Overview of the MI Choice Waiver
Michigan’s MI Choice Waiver Program provides home and community-based services (HCBS) for elderly and physically disabled state residents who are at risk of being institutionalized (being placed in a nursing home). A variety of benefits are available, and based on an individual care plan, program participants receive long-term services and supports to enable them to continue to live independently. Benefits might include home modifications, adult day care, meal delivery, personal emergency response systems, personal care assistance, and nursing services. Persons can live in their home, the home of a relative, an adult foster care home, or a home for the aged, which can be thought of as assisted living.
The services available via the MI Choice Program are provided by “waiver agencies”, many of which are Area Agencies on Aging (AAAs). There are approximately 20 waiver agencies throughout the state and each agency serves a specific region. Each agency functions as a Prepaid Ambulatory Health Plan (PAHP) and has their own network of care providers. Program participants receive services via these providers. Essentially, it is managed care plan.
However, there is some flexibility of providers for program beneficiaries. There is a self-determination option that allows persons to hire the provider of their choosing for some benefits, such as homemaker services and personal care. This means that rather than receive services via the waiver agency / PAHP’s network of licensed care providers, a program participant can hire their own caregiver. While relatives, such as an adult child, can be hired, a spouse cannot be hired. A financial management services agency handles the financial aspects of employment responsibilities such as background checks, tax withholding, and caregiver payments.
The MI Choice Waiver is not an entitlement program, which means meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.
The MI Choice Waiver is a Home and Community Based Services (HCBS) 1915(c) Medicaid Waiver. This program was previously called the Home and Community Based Services for the Elderly and Disabled Waiver Program (HCBS/ED). This program operates in conjunction with a 1915(b) Medicaid Waiver, which enables the services and supports to be received via prepaid ambulatory health plans (waiver agencies).
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for “Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a nursing home level of care and are at risk of institutionalization such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.
Benefits of the MI Choice Waiver
Follows is a list of the benefits available via the MI Choice Medicaid Waiver. An individual care plan will determine which services and supports a program participant will receive. Some benefits may be participant-directed, meaning the beneficiary is able to choose their own provider.
– Adult Day Health Care – supervised care in a community group setting a minimum of 4 hours / day. Transportation between home and facility may be provided.
– Case Management – also called supports coordination
– Chore Services – mowing the lawn, plowing snow, window washing, etc.
– Community Health Worker – provides assistance in obtaining community support
– Community Living Supports – assistance with daily living activities (i.e., bathing, personal hygiene, eating), preparation of meals, shopping for essentials, non-emergency transportation assistance, housecleaning, dementia care
– Counseling Services
– Financial Management Services – for persons self-directing their care
– Goods and Services – services / supports not otherwise available
– Home Meal Delivery – one to two meals / day
– Home Modifications – also called environmental accessibility adaptations. May include widening doorways, installing ramps / grab bars, and modifying a bathroom to be wheelchair accessible
– Independent Living Skills Training
– Nursing Services – on an intermittent basis
– Personal Emergency Response System (PERS)
– Private Duty Nursing / Respiratory Care
– Respite Care – in-home / out-of-home short-term care to alleviate a primary caregiver from caregiving responsibilities
– Specialized Medical Equipment / Supplies
– Transportation – non-emergency medical / non-medical
While program beneficiaries can live in an adult foster care home or a home for the aged, MI Choice does not cover the cost of room and board in these settings.
Eligibility Requirements for MI Choice Waiver
The MI Choice Waiver is for Michigan residents who are elderly (65+) or younger (18+) if disabled that are at risk of nursing home placement. Additional eligibility criteria are as follows:
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. In 2021, an applicant, regardless of marital status, can have a monthly income up to $2,382. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,382 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance. The maximum amount that can be transferred is $3,259.50 / month and is intended to ensure the non-applicant spouse does not become impoverished. The exact amount that can be transferred is based on the non-applicant’s own monthly income and his/her shelter / utility costs. In some cases, a non-applicant spouse might not be entitled to a spousal income allowance.
In 2021, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse can keep up to $130,380. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for eligibility purposes, Michigan Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a disabled, blind or minor (under 21 years old) child living in the home.
To learn more about the potential of Medicaid taking the home, click here.
Medical Criteria: Functional Need
An applicant must require a nursing facility level of care (NFLOC). For the MI Choice Waiver, an online tool called the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD) is used to determine if this level of care need is met. The LOCD is completed in person by the MI Choice waiver agency in one’s area. There are several functional areas of consideration, including one’s ability to complete their activities of daily living (i.e., transferring from the bed to a chair, mobility, eating, toileting, eating), their cognitive abilities (i.e., daily decision making, short term memory, ability to communicate), and potential behavioral difficulties (i.e., wandering, refusing care, inappropriate behavior). Furthermore, applicants must require supports coordination, in addition to one other waiver service. While many persons with Alzheimer’s disease or a related dementia likely will meet the functional criteria, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Michigan Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
While Michigan has a Spend-down Program that permits Medicaid applicants to spend “excess” income on medical expenses in order to meet Medicaid’s income limit, the MI Choice Waiver Program prohibits persons from qualifying via this avenue.
When persons have assets over the limits, there are a variety of options. While the majority of states allow irrevocable funeral trusts (IFTs), which are pre-paid funeral and burial expense trusts that Medicaid does not count as assets, Michigan does not allow IFTs. Instead, they permit irrevocable prepaid funeral contracts. With this type of contract, funeral and burial goods and services are selected and pre-paid. Another option are annuities that turns countable assets into a stream of income. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in the state of Michigan to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial criteria, but can also protect assets for family as inheritance. These strategies often violate Medicaid’s 60-month look back rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Michigan Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid planner.
How to Apply for the MI Choice Waiver
Before You Apply
Prior to submitting an application for the MI Choice Medicaid Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Since the MI Choice Waiver is not an entitlement program, there may be a waitlist for program participation. This waiver is approved for a maximum of approximately 17,402 total beneficiaries per year. In the case of a waitlist, priority is given to select groups of persons, such as those residing in a nursing home who wish to return to community living. If an applicant does not fall into a priority group, one’s placement on the waitlist is based on the date of application. Waitlists are agency specific, as each agency is allocated a set amount of participant slots.
To apply for the MI Choice Waiver, applicants should contact the MI Choice waiver agency that serves the area in which they live. A waiver agency regional map and coordinating contact information can be found here. An initial over-the-phone interview will take place to determine potential program eligibility and waitlist placement.
The Michigan Department of Health and Human Services’ (MDHHS) Medical Services Administration administers the MI Choice Waiver. MDHHS contracts with waiver agencies to provide MI Choice benefits.
Approval Process & Timing
The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists may exist, approved applicants may spend many months, or even longer, waiting to receive benefits.