Medicaid provides assistance with health care costs to people all over the country. This includes the cost of long-term care for people who, due to age, chronic illness, or disability, need help with daily activities. The Michigan Department of Health & Human Services (MDHHS) administers Medicaid in this state in conjunction with the federal government. Qualifying for long-term Medicaid assistance requires meeting a series of eligibility criteria. Before one dives into those calculations, however, it is worth examining what sorts of services are available with the assistance of the state long-term Medicaid program.
Individuals who meet the income and asset limits for Medicaid eligibility may be able to qualify for Medicaid coverage for services that assist them with activities of daily living (ADLs) over a lengthy period of time. Nursing homes provide this kind of service, but Michigan offers other options as well. Normally, Medicare only covers brief rehabilitation stays after discharge from the hospital. Medicaid coverage for long-term care does not have such a short time limit.
Medicaid coverage in Michigan is available to individuals who, in addition to meeting the financial eligibility criteria, are at least sixty-five years old, have a disability, or are blind. Long-term care coverage requires proof that a longer stay in a nursing home or other facility is “medically necessary.” This could be due to numerous chronic illnesses or conditions, or just the results of aging.
Staff members at a long-term care facility can assess medical necessity by making a level of care determination. In this process, they will evaluate how much assistance an individual needs in ADLs like eating, dressing, sitting and standing, moving between other locations, and toilet use. Michigan’s system has five levels, based on observations over a seven-day period:
Several types of facilities offer long-term care for individuals through the Medicaid program.
Michigan’s Public Health Code defines a nursing home as a “nursing care facility...that provides organized nursing care and medical treatment to 7 or more unrelated individuals suffering or recovering from illness, injury, or infirmity.” Nursing homes provide ongoing care, including medical care and assistance with ADLs, to individuals who require close attention and support do to age, illness, or injury. They are licensed by the Michigan Department of Licensing and Regulatory Affairs (LARA)
An adult foster care (AFC) home, as defined by LARA, “provides personal care, supervision and protection” to no more than twenty unrelated adults who require assistance due to age, developmental or physical disability, or mental illness. Services provided by an AFC include assistance with and supervision of ADLs, as well as “protection from physical harm” and other risks.
A home for the aged (HFA) provides “supervised personal care” to a minimum of twenty-one unrelated individuals aged fifty-five or older. If it is operated as part of a facility licensed by LARA as a nursing home, it can have fewer than twenty-one residents. Services include ADL assistance and “supporting a resident’s personal and social needs.”
Facilities that offer services targeted to seniors might not be licensed by the state, but might still be eligible to some extent for long-term Medicaid coverage. The term “assisted living” has no specific legal meaning for state or federal Medicaid purposes. Instead, it serves a marketing purpose.
This type of facility cannot offer medical care, but might offer ADL supervision and assistance for its residents. Since the state has far less direct oversight over these facilities, careful research is critically important. State regulators will step in if they believe a facility is offering services requiring a license. Residents with other complaints may find that their only recourse is in contract law.
Under Michigan’s Medicaid waiver program, known as MI Choice, individuals who need long-term care may be able to use home- or community-based services instead of moving into a residential facility. Services available through MI Choice include:
Elder law attorney Rebecca J. Braun practices in Southeast Michigan with Mobile Legal Services, PLLC. She is available to answer your questions and address your concerns about Medicaid eligibility, estate planning, and other related legal matters. She will travel, free of charge, to clients located in Oakland, Washtenaw, Wayne, Livingston, and Southern Macomb Counties. Please contact us through our website or call us at (734) 407-7657 today to schedule a free and confidential initial assessment.