Overview of Michigan’s Community Transition Services
Michigan’s Community Transition Services (CTS), or Transition Services for short, provides assistance for seniors and adults with physical disabilities who are institutionalized (i.e., residing in nursing home facilities) and wish to return to the community. A “transition navigator” assists program participants in planning their move and finding housing, which could be a private home, an assisted living residence, an adult foster care home, or a home for the aged. Program participants may also receive assistance with paying a security deposit and utility set-up fees, purchasing essential home furnishings, and making home modifications to allow for independent living. Furthermore, short-term personal care assistance may be provided until ongoing home and community based services can be secured via another program.
While many home and community based services (HCBS) Medicaid programs allow program participants to self-direct their own care, specifically allowing them to hire their own caregiver, this is not an option via Community Transition Services.
Michigan’s Community Transition Services (CTS) is a 1915(i) State Plan Home and Community Based Services (HCBS) benefit. CTS are an entitlement; meeting the state’s Medicaid eligibility requirements guarantees one will receive assistance without being put on a waiting list.
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. This means meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they are filled, a waitlist for benefits forms. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of Community Transition Services
Transition Services may include the following.
– Case Management (formally called Transition Navigator Services)
– Security Deposit & Utility Set-up Fees
– Essential Household Furnishings / Items – i.e., furniture, bedding, and cookware
– Essential Services for Health / Safety – i.e., allergen control and pest eradication
– Home and Community Based Personal Care Assistance – i.e., short-term assistance with bathing, dressing, mobility, toileting, meal preparation, and housekeeping until assistance can be received via another Medicaid program (i.e., Home Help Program, MI Choice Waiver, MI Health Link)
– Home Modifications – i.e., installing a wheelchair ramp and widening doorways for wheelchair access
– Personal Emergency Response Systems – cannot have continuing monthly costs
– Transportation – non-medical and non-emergency for tasks associated with transition (i.e., seeing apartments and going to the bank)
Transition Services do not cover rent, nor room and board in assisted living facilities, adult foster care homes, or homes for the aged.
Eligibility Requirements for Michigan’s Community Transition Services
Transition Services are for Michigan residents who are elderly (65+ years old) or physically disabled (18+ years old). Additional eligibility criteria follows.
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 150% of the Federal Poverty Level (FPL), which increases annually in January. In 2023, an individual applicant can have a monthly income up to $1,823. For married couples with both spouses as applicants, the income limit is $2,465. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,823 / month.
In 2023, 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 still limited. This is because 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 is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA).
The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $148,620. If the non-applicant’s share of assets falls under $29,724, they can keep 100% of the assets, up to $29,724.
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 it. 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, and in 2023, their home equity interest is no greater than $688,000. Home equity is the current value of the home minus any outstanding debt against it. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– A spouse lives in the home.
– The applicant has a disabled, blind or minor (under 21 years old) child living in the home.
Medical Criteria: Functional Need
While many Medicaid long-term care programs require an applicant to need a Nursing Facility Level of Care (NFLOC), this is not the case for Community Transition Services. However, the applicant must have a need for CTS, which is demonstrated by meeting one of the following criteria:
1. Requires assistance with a minimum of one Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL). These activities including transferring, using the toilet, bed mobility, bathing, personal hygiene, dressing, walking, eating, preparing meals, shopping, medication management, laundry, housework, telephone use, public transportation, and managing finances.
2. Has a short-term memory issue and requires very little assistance in making safe decisions in familiar situations, but has some difficulty making decisions when up against new tasks and situations OR Makes unsafe or poor decisions in situations that reoccur or has difficulty making decisions in new situations OR Has a short-term memory issue and is generally understood, but needs help finding the correct words or finishing a thought.
3. Requires assistance due to one of the following behaviors, which must have been present within the last week: resisted care, socially disruptive / inappropriate, verbally abusive, physically abusive, wandering.
An applicant must also have a minimum of one of the following risk factors:
1. A history or a risk of being unable to obtain or retain community housing.
2. A history or a risk of being unable to obtain home and community based services without assistance.
3. A history or a risk of being unable to obtain required documentation without assistance for living independently (i.e., birth certificate, health insurance card).
4. History of a living environment that is inaccessible or unsafe.
While persons with Alzheimer’s disease or a related dementia may meet the functional need for Community Transition Services, a diagnosis in and of itself does not mean one will automatically meet the need.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid in Michigan. 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.
Michigan has a Spend-down Program that permits Medicaid applicants to spend “excess” income on medical expenses in order to become income-eligible. With this option, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s medically needy income limit. The amount that must be “spent down” each month can be thought of as a deductible. Once one’s “deductible” has been met for the month, one is income-eligible for Community Transition Services. More about the medically needy pathway to eligibility.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons may also “spend down” countable assets on ones that Medicaid considers to be exempt (non-countable). Examples include making home reparations and modifications, purchasing home furnishings, and even taking a vacation. Annuities, in which a lump sum of cash is converted into a monthly income stream, is another option. There are many other Medicaid planning strategies available 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 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 Michigan’s Community Transition Services
Before You Apply
Prior to submitting an application for Community Transition Services, applicants need to ensure they meet the Medicaid 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 delayed is required documentation is missing or not submitted in a timely manner.
To be eligible for Community Transition Services, one must be eligible for Michigan Medicaid or have a Medicaid application pending with the likelihood it will be approved. Persons can apply for MI Medicaid via their Michigan Department of Health & Human Services county office.
After applying for Medicaid, one can make a “referral” for Community Transition Services to a transition agency in one’s county. Contact information by county for transition agencies can be found here or by calling the Michigan Community Transitions Line 833-686-7700. The “referral” can be made by anyone, including the individual themself, a loved one, or a medical professional.
Persons can learn more about Michigan’s Community Transition Services here or by calling the Community Transition Services Line at 833-686-7700.
Community Transition Services is administered by the Michigan Department of Health and Human Services (MDHHS) via transition agencies, which includes Centers for Independent Living, Area Agencies on Aging (AAA), and other community-based organizations.
Approval Process & Timing
Michigan’s 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. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.