Michigan Medicaid Waiver Assisted Living

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How Does The Process Work

Medicaid Home and Community-Based Services (HCBS) Waivers in Assisted Living Communities
    • Prescreening: Upon referral, a telephone intake screen is completed. A program referral may be made on your behalf, or you may take a self-referral. To obtain MI Choice Waiver program information call: 722-2830.
    • Assessments: To determine eligibility, an assessment is completed by a Registered Nurse and Social Worker in the home. With eligibility, a person-centered plan is created to address individual needs.
    • Supports Coordination: A Supports Coordinator will arrange services and supports for MI Choice Waiver Participants.
    • In-Home Services: Service needs are identified through person-centered planning.
    • Re-assessment: Ongoing assessments are completed to ensure individual needs and program guidelines are met.
    • If you enroll in MI Choice, you cannot also use nursing home services, Home Help, PACE, MI Health Link, or Habitation Supports Waiver services at the same time. You may only choose ONE of these at a time.

Appeal To The Michigan Administrative Hearing System For The Department Of Health And Human Services

The third kind of challenge is an appeal to the Michigan Administrative Hearing System for the Department of Health and Human Services . You can appeal a decision of medical ineligibility regardless of whether you had an Exception or Immediate Review.

When you are found medically ineligible for Medicaid-funded nursing home care or MI Choice, you will be issued an action notice. If you are not currently getting Medicaid-funded nursing home care or MI Choice services but are applying for one of them and you are found ineligible, you will receive an Adequate Action Notice. If you are currently getting Medicaid-funded nursing home care or MI Choice services but are found no longer medically eligible, you will receive an Advance Action Notice. These notices need to explain the procedure for requesting a hearing to appeal the decision that you are medically ineligible.

If the ALJ ultimately decides that you are medically ineligible for nursing home care or MI Choice and you think that your needs or circumstances have changed since the nursing home or waiver agency last assessed you and decided you didnt qualify, you can ask the nursing home or waiver agency to reassess you to see if you now pass the LOCD.

You can read more about appeals under How Do Appeals to the Michigan Administrative Hearing System for the Department of Community Health Work? below.

Get Assistance For Your Family

The community living supports vary and can include the following based on eligibility:

  • Home Delivered Meals
  • Personal Emergency Response System
  • Private Duty Nursing

Help in your own home.

Nursing homes used to be the only choice for older or disabled persons who needed help caring for themselves. Today, there may be the choice to stay in your home or a community setting, but you or a family member may need assistance in doing so.

How we can help you

The MI Choice Medicaid Waiver Program is a comprehensive, community-based program designed for Medicaid-eligible adults who need nursing home level of care. The goal of the Medicaid Waiver program is to offer alternatives to nursing home care.

Services you may qualify for:

Nursing Services Adult Day Health Home Modifications Community Health Worker

Do I Qualify?

The MI Choice Medicaid Waiver Program is available to older adults and persons with disabilities in Michigan. The Information Centers coverage area for the program is southern and western Wayne County if you live elsewhere in the state, we can connect you with your area Ml-Choice Medicaid Waiver provider.

Whats Next?

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Memory Care In Michigan

Michigan is facing an increased public health risk, with a projected 22.2% rise in Alzheimers disease diagnoses expected by 2025. Currently, the state Medicaid program spends an estimated $1.3 billion each year, with 586 million hours of unpaid care thats been donated by friends and family of someone with Alzheimers. This disease impacts 518,000 family caregivers each year, according to the Alzheimers Association. With 3,771 annual deaths from Alzheimers in Michigan, it is the 6th leading cause of death in the state.

Similar to assisted living, memory care facilities provide a safe and stable residential environment for seniors with Alzheimers disease and dementia. These individuals can participate in activities and specialized programs for those with memory afflictions. In Michigan, memory care units are often found in larger homes for the aged, serving at least 20 residents at a time. Every unit that advertises memory care must provide documents that describe the level of care provided and how it is tailored to meet the needs of residents with dementia. Some examples of dementia-specific care might include: additional security to prevent wandering, multisensory therapy, brain fitness classes and physical fitness sessions modified for memory care residents.

Keep reading for more information about memory care in Michigan, including a general look at care costs, financial assistance programs, free senior resources and regulations governing homes for the aged.

Michigan’s Resource Limit For Medicaid

Recently, the Michigan State Senate proposed a cut to the MI Choice ...

To qualify for Medicaid in Michigan, you must have no more than $2,000 in resources. Resources are assets like money and property. Some property does not count toward the resource limit. In Michigan, one car is exempt, and household goods are exempt. Your primary residence and any attached acreage is an exempt resource. However, if you need Medicaid for long-term care, then you cannot have more than $585,000 in equity in your home in 2019. Retirement accounts are counted as assets to the extent you can withdraw money from them.

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Assisted Living Facilities In Michigan

If you are enrolled in Medicaid or MI Choice , your regular benefits will cover some of your expenses while you live in an assisted living facility, like physical therapy or prescription costs. However, Michigan does not have a Medicaid program that will pay for room and board in an assisted living facility.

A Definition Of Medicaid Waivers

A Medicaid waiver is a provision in Medicaid law which allows the federal government to waive rules that usually apply to the Medicaid program. The intention is to allow individual states to accomplish certain goals, such as reducing costs, expanding coverage, or improving care for certain target groups such as the elderly or women who are pregnant.

Thanks to these waivers, states can provide services to their residents that wouldnt usually be covered by Medicaid. For instance, in-home care for people who would otherwise have to go into long-term institutional care.

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I What You Should Expect To Pay For Home Care In Arkansas

Per Genworths 2021 Cost of Care Survey, in-home care costs an average of $4,185 per month. This typically covers assistance with daily activities and personal care provided by an aide. You can expect to pay $4,195 per month for home health care, which includes clinical or rehabilitative care provided by a nurse, therapist or other licensed health care professional.

Other Facts About Mi Choice:

Assisted living residents forced to move
  • You can get MI Choice in your own home, the home of a loved one, or in a licensed or unlicensed assisted living community that works with the AAA 1-B.
  • A relative may be designated as a primary caregiver and be reimbursed for providing care. Spouses are excluded.
  • After a person or their loved one calls AAA 1-B at 800-852-7795, a screening and telephone assessment will be completed .

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Assisted Living In Michigan

We have gathered data for over 20,000 assisted living communities serving seniors across the U.S., and over 750 statewide. Our research indicated that a resident in an assisted living community in Michigan will pay $3,850 per month on average.

According to the United States Census Bureau, the population of the elderly living in Michigan is growing. One of the reasons why seniors are choosing to retire in the state may be because there is no sales tax on social security retirement, U.S. military pensions, Michigan National Guard pensions, or railroad pensions.

Medicaid Programs & Waivers

Background Information

Medicaid is a health insurance program, though the benefits it offers go well beyond those of typical health insurance. Michigan has several different Medicaid programs. But for the purposes of this article, we are focused on Long Term Care Medicaid and the associated waivers, as these are most relevant to the elderly.

Originally intended to cover low-income seniors who required nursing home care, or limited personal care, Long Term Care Medicaid has now expanded to offer other programs that provide assistance outside of the nursing home environment.

Home Help, MI Choice, and Health Link

While not a Medicaid waiver, the Michigan Home Help Program, which is part of Michigans state Medicaid plan, provides personal care assistance in ones home. The goal is to prevent or delay nursing home placement of elderly Michigan residents by providing assistance with bathing, dressing, eating, housecleaning, laundry, and shopping for essentials. This program allows for self-direction of services, including the hiring of certain family members.

The state of Michigan currently offers one Medicaid waiver that is relevant to seniors. . Unlike the state Medicaid program, the waiver is not an entitlement program. This means that there are a limited number of people who can receive services under this program. Therefore, if all of the enrollment slots are filled, there may be a waiting list.

Michigan Medicaid Eligibility

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Medicare: Skilled Nursing Facility Care And Home Health Services

Your nursing home will give you a notice called a Skilled Nursing Facility Advance Beneficiary Notice if it thinks Medicare may not cover your care or stay because it isnt reasonable or necessary or is considered custodial care.

Your home health agency will give you a notice called a Home Health Advance Beneficiary Notice if the home health agency reduces or stops providing any of your home health services for business-related reasons or because your doctor changed your orders, or if the agency plans to give you a service or supply that Medicare probably wont pay for. The Notice will explain what service or supply is going to be reduced or stopped. The Notice will also tell you what you can do if you want to keep getting it.

You have the right to have your nursing home or home health agency send your claim to Medicare so Medicare will make a decision about payment. You can also keep getting the services, but you may have to pay the nursing home or home health agency for them.

When your nursing home care or all of your covered home health services are ending, your nursing home or home health agency will give you a written notice called the Notice of Medicare Provider Non-Coverage at least 2 days before your services end. This Notice tells you the date your services will end, how to ask for a fast appeal, and your right to get a detailed notice about why your services are ending.

Home Health Care And Assisted Living

Medicaid Waiver: MI Choice Presentation
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    What Is The Mi Choice Medicaid Waiver

    The MI Choice Medicaid Waiver is a program funded through the Michigan Department of Health & Human Services to provide in-home and community-based services to frail, elderly or physically disabled adults who would otherwise require nursing home care. For those who would prefer to stay in their own home, the MI Choice Waiver staff will help explain their long-term options and arrange for the healthcare services they need. Services are funded through MDHHS and provided at no charge to participants meeting the programs medical and financial guidelines.

    Can You Tell Me About The Home Help Program In A Nutshell

    The Home Help program provides unskilled personal care services to help people who have certain limitations to function as independently as possible.

    The Home Help program is run by the Michigan Department of Health and Human Services . If you are interested in and/or enrolled in Home Help, you will be working with a DHHS employee called an adult services specialist.

    To be eligible for Home Help, you must:

    • Be eligible for Medicaid

    • Have a certification of medical need for personal care services from a Medicaid-enrolled doctor, nurse practitioner, or therapist

    • Need at least some direct assistance with one or more of the following things:

    • Eating

    • Mobility

  • Have an appropriate level of care status

  • You are not eligible for Home Help services if you have a spouse who is able and available to provide the services. Your spouse is considered unable if he or she has his or her own disabilities that prevent him or her from caring for you. Your spouse is considered unavailable if he or she is away from your home for an extended period because of something like work or school.

    YourDHHS adult services specialist will come meet with you in your home to assess whether and how much help you need with the things listed above.

    Home Help can help you with the following things:

    • Eating
    • Light housework
    • Shopping and errands

    There are some things Home Help cannot help you with, including:

    • Transportation

    • Home-delivered meals

    • Adult day care

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    Choice Veterans Direct Home & Community Based Care Program

    The is a collaborative partnership between local Area Agencys on Aging, the Veterans Health Administration, and the U.S. Department of Veterans Affairs. The program provides services to veterans to help them remain in their home or the home of a loved one, with the support of paid caregivers and purchased services such as chore services, respite care and personal care.

    Working with a Veterans Health Administration social worker and a support coordinator from CareWell Services, veterans develop a plan to meet their care needs. Examples of services that may be available include:

    • Homemaker and personal care
    • Shopping, transportation, and errands provided by a paid caregiver
    • Personal Emergency Response System
    • Chore services
    • Home delivered meals
    • Caregiver support and training

    What About Assisted Living Medicaid Or In

    The MI Choice Waiver program

    Assisted living or in-home Medicaid in Florida is very difficult to access. If the applicants assets are less than the income and asset limit, this does not mean the applicant will get Medicaid to help pay for assisted living. There is a long waitlist to get Medicaid for assisted living care and we have no way of telling when or if the elder will come off the wait list. We have more on assisted living Medicaid and bypassing the assisted living waitlist here.

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    Area Agencies On Aging

    Area Agencies on Aging is a network of hundreds of nonprofit organizations across America that provide federally funded services to adults over 60 in their local areas.

    Michigan has many Area Agencies on Aging that offer comprehensive information on various kinds of programs and community supports for seniors.

    Area Agency On Aging

    Homes For The Aged Adult Foster Care Homes And Unlicensed Assisted Living Facilities

    For information about homes for the aged and adult foster care homes in Michigan, see the following resource:

    Adult Foster Care and Homes for the Aged. Michigan Department of Licensing and Regulatory Affairs, Adult Foster Care and Homes for the Aged Licensing Division.

    For information about evaluating and choosing a home for the aged, adult foster care home, or unlicensed assisted living facility, see the following resources:

    For information about addressing problems in a home for the aged, adult foster care home, or unlicensed assisted living facility, see the following resources:

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    Choice Nursing Home Transition Self

    CareWell Services Nursing Facility Transition coordinator specializes in helping persons currently in nursing homes, who wish to leave the nursing home and transition back into living in a less restrictive home, apartment, or adult foster care environment. The NFT coordinator helps you understand and organize your options for everything you need for transitioning out of the nursing facility: housing, , durable medical equipment like hospital beds, shower seats, and home safety support, plus care management planning for nursing, homecare services and community services like transportation and senior nutrition.

    Memory Care Costs In Nearby States

    PPT

    Memory care in Michigan is fairly affordable, according to Genworth Financials Cost of Care Survey for 2019. At an average of $5,000 per month, it is $64 less than the national average. Neighboring states are all a bit more expensive than Michigan, with Wisconsin at the top of the price range at $5,438 per month $438 more than Michigan. Indiana is Michigans most affordable neighbor at an average cost of $5,125 while Illinois is not far behind at $5,213. Ohio is up there with Wisconsin, being $424 more expensive than Michigan.

    Ohio

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