Overview of the MI Health Link HCBS Waiver Program
MI Health Link is a managed care program through which “dual eligible” aged and disabled Michiganians can receive all of their Medicare and Medicaid benefits. The term “dual eligible” is used for persons who are eligible for both Medicaid and Medicare. MI Health Link combines the benefits of both programs into one delivery system, making it easier to coordinate services and supports.
While medical care, prescription drugs, behavioral health services, and nursing home care are available benefits, MI Health Link also has a component through which home and community based services (HCBS) are available. This portion of the program is called the MI Health Link HCBS Waiver. A variety of HCBS are available to persons who require a nursing home level of care and live at home, the home of a family member, an adult foster care home, or a home for the aged, which can be thought of as assisted living. The exact long-term services and supports one receives is based on one’s specific needs and circumstances. Potential benefits include adult day care, home delivered meals, personal care assistance, home and vehicle modifications, and personal emergency response systems.
Beneficiaries of MI Health Link / MI Health Link HCBS receive their benefits via a single Medicaid plan provided by an Integrated Care Organization (ICO). ICOs are managed care organizations (MCOs) that are essentially private healthcare companies. ICOs have a network of care providers and program participants receive services via these providers. Based on the region of Michigan in which one lives, persons may be limited to a single managed care plan while others have several plans from which to choose. At the time of this writing, MI Health Link / MI Health Link HCBS is only available in 25 counties.
There is some flexibility of providers for home and community based services, as some benefits, such as personal care assistance, may be participant directed. This means that rather than receive services by the ICO’s network of licensed care providers, a program participant can hire their own caregiver. This includes adult children, nieces / nephews, grandchildren, and siblings, but not spouses and legal guardians. The individual must meet all required provider qualifications for the service for which they are being hired. A financial management services agency handles the financial aspects of employment responsibilities, such as withholding tax and issuing payments.
Home and community based services via MI Health Link are not an entitlement. This means meeting eligibility requirements does not equate to immediate receipt of these benefits. Instead, the HCBS Waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.
The MI Health Link Medicaid Waiver is a 1915(b) Managed Care Delivery System Waiver. It operates jointly with the MI Health Link HCBS Waiver, which is a 1915(c) Home and Community Based Services (HCBS) Waiver.
Medicaid pays doctors, hospitals, and other providers in one of two ways, either “Fee-For-Service” or “Managed Care”. Under Fee-For-Service, Medicaid pays providers directly for each service they provide. Beneficiaries can receive services from any Medicaid-certified provider. Under Managed Care, Medicaid contracts with a Managed Care Organization (MCO). Medicaid pays the MCO a set amount for each beneficiary, rather than for each service provided. The MCO has a network of doctors, hospitals, and other providers and the MCO pays them. Beneficiaries must use providers within the network.
Benefits of the MI Health Link HCBS Waiver Program
Program participants receive all of their Medicaid and Medicare benefits via MI Health Link. In addition to medical benefits, such as physician appointments, laboratory work, x-rays, and hospitalization, dental services, hearing aid coverage, behavioral health services, prescription drugs, and nursing home care, a variety of long-term home and community based services (HCBS) are also available via MI Health Link. The list that follows are potential HCBS, although an individualized care plan determines which benefits a program participant receives.
– Adaptive Medical Equipment / Supplies (i.e., lift chairs, shower seats, bath lifts, medical alert bracelets)
– Adult Day Health Care – supervised care in a community group setting a minimum of 4 hours / day. Transportation between home and the facility may be provided.
– Assistive Technology – includes vehicle modifications
– Care Coordination
– Chore Services – mowing the lawn, plowing snow, window washing, etc.
– Expanded Community Living Supports – assistance for persons who require prompting and supervision to do daily living activities (i.e., bathing, dressing personal hygiene, eating)
– Community Transitions Services – assistance for persons moving from a nursing home back into the community. Includes security deposits and utility set up fees, moving fees, home modifications, such as the addition of a wheelchair ramp, etc.
– Financial Management Services – for persons self-directing their care
– Home Meal Delivery – one to two meals / day
– Home Modifications – also called environmental modifications. May include widening doorways, installing ramps / grab bars, and modifying a bathroom to be wheelchair accessible
– Nursing Services – on an intermittent basis
– Personal Emergency Response System (PERS)
– Private Duty Nursing – up to 16 hours daily
– Respite Care – in-home / out-of-home short-term care to alleviate a primary caregiver from caregiving responsibilities
– Transportation – non-medical
While services can be received in an adult foster care home or a home for the aged, MI Health Link HCBS does not cover the cost of room and board.
Eligibility Requirements for MI Health Link HCBS Waiver Program
The MI Health Link Program is a Medicaid program for MI residents who are 21+ years old, eligible for Medicaid and Medicare (Parts A, B and D), not on hospice, and live in one of the 25 counties in which the program is available. The counties include Alger, Baraga, Barry, Berrien, Branch, Calhoun, Cass, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Kalamazoo, Keweenaw, Luce, Mackinac, Macomb, Marquette, Menominee, Ontonagon, Schoolcraft, St. Joseph, Van Buren, and Wayne. While additional eligibility criteria follows, the eligibility criteria below is specific to those who require long-term home and community based services. MI Health Link without HCBS has different criteria.
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
For home and community based services, an applicant must require a nursing facility level of care (NFLOC). For the MI Health Link HCBS Waiver, the tool used to make this determination is the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD). 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). 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 Health Link HCBS 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 / services are selected and pre-paid. Another option, but for persons with a significant amount of “excess” assets, are Medicaid asset protection trusts (MAPTs). The assets that are put in this type of trust are no longer are considered to be owned by the applicant. However, a shortcoming of MAPTs is that they must be created well in advance of the need for long-term care. 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, some planning strategies, such as MAPTs, not only help one meet Medicaid’s financial criteria, but also protect assets from Medicaid’s estate recovery program. These strategies often violate Medicaid’s 60-month look back rule, and therefore, should only be implemented with very careful planning. This is because there are some workarounds. Fortunately, 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 Health Link HCBS Waiver Program
Before You Apply
Prior to submitting an application for the MI Health Link / MI Health Link HCBS, 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 Health Link HCBS Waiver is not an entitlement program, there may be a waitlist for program participation. This waiver is approved for a maximum of approximately 5,100 total beneficiaries per year, with each region allotted a specific number of participant slots. This means waitlists are region specific. At the time of this writing, there are no waitlists. However, based on need, the available slots in each region are adjusted accordingly. 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 and those who will require nursing home admission in the very near future. If an applicant does not fall into a priority group, one’s placement on the waitlist is based on the date of application.
To enroll in MI Health Link HCBS, one must be eligible and enrolled in both Medicaid and Medicare. To apply for Michigan Medicaid, persons should contact their local Michigan Department of Health & Human Services office. Persons can apply online for Medicare here.
Persons eligible for MI Health Link should receive a letter from Michigan ENROLLS with instructions on how to enroll. One option is to call Michigan ENROLLS at 1-800-975-7630. Persons have the option to select their ICO. If none is selected, one will automatically be assigned. ICOs are available by region. ICOs can be found here and a service map here. An initial screening and functional assessment will be completed by the ICO.
For additional information about MI Health Link / MI Health Link HCBS, click here. The Michigan Department of Health and Human Services’ (MDHHS) Medical Services Administration administers the MI Health Link Waiver /MI Health Link HCBS Waiver.
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, if wait-lists exist, approved applicants may spend many months waiting to receive benefits.