Eligibility Requirements and the Application Process

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Applying for Medicaid Waivers in Michigan requires a bit of legwork, but knowing the requirements upfront can ease the process considerably. While each waiver has specific criteria, there are overarching similarities that apply to all HCBS programs.

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Financial Eligibility

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Generally, Medicaid waivers require the individual to meet financial eligibility standards set by the state. In Michigan, this usually means that the applicant has limited income and assets. For 2024, an individual must typically earn less than $2,829 per month (300% of federal SSI rates) and have assets below $2,000. However, there are exceptions and flexibilities, especially for married couples where one partner remains in the community.

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Michigan allows the use of a Medicaid “Spend Down” process, where individuals with income slightly above the limit can deduct certain medical expenses to meet the requirement. This is particularly important for older individuals who may have higher out-of-pocket caregiving or prescription costs.

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Level of Care Determination

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Beyond financial requirements, waiver applicants must demonstrate a need for a level of care that would typically justify institutional placement—meaning they must have medical, developmental, or behavioral needs significant enough to warrant constant or substantial support.

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For example, someone applying for the MI Choice Waiver must be deemed in need of nursing facility level care by a professional assessment conducted by a caseworker or nurse from the Area Agency on Aging. For children’s or behavioral health waivers, an assessment from a psychologist or licensed clinical social worker may be required.

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Application Steps

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The process typically includes the following steps:

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1. Contact the Correct Agency: Each waiver has a different point of entry. For MI Choice, it’s your local Area Agency on Aging. For Children’s Waiver or Habilitation Supports, you’ll likely start with your local Community Mental Health Services Program (CMHSP).

1. Schedule a Needs Assessment: This clinical evaluation determines the applicant’s level of care needs, functional abilities, and daily living limitations.

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1. Complete Financial Review: You’ll fill out state Medicaid forms and submit documentation such as income verification, bank statements, and medical expenses.

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1. Wait for Determination: If accepted, you’ll be assigned a case manager who will help draft a Person-Centered Plan—a customized service blueprint based on your loved one’s personal needs and preferences.

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It’s worth noting that Michigan has waiting lists for some waiver programs, particularly the Children’s Waiver. Therefore, starting early and staying in regular contact with your case manager is critical.

Services Covered Under Michigan HCBS Waivers

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Once enrolled in a Michigan Medicaid Waiver program, families gain access to a suite of services tailored to meet daily care and long-term health needs. These services go beyond what is typically offered through standard health coverage—in many cases, they are designed with the family caregiver in mind as well.

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Personal and Home Care Assistance

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This includes help with activities of daily living (ADLs) such as bathing, eating, dressing, and medication management. Trained aides or nurses can come to the home on a regular schedule, providing both care for the individual and relief for family caregivers.

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Respite Care

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Caregiving can be exhausting, both physically and emotionally. Michigan HCBS programs understand this and offer respite services—temporary care provided so the primary caregiver can rest, run errands, or attend to personal matters. Some waivers allow for overnight respite placements or day programs where individuals can socialize and receive supervision.

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Home Modifications and Equipment

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From wheelchair ramps to bathroom safety rails, waivers can fund alterations to make a home safer and more accessible. Additionally, waivers may cover the cost of durable medical equipment like hospital beds, oxygen machines, or mobility devices.

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Transportation Services

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Missed medical appointments can quickly spiral into bigger health issues. For individuals who cannot transport themselves, waivers provide non-emergency medical transportation to and from doctor visits, therapy sessions, or even adult day care centers.

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Community Integration Activities

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Some waiver programs include therapeutic and recreational services intended to encourage social engagement and community participation. For people with developmental disabilities, for example, this might mean supervised outings or classes aimed at building independent living skills.

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Case Management and Care Coordination

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Once enrolled, families don’t have to navigate everything alone. Each participant is assigned a case manager or service coordinator—a professional who ensures the individual is getting the intended services and that those services are adapted as needs change. These professionals often become trusted partners to families.

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The availability and extent of these services can vary by county and by program, so it’s important to review individual waiver guidelines. Still, the spectrum of support can significantly improve the ability to keep a loved one safely at home—and may prevent costly or traumatic institutional placements.