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Michigan’s Medicaid Home and Community Based Waiver Program helps people over the age of 18 stay in their own home and receive nursing home level services. This Medicaid program is designed to delay or prevent the need for a move to a nursing home. The state Medicaid service is also called the "Medicaid Waiver," or, "The Waiver", and sometimes, "MI Choice". It is a Medicaid program administered through the Michigan Department of Community Health (MDCH) and the Office of Services to the Aging (OSA).

To get Medicaid Home and Community Based Waiver you must:

• Be at least 18 years of age,
• Need nursing home level care,
• Meet the financial asset limits of the Michigan Medicaid nursing home program,

to people living in a nursing home,

• Meet more restrictive income limits than the Medicaid nursing home program (or

protections for a spouse available to people living in a nursing home.

Waiver Services are available in every county in Michigan. In fact, most areas of the state have more than one

waiver site or agent. A list of the Waiver sites or agents for your area is attached to this fact sheet.

Michigan has made a commitment to have the Medicaid Home and Community Based Waiver Services program available statewide for all those who qualify. No one should be denied Waiver services because of any lack of "openings" or "slots" in their community. No waiting lists are to be used by Waiver agents or their providers. Feel free to contact your waiver agent or site and your local CBC office to discuss any problems with waiver services or how you believe it can be improved.

First, becoming a Waiver recipient does NOT mean you have to give up other Medicaid services, Medicare benefits, and especially, family care giving. Indeed, Waiver agents are required to use and maximize all other resources before Waiver services are used.

Services paid for under the Waiver include:

Each of these Waiver services must be "medically justified" as needed to keep you out of a nursing home, as well as needed on a "continual basis".

No. Spousal impoverishment protection of incomes and assets given to community spouses of nursing home residents in Michigan belong to the spouses of Waiver clients. Generally, your spouse will be able to keep all of their monthly income and a substantial portion of your income. Your spouse will also be able to keep at least the first $18,000 of your countable assets or half of your countable assets, whichever is greater.

Medicaid eligibility requirements are complicated. CBC has a separate booklet explaining Medicaid eligibility requirements for a married couple. Please call your local CBC office for a copy of that booklet. Also, call the Legal Hotline for Older Michiganians (1-800-347-5297) to talk with an attorney about Medicaid and whether you might need a Miller Trust.

Waiver agents are to provide detailed information to you about the financial eligibility standards of Medicaid and help you with the application. Be sure to ask for the full protections of spousal impoverishment from the Waiver agent and the local Family Independence Agency (FIA) that processes your Medicaid application.

First, a telephone "screening" is conducted by the Waiver site’s employees to assess your need for waiver services. You will be asked about 20 questions about your abilities to care for yourself or the help you need.

If you do not pass this initial screening, you will be referred to other agencies or to another department within the Waiver site for help. You have the right to appeal this first denial of Medicaid Waiver services. Make sure to ask the Waiver agent for a written explanation of why you did not pass this telephone screening and your right to a hearing. Feel free to contact your local CBC office for help if you do not pass the telephone screen.

The Waiver Program represents a new and exciting opportunity for Michigan’s long term care consumers to consider new choices in long term care services. However, you might face problems with this health care program similar to others you may have faced.

For example, if the home health aide that is to help your does not show up at your home, you should immediately contact the aide’s employer and the care manager at the Waiver site. Both organizations need to provide you with dependable, well-trained in-home caregivers.

If the care manager refuses to supply any waiver service that you believe is needed, take extra time to talk with the care manager about why you need the service and why the manager says that it is not available or needed.

You must get a written explanation of any decision to reduce, end, or deny services along with an explanation of your tight to a hearing to challenge the waiver side’s decision. If the plan is to end or reduce a current service, you must receive a written notice 10 days before the service is to be ended or reduced. If you request a hearing within the 10 days, the services will continue until the hearing. You have 90 days to request the hearing and CBC’s local office can help you if needed.

Problems of theft or assault should be reported immediately to the county Family Independence Agency (FIA), the Adult Protective Services (APS) and local law enforcement agencies. Anyone may telephone a statewide APS abuse hotline at 1-800-966-6228 to report abuse, neglect, and financial exploitation of vulnerable adults.

Contact your Area Agency on Aging (AAA) or your local Center for Independent Living (CIL). For complete information on your AAA’s CIL’s long term care facilities, assisted living, and other care options, contact your local CBC office.

Also, consider talking with your state senator and state representative about more services for elders and the disabled who want to live independently and need more long term care options.

Rev: 9/99, 03/00, 03/04

Southeastern Michigan Area Main Office ~ 800.833.9548	Lansing/Jackson Area 517.347.7398	Saginaw/Flint Area 800.284.0046
Traverse City Area 231.947.2504	Grand Rapids Area 800.782.2918