Waiting lists for the Medicaid MI Choice Home and Community Based Waiver Services continue to grow around the state.  While Tri-county Office on Aging for years consistently had waiting lists of 100 people, it now has 350 people on its waiting list.  In the Detroit area, waiting lists exceed 2,000 individuals.  Although the news is grim for individuals in the community who are not at risk of immediate institutionalization, there is still the opportunity for prompt enrollment in the program for applicants in nursing homes who wish to transition out to the community (including to their own homes, adult foster care, homes for the aged, or unlicensed assisted living facilities) and for individuals still in the community who are at imminent risk for nursing home placement. 

Nursing home transition clients are priority clients for the program and should be assessed and assisted to transition out, with the services of the MI Choice program if they require them, as soon as they express a desire to leave the facility.  The state has consistently increased funding for nursing home transitions and that program has very strong bipartisan support in the legislature and the support of the Administration.    During the last fiscal year, the state transitioned out 900 nursing home residents and it is on track this year to assist an additional 1200 residents to leave their facilities. The Nursing Facility Transition program tries to target individuals who face significant barriers leaving their facilities; last year, one resident transitioned home after 11 years in a nursing home and the oldest transition client was 108! To obtain assistance for a client who wishes to transition out, contact your local waiver agents, centers for independent living, or long term care ombudsman program.

Many clients living in the community will not be able to remain at home while they wait to move up the voluminous MI Choice Waiting List.  These individuals can avoid institutionalization  if they qualify as a priority “nursing home diversion” client.  To do so, they must be eligible for Medicaid long term care benefits (in 2010, the income limit for the MI Choice Program is $2022/month and the asset limits are the same as for those applying for Medicaid nursing home benefits), pass an “Imminent Risk Assessment,” and  be approved as nursing home diversion clients by the Medical Services Administration in MDCH.  Sadly, most clients do not know that they can ask to be assessed for the diversion program but advocates have found both many waiver agents and the Medical Services Administration to be extremely sympathetic and responsive to the needs of applicants who are very likely to face immediate nursing home placement.  Advocates or clients should call their local waiver agents if the client might qualify as a diversion client and ask for an in-person assessment for the diversion program.  The assessment form is available at http://www.michigan.gov/documents/ltc/11_Imminent_Risk_of_Nursing_Facility_Placement_Assessment.._300158_7.pdf.  Instructions to waiver agents regarding how to complete the assessments and request the exceptions for nursing home diversion clients are available at  http://michigan.gov/documents/ltc/Instructions_for_Completing_the_Imminent_Risk_Assessment_T_304223_7.pdf.   MDCH policy regarding priority categories for MI Choice are available in two recent policy bulletins: MSA 09-56 available at http://www.michigan.gov/documents/mdch/MSA-09-56_300383_7.pdf and MSA  09-47 available at http://www.michigan.gov/documents/mdch/MSA-09-47_With_Attachments_290366_7.pdf.