It can be hard to watch a loved one age, knowing he or she is no longer able to do what is needed to maintain the family home, or protect his or her own health. But just because a person needs help doesn't mean he or she should be sent to a nursing home or senior living facility. If you make the choice to age in place, will you be forced to pay the cost or will Michigan Medicaid cover in-home care?

In this blog post, I will review the Michigan Medicaid in-home care waiver, MI Choice. I will explain what benefits are available to pay for hospice and other in-home treatments, and what a person must do to qualify.

Aging In Place Using MI Choice Elderly and Disabled Waiver Program

Medicaid is a joint program between the state and federal government. While the federal program establishes a baseline for what will be covered, states are given the flexibility to set eligibility criteria and provide additional benefits. For Michigan residents, that includes the MI Choice Medicaid Waiver program (formerly known as the Home and Community Based Services for the Elderly and Disabled or HCBS/ED). This waiver program gives seniors and disabled individuals the option to remain living at home or in an assisted living or adult foster care facility rather than moving to a fully-staffed nursing home.

Who Is Eligible for MI Choice?

MI Choice is a needs- and means-tested program. This means that to qualify for in-home care services, you or your loved one must:

• Be a Michigan resident
• Be age 65 or more (or 18-64 with a qualifying disability)
• Qualify for nursing home levels of care
• Require at least one service provided by the waiver on an ongoing basis (described below)
• Have limited financial means, including both income and assets

The financial figures to qualify for MI Choice are adjusted every year. For 2018, a single individual must not earn more than $2,250 gross per month, and cannot have more than $2,000 in countable resources. If married couples are applying for MI Choice together, their incomes will be measured separately, but their countable resources will be considered together up to $3,000. "Countable resources" include any assets the couple or individual owns except:

• An owner-occupied home up to $527,000 in value
• Primary vehicles
• Burial plots
• Irrevocable funeral trusts
• Life insurance with no more than a $1,500 face value

If only one half of a couple is applying for MI Choice, the non-applicant spouse may retain up to $123,600 on top of the applicant's $2,000 in countable resources.

Who Directs Care in the MI Choice System?

Qualifying individuals in the MI Choice system can have the state manage their services, or they may choose to self-direct their own care. If the state manages a person's services they may be assigned to licensed home-care professionals. Under the self-directed option, the elderly or disabled person may designate a representative, including a family member or adult child, to direct his or her care. The self-directed option also allows qualified applicants to hire family members to provide care services (although spouses and legal guardians are not generally eligible).

What In-Home Care Services will Michigan Medicaid Cover through MI Choice?

The services a qualifying individual may receive are determined on a case-by-case basis, depending on need. However, they may include:

• Case management
• Adult group day care
• Training services
• Personal care supervision
• Personal care assistance
• Respite care to relieve the primary caregiver
• Short-term private duty nursing
• Transition assistance from nursing home to home care
• Disposal of medical supplies and equipment
• Chore services
• Preparation and delivery of hot meals
• Medical and non-medical transportation
• Personal emergency response systems (PERS)
• Counseling (including family counseling sessions)
• Home and vehicle modifications (such as wheelchair ramps or grab handles)

How to Apply for the MI Choice Waiver Program

The Michigan Department of Community Health's (MDCH) Medical Services Administration (MSA) is in charge of handling all MI Choice waiver applications in the state. The program can have 14,000 participants at any one time. Currently, there is a waiting list of approximately 6-12 months to begin receiving benefits; however, this fluctuates frequently. Individuals requiring more immediate assistance may consider the Michigan Home Help Program instead, or in addition to the MI Choice Wavier.

For higher-asset individuals or families, the financial requirements of the MI Choice Waiver Program can create an additional obstacle to receiving services. If not handled properly, the "spend-down" to qualify for Michigan Medicaid benefits can result in penalties. In those cases, an early meeting with a skilled elder law attorney can help increase your options and protect your assets when you or your loved one prefers to age in place.

Rebecca J. Braun, J.D., is an estate planning and elder law attorney for Mobile Legal Services, PPLC, in Southeast Michigan. She can help with estate planning and trust administration. She will travel to clients, free of charge, in Livingston, Oakland, Washtenaw, Wayne, and Southern Macomb Counties. Contact us for an initial assessment.