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Changes Likely in MiChoice Home and Community Based Waiver Program

MPLP Summer 2007 Elder Law Section Newsletter Article

Issue 34, Summer 2007

Changes Likely in MiChoice Home
and Community Based Waiver Program


A number of changes are likely to occur in the MiChoice Home and Community Based Waiver Program in the next year.  These include:



In four regions of the state, MiChoice recipients can already participate in Self-Determination or “Cash and Counseling”, a program  in which MiChoice recipients are able to hire their own caregivers and manage their own budgets.  In the Self-Determination program, clients are free to hire neighbors, friends, or others and are not limited to certified agency staff.  And while these clients have more control over their individual budget for supports and services, they receive help from a fiscal intermediary to assure financial accountability and help fulfill their responsibilities as employers. The “pioneer sites” are the Upper Peninsula, and the areas served by the Detroit Area Agency on Aging, the Tri-county Office on Aging in Lansing, and Burnham Brook Area Agency on Aging in southwest Michigan.  This program is supposed to be available statewide beginning October 1, 2007 so that all  waiver clients who choose to do so will be able to hire their own staff and have greater control over their waiver budget.


Expansion into Licensed Assisted Living Settings


Currently, waiver services are available only in recipients’ own homes or in unlicensed assisted living settings.  The Department of Community Health Office of Long Term Care Supports and Services is now working with providers and advocates to make the waiver available to residents of homes for the aged (HFAs) and adult foster care facilities (AFCs).  The state has proposed submitting a request to permit this change to the Centers for Medicare & Medicaid Services in October and implementing the change, which CMS is expected to approve, in January, 2008.


Permitting waiver services to supplement the services already provided in these facilities will allow clients to remain in or choose these facilities rather than a nursing home when their needs exceed those of a typical hfa or afc resident.  This change was recommended by the Governor’s Medicaid Long Term Care Task Force for several reasons.  First, advocates wanted to provide clients with the widest possible choice of care settings.  Second, since waiver clients are already permitted to live in unlicensed assisted living settings, it seemed absurd to deny them the right to live in licensed settings which are often indistinguishable from unlicensed settings in terms of the services they provide and the appearance of the facility but that provide clients with greater rights, regulatory oversight, and access to the services of the long term care ombudsman program. Third, enabling residents of these facilities to avoid nursing home placement will be cost-effective for the state.


Although this change will permit more options for waiver clients, the MiChoice program will not receive any additional funding to accommodate this new population of potential waiver recipients.  Some observers fear that making the waiver available to hfa and afc clients will simply increase the waiting list for MiChoice which already exceeds 4,000 individuals statewide.  Moreover, they are concerned that waiver services will be diverted from the community to licensed and sometimes quite institutional settings, thus defeating the purpose of the waiver to provide clients with care in community settings instead of institutions. Finally, some stakeholders fear that savvy hfa and afc providers will game the system, crowd the waiting lists with hfa and afc residents, and use the waiver program to provide services the facilities themselves are already required to provide.  To address some of these concerns, the Department has convened a workgroup which hopes to make recommendations by the end of the summer. 


Spenddown for the Waiver Program

Currently, waiver clients are permitted to have monthly incomes of $1869/month (PEM 164) but are not permitted to have a spenddown.  Mike Head, director of the Office of Long Term Care Supports and Services, recently announced that his office intended to submit a waiver amendment to CMS to permit spenddown in this program although he did not specify a time frame for the change.  This amendment would assist moderate income clients who are unable to pay for all the supports and services they need out of their own pocket to receive some assistance from the program.  Like the expansion to licensed assisted living settings, however, this change is also likely to increase the waiting lists since it would  make the waiver program available to a wider array of individuals.


Slightly Increased Funding and Support for Nursing Home Transitions

Although the FY 2008 budget has not yet been finalized, the MiChoice program is likely to receive increased funding in the next fiscal year.  Moreover, as a result of a grant from the federal government, additional efforts and funding will be available to assist individuals transitioning from nursing homes to the community on the MiChoice program.  Unfortunately, it is highly unlikely that the additional funding will be sufficient to substantially eliminate the voluminous waiting list for  the program or raise the average per diem rate to one that is sufficient to make MiChoice a true alternative to nursing home placement for many individuals.  Continuing advocacy is required to secure additional funding for this cost-effective and important program.

Elder Law Section

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