Michigan Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Michigan Medicaid Long Term Care, which is different from regular Medicaid. In Michigan, Medicaid is sometimes called Medical Assistance. Medicaid will help pay for long-term care for Michigan residents in a nursing home, in their home and in other residential settings through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.

 

Michigan Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Michigan Medicaid will cover the cost of long term care in a nursing home for eligible Michigan residents through its Nursing Home / Institutional Medicaid. This includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with Activities of Daily Living (eating, bathing, moving, dressing, toileting).

Some of the things that Michigan Medicaid won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.

Any Michigan Medicaid beneficiary who receives Nursing Home Medicaid coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $60 / month. This can be spent on personal items such as clothes, snacks, books, haircuts, cell phones, etc. It cannot be spent on any item that Medicaid covers, including hygiene basics like a toothbrush, soap, deodorant, razors and incontinence supplies, unless the Medicaid beneficiary wants a specific brand that is not covered by Michigan Medicaid. In this case, they could spend their personal needs allowance on the item.

 

Home and Community Based Service (HCBS) Waivers

Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help Michigan Medicaid recipients who require a Nursing Facility Level of Care remain living “in the community” instead of moving to a nursing home. Living “in the community” can mean living in their home, the home of a relative, an adult foster care home, or a home for the aged, which is similar to an assisted living residence. Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. This means that even if an applicant is eligible for an HCBS Waiver, they are not guaranteed by law to receive the benefits.

Michigan Medicaid offers two waiver programs relevant to residents requiring long term care.

MI Choice Waiver Program
The MI Choice Waiver Program provides long-term supports and services to qualified elderly (age 65+) Michigan residents who require a Nursing Facility Level of Care but instead live in their home, the home of a relative, an adult foster care home, or a home for the aged, which is similar to an assisted living residence. The MI Choice Waiver Program will provide services in all those settings, but it will not pay for room and board.

Each MI Choice Waiver beneficiary will be evaluated and receive benefits specific to their needs and circumstances. Benefits can include adult day care, home modifications, nursing services, specialized medical equipment, transportation and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are delivered by Michigan’s 20 waiver agencies, which are spread across the state and have a network of care providers. This state website can help you find the waiver agency closes to you. MI Choice Waiver Program participants also have a self-determination option that allows them to choose their own caregivers for some services, like personal care and housekeeping. This includes adult children, adult grandchildren, nieces, nephews and siblings, but not spouses. If the program participant chooses to self-direct, a financial management services agency will be provided to handle the monetary aspects of employing a caregiver, such as withholding taxes and making payments.

Like all HCBS Waivers, the MI Choice Waiver Program is not an entitlement. This means that even if an applicant is eligible, they are not guaranteed to receive the benefits. Instead, there are a limited number of enrollment spots and once those spots are full any additional eligible applicants will be placed on a waiting list. Currently, the MI Choice Waiver Program is approved for a maximum of 17,402 program participants per year.

MI Health Link/MI Health Link HCBS Waiver
MI Health Link is a managed care program for Michigan residents who are eligible for both Medicaid and Medicare (also known as dual eligible) that combines the benefits of both programs into one plan. A portion of this plan is known as the MI Health Link HCBS Waiver and it provides long-term care services and supports to beneficiaries who live at home, in the home of a family member, an adult foster care home or a home for the aged (also known as an assisted living residence), although it will not pay for room and board in any of these settings.

MI Healthy Link/ MI Health Link HCBS Waiver are currently available in 25 counties in Michigan – 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.

MI Health Link delivers its benefits through a single Medicaid plan provided by an Integrated Care Organization (ICO) that has its own network of care providers. Program participants receive all of their medical care (doctor’s visits, lab work, prescription medication, hospitalization, nursing home care, etc.) through this plan. And the plan will provide all of the in-home services for individuals who are also eligible for the MI Health Link HCBS Waiver. These benefits include adult day care, home modifications, medical equipment, nursing services, transportation and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Some of these benefits, like the personal care help, can be self-directed, which means the program participant can select their own caregiver. This includes adult children, adult grandchildren, nieces, nephews and siblings, but not spouses. If the program participant chooses to self-direct, a financial management services agency will be provided to handle the monetary aspects of employing a caregiver, such as withholding taxes and making payments.

MI Health Link HCBS Waiver beneficiaries must need a Nursing Facility of of Care. To see if this level of care is required, the state uses the Michigan Medicaid Nursing Facility Level of Care Determination. This also helps the state determine which program benefits each individual will receive.

Like all HCBS Waivers, the MI Health Link HCBS Waiver is not an entitlement. This means that even if an applicant is eligible, they are not guaranteed to receive the benefits. Instead, there are a limited number of enrollment spots and once those spots are full any additional eligible applicants will be placed on a waiting list. Currently, the MI Health Link HCBS Waiver is approved for a maximum of 5,100 program participants per year.

 

Aged Blind and Disabled / Regular Medicaid

Michigan’s Aged Blind and Disabled (ABD) Medicaid, also known as Regular Medicaid, provides healthcare and personal service benefits to low-income Michigan residents who are aged (age 65+) or disabled and live “in the community.” Living “in the community” can mean living in their home, the home of a loved one, an assisted living facility, an adult foster care home or some group homes, such as those for people with mental illness or developmental disabilities. While ABD Medicaid will cover services in all of those settings, it will not cover room and board costs.

ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait. This includes a variety of long-term care benefits such as adult day care, doctor’s visits, skilled nursing care, in-home personal care, prescription assistance and transportation. ABD Medicaid beneficiaries qualify for these benefits and services one at a time, which is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, ABD Medicaid recipients will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

Michigan Medicaid offers two ABD Medicaid programs relevant to residents requiring long term care.

Home Help Program
Michigan Aged Blind and Disabled (ABD) Medicaid beneficiaries who can not perform all of their Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (cooking, cleaning, shopping) can receive help with these activities through the Home Help Program. In order to be eligible for this program, applicants must need hands-on assistance with at least one Activity of Daily Living. Michigan uses an Adult Services Comprehensive Assessment (MDHHS-5534) to make this determination. The need for help can be due to aging, illness or cognitive issues caused by Alzheimer’s Disease or other dementias.

Home Help Program applicants must live at home or in the home of a relative, they can not live in an adult foster care home or an adult care home. Benefits can provided by licensed caregivers, or program participants can self-direct their care and hire family members as caregivers, although spouses can not be hired. If they choose to self-direct, a financial management services agency will be provided to handle the monetary aspects of employing a caregiver, such as withholding taxes and making payments. Benefits include help with Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (cooking, cleaning, shopping).

Program of All-Inclusive Care for the Elderly (PACE)
Elderly (age 65+) Michigan residents who have Aged Blind and Disabled (ABD) Medicaid can coordinate their medical, social service and non-medical personal needs into one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE is intended to help Michigan residents who need a Nursing Facility Level of Care but want to keep residing and receiving care in their home or somewhere else in the community. This program can be used by people who are “dual eligible” for Medicaid and Medicare and will help them coordinate the care from those two programs. The National PACE Association can help locate a PACE program near you.

 

Eligibility Criteria For Michigan Medicaid’s Long Term Care Programs

To be eligible for Michigan Medicaid, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.

 The easiest way to find the most current Michigan Medicaid eligibility criteria for one’s specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

Michigan Medicaid Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Michigan residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2022, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single applicant is $2,523 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Nursing Home Medicaid recipients are only allowed to keep $60 / month of their income as a “personal needs allowance” and must give the state the rest to help offset nursing home costs.

For married applicants with both spouses applying, the 2022 asset limit for Nursing Home Medicaid through Michigan Medicaid is $3,000 combined, and the income limit is $2,523 / month per spouse for a total of $5,046 / month combined. For a married applicant with just one spouse applying, the 2022 asset limit is $2,000 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $2,523 / month for the applicant. The income of the non-applicant spouse is not counted.

Michigan Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Michigan Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Nursing Home Medicaid in Michigan is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. This is determined through a state assessment and reports from the applicant’s doctors and other relevant healthcare professionals.

 

Michigan Home and Community Based Service (HCBS) Waivers Eligibility Criteria

Financial Requirements
Michigan residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2022, the asset limit for HCBS Waivers in Michigan is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single applicant is $2,523 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2022 asset limit for HCBS Waivers in Michigan is $3,000 combined, and the income limit is $2,523 / month per spouse. For a married applicant with just one spouse applying, the 2022 asset limit is $2,000 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $2,523 / month for the applicant. The income of the non-applicant spouse is not counted.

Michigan Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Michigan Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers in Michigan is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. This is determined through a state assessment and reports from the applicant’s doctors and other relevant healthcare professionals.

 

Michigan Aged Blind and Disabled Medicaid Eligibility Criteria

Financial Requirements
Michigan residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid. For a single applicant in 2022, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single applicant is $1,133 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants, the 2022 asset limit for Michigan ABD Medicaid is $3,000 combined between the two applicants/spouses, and the income limit is a combined $1,526 / month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.

Michigan Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Michigan Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional requirements for Michigan Aged Blind and Disabled (ABD) Medicaid are being disabled, blind or aged (65 or over), and needing help with Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Michigan Medicaid will conduct an assessment of ABD Medicaid applicants and their ability to perform Activities of Daily Living to determine the kind of services the beneficiary needs and the state will cover.

 How Michigan Medicaid Counts the Home
One’s home is often their most valuable asset, and if counted toward Michigan’s Medicaid asset limit, it would likely cause them to be over the limit for eligibility. However, in some situations the home is not counted against the asset limit. If the applicant lives in their home and the home equity interest is less than $636,000 (as of 2022), then the home is exempt from the asset limit. Home equity interest is portion of the home’s equity value that the applicant owns, and the home’s equity value is the current value of the home minus any outstanding mortgage / debt against the home. If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives. If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $636,000. These rules apply to all three types of Medicaid.

 

Applying For Michigan Medicaid Long Term Care Programs

The first step in applying for a Michigan Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one wants to apply for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Michigan Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Michigan Medicaid applicant. These documents will be needed for the official Michigan Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Michigan residents can apply for Medicaid by contacting their local Michigan Department of Health & Human Services office. There is currently no online option for applying.

To apply for the MI Choice Waiver, Michigan residents should contact the waiver agency that serves their area of residence. To apply for the MI Health Link HCBS Waiver, individuals should contact their local Michigan Department of Health & Human Services office.

 

Choosing a Michigan Medicaid Nursing Home

After an applicant has been approved for Nursing Home Medicaid through Michigan Medicaid, they need to choose which Medicaid-approved nursing home they will live in. Even though Nursing Home Medicaid is an entitlement, Michigan Medicaid will only cover stays and care in approved nursing homes. Michigan residents can find and compare nursing homes using this Health Care Association of Michigan Facility Finder. They can also use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country. All of the nursing homes on this site are either Medicaid- or Medicare-approved.