some cases, a family member can be paid as a care provider through the program, though such payment is not available to spouses. 

Although there are income limits for program eligibility, simply meeting those limits does not mean that qualifying individuals will begin receiving program benefits. The program has a limited number of slots for participants, which means that some applicants must wait for months or even years to be able to participate. 

Who is Eligible for the Michigan MI Choice Waiver? 

The program is designed for adults who are elderly (aged 65 or older) or adults over the age of 18 who are disabled. Regardless of age, an applicant must be at risk of nursing home placement. As mentioned above, there are both financial and medical criteria for participation in the program.

Financial Criteria for MI Choice Waiver Eligibility

• Applicant income of no more than 300% of the Federal Benefit Rate (FBR), adjusted annually. For 2023, the monthly income limit is $2,742. If both spouses in a couple are applying, they are considered individually for income purposes. If only one spouse is an applicant, their spouse’s income is not considered toward their eligibility.
• An applicant spouse with income above the limit can transfer some of their monthly income to the non-applicant spouse. This transfer is called a Spousal Income Allowance or Monthly Maintenance Needs Allowance. The Allowance must not cause the non-applicant spouse’s monthly income to exceed a maximum amount, currently $3,715.
• A single applicant’s assets are limited to $2,000 (however, some categories of assets are not counted toward this total, such as a primary home in most cases). When both spouses are applying for the MI Choice Waiver program, they are limited to $3,000 in assets. If one spouse is not applying for the program, they may keep a larger portion of the couple’s assets; this is known as the Community Spouse Resource Allowance (CSRA).
• An applicant’s primary home, household furnishings and appliances, personal effects, and vehicle are generally not counted toward the asset limit. 
• Equity in a primary home is not countable toward the Medicaid asset limit so long as the applicant lives in the home or intends to return there; or a spouse lives in the home, or the applicant has a disabled, blind, or minor (under 21) child living there. While homeownership does not disqualify an applicant for the MI Choice Waiver Program, applicants should be aware that after a program participant’s death, Michigan could try to recoup some of its expenditures on behalf of the participant through the state’s Medicaid Estate Recovery Program.

Medical/Functional Requirements for MI Choice Waiver Eligibility

To ensure that the MI Choice Medicaid Waiver Program’s limited resources are received by those who genuinely need them, participants must require a nursing facility level of care (NFLOC). An applicant’s functional need level can be determined using the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD). Areas considered include:

• Ability to complete Activities of Daily Living (ADLs) such as bathing, transferring from bed to chair, toileting, and eating
• Cognitive abilities, including decision-making, short-term memory, and ability to communicate
• Potential behavioral difficulties, such as refusal of care, inappropriate conduct, or wandering
• Medical conditions for which the applicant is receiving treatment
• Need for skilled rehabilitation therapies
• Need for support coordination (case management) as well as at least one other MI Choice Waiver program service.

Applying for the Michigan MI Choice Waiver

If you want to apply for the Michigan MI Choice Medicaid Waiver on behalf of yourself or a loved one, you will need to ensure that eligibility requirements are met and that you have the appropriate documentation. An experienced elder law attorney can help make the application process easier and can help you explore other alternatives to nursing home care, such as the Michigan PACE program. 

To learn more about options, or to get assistance applying for the MI Choice Waiver, contact Estate Planning & Elder Law Services to schedule a consultation.