Many Clients Eligible for MI Choice Nursing Home Diversion Status Are Being Denied Prompt Access to Services

As noted in previous newsletter articles, the MI Choice home and community based waiver program is supposed to provide prompt assessment and services to nursing home “diversion” clients who are a priority category for services. These individuals are either making an initial request for services or currently on a waiting list for services and are determined to be at imminent risk of nursing home placement. In these cases, waiver agents are supposed to assess the client promptly with the state’s “Imminent Risk Assessment” form. The 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. If clients are medically and financially eligible for MI Choice and either obtain a score of 8 on the Imminent Risk Assessment or obtain an exception to qualify for services, they are supposed to receive waiver services promptly.

Unfortunately, some waiver agents are now refusing to serve diversion clients. For example, one waiver agent has determined that it will no longer be able to accept diversion clients because it says the state does not provide sufficient reimbursement to enable the agency to maintain these clients, who generally have more expensive needs, in the long–term. Another agent explained that staff may not be able to go out to assess clients who seek diversion status for a number of weeks because of staff shortages even though clients who are in urgent need of services may not be able to remain in the community pending the assessment. Moreover, most waiver agents do not publicize that diversion status may be available and do not track individuals on the waiting list or new callers carefully enough to determine when a client is at real risk of institutionalization.

As a result of all of these issues, some clients are being forced to accept nursing home care instead of receiving the services they want and need in the community. MPLP, Michigan Protection and Advocacy Service, and the Olmstead Coalition are now considering whether the failure to serve diversion clients violates the “integration mandate” of the Americans with Disabilities Act and how consumers and advocates can respond to this issue.

Advocates have begun discussions with the Medical Services Administration of the Michigan Department of Community Health regarding how the state can resolve this issue. Advocates have requested that:

1. Waiver agents be required during the initial telephone screen of new applicants for MI Choice to determine whether the applicant is at imminent risk of nursing home placement and to provide diversion services to those who are.
2. Waiver agents be required to monitor individuals on their waiting lists to determine if and when these individuals become at imminent risk of institutional placement and to provide diversion services to those who are.
3. Waiver agents notify all clients when they are placed on the waiting list that they can request diversion status if their circumstances change necessitating nursing home care before the client reaches the top of the waiting list;
4. The Department revise the Imminent Risk Assessment form to better identify individuals in the greatest need for immediate services;
5. The Department compensate waiver agents fairly for diversion clients if these clients do require higher levels of care; and
6. The Department collects data about the nursing home diversion program to establish whether appropriate clients are being assessed and served by waiver programs.

In the meantime, MPLP is eager to hear about consumers’ experience in obtaining diversion services. Please contact Alison Hirschel, hirschel@lsscm.org . Advocates should continue to request diversion services on behalf of appropriate clients. Moreover, advocates should be aware that a substantial number of diversion clients do not obtain the requisite score of 8 on the Imminent Risk Assessment but are approved for services through an exception process at MSA. Thus, advocates can request diversion status even if the client fails the assessment. Finally, if clients are forced to enter nursing homes in the absence of diversion services, they can apply for nursing home transition services immediately and receive assistance with returning home with the supports and services—including MI Choice if appropriate—they need.