The MI Choice Waiver Program in Michigan offers vital support for seniors and individuals with disabilities, enabling them to receive necessary care within their communities rather than in nursing homes. For those considering adult foster care as a living arrangement, understanding how the MI Choice Waiver integrates with adult foster care homes is crucial. This guide provides a comprehensive overview of the MI Choice Waiver, its benefits, eligibility requirements, and how it facilitates access to adult foster care services.
Understanding the MI Choice Waiver: A Pathway to Community-Based Care
Michigan’s MI Choice Waiver program is a Home and Community-Based Services (HCBS) Medicaid Waiver designed to support elderly and disabled residents who are at risk of nursing home placement. The core mission of the program is to empower individuals to live as independently as possible by providing access to long-term services and supports tailored to their unique needs. These services are delivered through a network of “Waiver Agencies,” many of which are Area Agencies on Aging (AAAs), operating across different regions of the state. These agencies function as Prepaid Ambulatory Health Plans (PAHPs), managing a network of care providers who deliver the approved services.
Participants in the MI Choice Waiver program benefit from a personalized care plan that outlines the specific services and supports they will receive. These benefits are diverse and designed to cover various aspects of daily living and care needs. They can include home modifications to enhance accessibility, adult day care for social and therapeutic engagement, meal delivery to ensure proper nutrition, Personal Emergency Response Systems (PERS) for immediate assistance in emergencies, personal care assistance for activities of daily living, and skilled nursing services when medically necessary. Importantly, the MI Choice Waiver allows participants to reside in various settings, including their own homes, the homes of family members, adult foster care homes, or homes for the aged (assisted living facilities).
One of the distinguishing features of the MI Choice Waiver is its flexibility in provider selection. The program offers a self-determination option, allowing beneficiaries to have greater control over who provides certain services, particularly homemaker services and personal care. Instead of being limited to the Waiver Agency’s network of licensed providers, participants can choose to hire their own caregivers. This option extends to relatives, including adult children or spouses, who can be compensated for their caregiving. To manage the administrative and financial complexities of this self-directed care model, a financial management services agency is involved to handle responsibilities such as background checks, tax withholding, and caregiver payments.
It is essential to note that the MI Choice Waiver is not an entitlement program. Enrollment is limited, and when the program reaches its capacity, eligible individuals may be placed on a waitlist. This waitlist underscores the importance of understanding alternative options and planning ahead.
Wait List Considerations: Given the potential for waitlists, it is prudent to explore alternative Medicaid programs that might offer more immediate care solutions outside of nursing homes. Consulting with a Medicaid Planning Professional can provide valuable insights into these alternatives and help navigate the complexities of long-term care planning.
The MI Choice Waiver, formerly known as the Home and Community Based Services for the Elderly and Disabled Waiver Program (HCBS/ED), operates under the framework of a 1915(c) Medicaid Waiver, complemented by a 1915(b) Medicaid Waiver. This structure enables the delivery of services and supports through Prepaid Ambulatory Health Plans (Waiver Agencies), ensuring coordinated and managed care for participants.
Advantages of the MI Choice Waiver Program
The MI Choice Medicaid Waiver offers a comprehensive suite of benefits tailored to support individuals in community-based settings. The specific services a participant receives are determined by an individualized care plan, ensuring that support is aligned with their unique needs. Notably, some benefits are participant-directed, empowering beneficiaries to choose their own providers for certain services.
Here’s a detailed list of the benefits available through the MI Choice Waiver:
- Adult Day Health Care: Provides supervised care in a community group setting for a minimum of 4 hours per day. Transportation between home and the facility may be included.
- Assistive Technology: Access to devices and equipment that enhance independence and functionality.
- Case Management (Supports Coordination): Ongoing support and coordination of services to ensure holistic care.
- Chore Services: Assistance with tasks such as lawn mowing, snow removal, and window washing to maintain a safe and accessible home environment.
- Community Health Worker: Guidance and support in accessing community resources and supports.
- Community Living Supports: Hands-on assistance with daily living activities, including bathing, personal hygiene, eating, meal preparation, essential shopping, non-emergency transportation, housecleaning, and specialized dementia care.
- Counseling Services: Access to professional counseling for mental and emotional well-being.
- Financial Management Services / Fiscal Intermediary: Support for individuals who self-direct their care, managing financial aspects of employing caregivers.
- Goods and Services: Coverage for services and supports that are essential but not otherwise available through traditional program benefits.
- Home Meal Delivery: Provision of one to two meals per day, including meal delivery kits and grocery delivery service fees, ensuring nutritional needs are met.
- Home Modifications (Environmental Accessibility Adaptations): Alterations to the home to improve accessibility, such as widening doorways, installing ramps and grab bars, and modifying bathrooms for wheelchair access.
- Independent Living Skills Training: Education and training to enhance skills necessary for independent living.
- Nursing Services: Intermittent skilled nursing care provided in the community.
- Personal Emergency Response System (PERS): Installation and monitoring of a system that allows for immediate help in case of emergencies.
- Private Duty Nursing / Respiratory Care: More intensive nursing care for individuals with complex medical needs.
- Residential Services: Personal care, homemaker services, chore services, and meal preparation specifically within homes for the aged and adult foster care homes. It’s important to reiterate that while MI Choice covers these support services within these residential settings, it does not cover the cost of room and board in adult foster care or homes for the aged.
- Respite Care: Short-term care provided in-home or out-of-home to offer temporary relief to primary caregivers.
- Specialized Medical Equipment / Supplies: Access to necessary medical equipment and supplies beyond standard coverage.
- Supports Brokerage: Assistance and guidance for individuals who choose to self-direct their care and manage their own services.
- Transportation: Non-emergency medical and non-medical transportation to access services and appointments.
MI Choice Waiver Eligibility Criteria: Is Adult Foster Care Support Accessible to You?
To qualify for the MI Choice Waiver and access support within adult foster care, applicants must meet specific eligibility requirements. These criteria encompass residency, age or disability status, risk of nursing home placement, and financial and medical needs.
The American Council on Aging provides a helpful Medicaid Eligibility Test for Michigan seniors which can offer an initial assessment of potential eligibility.
General Eligibility:
- Residency: Applicants must be residents of Michigan.
- Age or Disability: Must be age 65 or older, or age 18 or older and disabled.
- Nursing Home Risk: Applicants must demonstrate a need for care at a Nursing Facility Level of Care and be at risk of institutionalization in a nursing home if community-based services are not provided.
Detailed Eligibility Criteria:
Financial Eligibility: Income, Assets, and Homeownership Considerations
Income Limits: In 2025, the monthly income limit for MI Choice Waiver applicants is capped at 300% of the Federal Benefit Rate (FBR), which translates to $2,901 per month. This income limit applies equally to single and married applicants. If both spouses are applying, each is assessed individually and can have income up to $2,901 per month. For married couples with only one applicant, the income of the non-applicant spouse is not considered for the applicant’s income eligibility. Furthermore, a portion of the applicant spouse’s income can be allocated to the non-applicant spouse as a Spousal Income Allowance, also known as the Monthly Maintenance Needs Allowance (MMMNA), to ensure the non-applicant spouse has sufficient financial support.
Michigan has established a minimum Spousal Income Allowance of $2,555 per month (effective July 2024 – June 2025), allowing the applicant spouse to supplement the non-applicant spouse’s income up to this level. The maximum Spousal Income Allowance in 2025 is $3,948 per month, potentially allowing for a higher allowance based on the non-applicant spouse’s shelter and utility costs, but never exceeding the $3,948 monthly cap.
Important Note: Michigan Medicaid also offers the MI Health Link HCBS program for individuals who are “dual eligible” (eligible for both Medicaid and Medicare), providing another avenue for Home and Community Based Services.
Asset Limits: In 2025, the asset limit for a single MI Choice Waiver applicant is $9,660. For married couples where both are applicants, each spouse is allowed up to $9,660 in assets. When only one spouse applies, Medicaid considers the assets jointly owned. In this scenario, the applicant spouse can retain up to $9,660 in assets, while the non-applicant spouse is protected by the Community Spouse Resource Allowance (CSRA).
The CSRA allows the non-applicant spouse to retain 50% of the couple’s countable assets, up to a maximum of $157,920. If the non-applicant spouse’s share of assets is below $31,584, they are permitted to keep 100% of the assets, up to $31,584.
Certain assets are considered non-countable and are exempt from Medicaid’s asset limit. These typically include the applicant’s primary residence, household furnishings, personal effects, and a vehicle.
Look-Back Period: It is crucial to be aware of Medicaid’s Look-Back Rule, which scrutinizes asset transfers made within 60 months of applying for long-term care Medicaid. Gifting assets or selling them below fair market value during this period can lead to a Penalty Period of Medicaid ineligibility.
To assess potential asset levels relative to Michigan Medicaid’s limits, the Spend Down Calculator can be a valuable tool.
Home Ownership and Medicaid: For many, the home is a significant asset, and concerns about Medicaid taking the home are common. Michigan Medicaid provides exemptions for the home in specific situations:
- Applicant’s Residence: If the applicant lives in the home or intends to return home (with “Intent to Return”), and their home equity interest is $730,000 or less in 2025. Home equity is the home’s current market value minus any outstanding debts. Equity interest refers to the applicant’s ownership portion of the home’s equity.
- Spouse in the Home: If the applicant has a spouse residing in the home.
- Dependent Children: If the applicant has a child who is blind, disabled (of any age), or under 21 years old living in the home.
While the home may be exempt during Medicaid benefit receipt, it might still be subject to Medicaid Estate Recovery after the beneficiary’s death. Understanding the potential implications of Medicaid taking the home is an important aspect of long-term care planning.
Medical Need: Functional Requirements for MI Choice Waiver
Meeting the medical eligibility criteria for the MI Choice Waiver necessitates demonstrating a Nursing Facility Level of Care (NFLOC). Michigan utilizes an online tool, the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD), to assess this requirement. This assessment is conducted in person by a representative from the local MI Choice Waiver Agency.
The LOCD evaluates several functional areas, including:
- Activities of Daily Living (ADLs): Ability to perform essential self-care tasks such as transferring, mobility, eating, and toileting.
- Cognitive Abilities: Assessment of cognitive functions like daily decision-making, short-term memory, and communication skills.
- Behavioral Issues: Evaluation of potential behavioral difficulties such as wandering, resisting care, or inappropriate behavior.
In addition to demonstrating NFLOC, applicants must also require supports coordination and at least one other waiver service to qualify for the MI Choice Waiver. While conditions like Alzheimer’s disease and related dementias often lead to meeting the functional criteria, a dementia diagnosis alone does not automatically guarantee NFLOC.
For further information on Michigan Medicaid long-term care eligibility, resources are available at Michigan Medicaid long-term care.
Strategies for Qualifying When Income or Assets Exceed Limits
Exceeding Medicaid’s income or asset limits does not automatically disqualify an individual from MI Choice Waiver eligibility. Various Medicaid planning strategies can help individuals who might otherwise be ineligible to qualify for the program. These strategies range in complexity, from straightforward to highly intricate.
While Michigan has a Spend-down Program that allows applicants to use excess income for medical expenses to meet income limits, this option is not available for the MI Choice Waiver Program.
For individuals with assets above the allowable limits, several options exist to reconfigure assets in Medicaid-compliant ways. While many states permit Irrevocable Funeral Trusts (IFTs), Michigan allows Irrevocable Prepaid Funeral Contracts. These contracts involve pre-selecting and pre-paying for funeral and burial goods and services, effectively sheltering these funds from countable assets. Another strategy involves utilizing Medicaid-Compliant Annuities, which convert countable assets into an income stream. Numerous other Medicaid planning techniques can be employed to address asset overages.
Improperly executed Medicaid planning can lead to application denials or delays in benefit receipt. Consulting with professional Medicaid Planners is highly recommended. These experts possess in-depth knowledge of Michigan’s Medicaid rules and planning strategies to help individuals meet financial eligibility requirements while safeguarding assets. Furthermore, advanced planning strategies can both achieve Medicaid eligibility and protect assets for future inheritance, although these often involve Medicaid’s 60-month Look-Back Rule and should be implemented well in advance of needing long-term care. However, Medicaid planners are familiar with potential workarounds and strategies even in less ideal timeframes. To find qualified assistance, you can Find a Certified Medicaid Planner.
Applying for the MI Choice Waiver: Steps to Access Adult Foster Care Support
Pre-Application Steps
Before applying for the MI Choice Medicaid Waiver, it is essential to confirm that you meet the basic eligibility criteria. Applying without meeting the income and/or asset limits will result in denial. Utilizing the American Council on Aging’s Medicaid Eligibility Test can provide a preliminary assessment.
Gathering necessary documentation is a crucial pre-application step. This typically includes:
- Copies of Social Security cards
- Medicare cards
- Life insurance policies
- Property deeds
- Pre-need burial contracts
- Bank statements for the 60 months preceding the application
- Proof of income
Incomplete documentation or delays in submission are common causes of application processing delays.
Given that the MI Choice Waiver is not an entitlement program and may have waitlists, understanding the potential for wait times is important. The waiver has a cap on participant enrollment, approximately 20,171 per year. Waitlist priority is often given to specific groups, such as individuals currently in nursing homes seeking to return to community living. For applicants not in a priority group, waitlist placement is generally based on the application date. Waitlists are managed at the Waiver Agency level, as each agency has a designated number of participant slots.
The Application Process
To formally apply for the MI Choice Waiver, the first step is to contact the MI Choice Waiver Agency serving your specific geographic area. A map of Waiver Agency regions and contact information is available here. An initial phone interview will be conducted to assess preliminary eligibility and potential waitlist placement.
For more in-depth information about the MI Choice Waiver, you can visit the official MI Choice Waiver program page and the website for your regional MI Choice Waiver Agency.
The MI Choice Waiver program is administered by the Behavioral and Physical Health and Aging Services Administration (BPHASA) within the Michigan Department of Health and Human Services (MDHHS). MDHHS contracts with the various Waiver Agencies to deliver MI Choice benefits across the state.
Approval Timeline and Process
The Medicaid application process, from initial submission to receiving a decision letter, can take up to 3 months or longer. Completing the application and gathering all supporting documentation typically takes several weeks. Applications that are incomplete or lack necessary documentation will experience further delays. While federal regulations mandate Medicaid offices to review and approve or deny applications within 45 days (up to 90 days for disability-based applications), processing times can sometimes exceed these guidelines. Furthermore, even after approval, waitlists can mean additional months of waiting before benefits commence.
Understanding 1915(c) HCBS Medicaid Waivers: Historically, Medicaid primarily covered long-term care within nursing institutions. The introduction of 1915(c) HCBS Medicaid Waivers marked a significant shift, enabling states to offer long-term care services in home and community-based settings. “HCBS” stands for Home and Community Based Services. The overarching goal of HCBS waivers is to prevent or postpone institutionalization by providing care in more integrated settings such as private homes, family member’s homes, assisted living facilities, or adult foster care/adult family living homes. These waivers are often targeted towards specific populations at risk of institutionalization and requiring a Nursing Home Level of Care, such as the elderly, individuals with disabilities, or those with Alzheimer’s disease. It’s important to remember that HCBS waivers are not entitlement programs; meeting eligibility requirements does not guarantee immediate benefit receipt due to program enrollment limitations.
