Home Help Program: Medicaid-Funded Personal Care Assistance for Michigan Seniors

Last updated: May 27, 2021

 

Overview of the Michigan Medicaid Home Help Program

Michigan’s Home Help Program provides in-home personal care assistance for elderly and disabled persons who are unable to complete their activities of daily living (ADLs) and instrumental activities of daily living (IADLs) independently. ADLs are everyday tasks that are necessary to take care of oneself. This includes bathing and grooming, dressing and undressing, using the toilet and cleaning up oneself, the ability to move from one room to another room within one’s home, and eating. IADLs are tasks that are imperative for independent living, but are not required daily. This includes preparing meals, housework, and shopping for essential items. Via the Home Help Program, eligible state residents receive assistance with these activities.

The services offered under the Medicaid Home Help Program may be provided by licensed agency caregivers or program participants have the option to self-direct their own care. This means they are able to hire a relative or friend who is 18+ years old to provide care. A financial management services agency handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments. Some of the persons who are qualified to be hired as caregivers include sons, daughters, adult grandchildren, nieces, and nephews. Spouses cannot be hired to provide care.

The MI Home Help Program is an entitlement program. This means if one meets the eligibility criteria, services via this program must be made available. Stated differently, a waitlist for program benefits cannot exist.

The Home Help Program is available through Michigan’s regular state Medicaid plan. This program might also be called the Home Help Services Program.

 HCBS Medicaid Waivers versus HCBS State Plan Medicaid?
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. Put differently, 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 have been filled, a waitlist for benefits begins. 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 the Home Help Program

In addition to case management, assistance with a variety of daily activities is provided. This includes bathing / showering, personal hygiene, dressing / undressing, mobility, transitioning, eating, and toileting. Assistance may also be provided with medication management / administration, shopping for groceries and other essential items, preparing meals and cleaning up, light housecleaning, and laundry.

Persons can live in their own home or the home of a loved one and receive benefits through the Home Help Program. Unfortunately, persons cannot reside in an adult foster care home or an adult care home (similar to an assisted living residence).

 

Eligibility Requirements for Michigan Medicaid Home Help Program

The Home Help Program is for Michigan residents who require assistance with their daily living activities. Additional eligibility criteria, relevant for persons 65+ years of age, are as found below.

 The American Council on Aging provides a quick and easy Medicaid eligibility test for Michigan seniors. /

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 100% of the Federal Poverty Level (FPL), which increases on an annual basis in January. In 2021, a single applicant can have a monthly income up to $1,073. Married couples, with one or both spouses as applicants, are allowed up to $1,452 / month in income.

 While many home and community based services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets, the Home Care Program does not. In contrast, Michigan’s MI Choice Waiver and Health Link HCBS Waiver do allow a non-applicant spouse a monthly maintenance needs allowance from his/her applicant spouse and a community spouse resource allowance.

Assets
In 2021, the asset limit is $2,000 for a single applicant. The asset limit for a married couple, regardless of if one or both spouses are applicants, is $3,000. 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.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our spend down calculator

Home Ownership
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 hands on assistance with one activity of daily living. This includes eating, bathing, dressing, grooming, mobility within one’s home, transferring (moving from one position to another, such as going from the bed to a chair), and toilet use. An Adult Services Comprehensive Assessment (MDHHS-5534) is used to determine one’s need. The reason for the necessity of assistance is not important. Need could be due to the natural process of aging, cognitive impairments from Alzheimer’s Disease or a related dementia, a physical disability, and so forth.

 For more information about long-term care Medicaid in Michigan, click here

 

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. 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 meet Medicaid’s income limit. 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 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, the Home Help Program will pay for care services and supports.

When persons have assets over the limits, there are a variety of options. Unfortunately, Michigan is one of only a few states that does not allow irrevocable funeral trusts (IFTs). IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. However, MI permits irrevocable prepaid funeral contracts. With this type of contract, funeral and burial goods / services are pre-selected and paid in advance. Persons might also opt for an annuity, which turns a lump sum of cash (a countable asset) into a stream of income. There are many additional options when the applicant has assets greater than Medicaid’s asset 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. While these strategies protect assets from Medicaid’s estate recovery program, they often violate Medicaid’s 60-month look back rule. Therefore, it is vital that these planning techniques be implemented well in advance of the need for long-term care. However, there are some workarounds, and 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 Michigan Medicaid Home Help Program

Before You Apply

Prior to submitting an application for the Michigan Medicaid Home Help Program, 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.

 

Application Process

To apply for the Medicaid Home Help Program, persons must be eligible for MI Medicaid. To apply, one should contact their county Michigan Department of Health & Human Services office. Contact information can be found here. As part of the application process for home services, a functional needs assessment will be completed.

For additional information about the Home Health Program, click here and here. A program brochure can be found here. The Michigan Department of Health and Human Services (MDHHS) administers the Home Help Program.

 

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.

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