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MDCH Promotes Transitions from Nursing Homes to the MiChoice Program

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MDCH Promotes Transitions from Nursing Homes to the MiChoic
Issue 30, Winter 2006

MDCH Promotes Transitions from Nursing Homes to the MiChoice Program

by Alison Hirschel, MPLP Elder Law Attorney

In an effort to expand access to the MiChoice program for residents of nursing homes, the Michigan Department of Community Health (MDCH) has provided the potential for additional funding to waiver agents who transition residents. Under the new plan, MDCH will pay reasonable, directly-related transition costs for Medicaid beneficiaries who transition out of facilities and will provide funding for a new "slot" for individuals leaving nursing homes. These transitions will be funded by money outside of the MiChoice budget of $100 million, providing the first significant infusion of money into MiChoice since the program reopened a couple of years ago.

Under the somewhat peculiar DCH plan, waiver agents are permitted to create a new slot for residents who have been in the nursing home at least six months. In addition, for each resident who is transitioned out after a minimum six month stay, waiver agents may transition a client who has been in the nursing home for fewer than six months. Moreover, Medicaid Director Paul Reinhart will grant a number of exceptions for individuals who seek to transition out after fewer than six months in the nursing home if, for example, they are dying and wish to return home, will lose their residence if they cannot return home promptly, or present other compelling circumstances. Medicaid officials have repeatedly encouraged waiver agents to be energetic in their efforts to transition clients who seek to leave the nursing home.

Unfortunately, waiver agents have not been transitioning clients as quickly as advocates had hoped for a number of reasons. First, there is a lack of adequate, accessible low income housing options for clients. Second, some waiver agents seem confused by the new plan and the accounting mechanisms that fund it or are distrustful that the Department will actually reimburse them the additional costs they incur in transitioning nursing home residents. Other waiver agents are concerned that when they transition nursing home residents who might have more acute needs than most current waiver clients, they are still required to serve individuals for an aggregate average daily service rate of $38. This rate is likely inadequate to meet the needs of many former nursing home residents. Finally, many waiver agents have reduced staff in the many years that funding for the program has been stalled and do not have enough staff to embark on the often labor intensive efforts required to help a nursing home resident leave a facility.

Despite these obstacles, advocates should strongly encourage waiver agents to transition nursing home residents who wish to leave nursing homes and educate them about residents rights and available resources. For example, nursing home residents are frequently erroneously advised that they are not eligible for the waiver program or it is not appropriate for them if they have significant needs. This is incorrect. All clients who are eligible for Medicaid funded nursing home care are also eligible for waiver services. Like all waiver recipients, these clients must be provided with both all the waiver services and the number of hours of service necessary to meet their needs. In fact, in extraordinary circumstances, a waiver client can receive 24 hour care. Although waiver agents are supposed to serve people for an average cost of $38/day, there is no individual cap on the cost of services. Moreover, waiver agents can apply for a "SMOU" (Special Memorandum of Understanding) to obtain additional funding for clients whose needs for services and supports are extremely expensive. If clients are being denied the extent of services they need or denied admission to the program, they should appeal and waiver agents should, in appropriate circumstances, be encouraged to consider applying for a SMOU.

Lack of staff at waiver agencies and lack of experience with nursing home transitions can also be a barrier for nursing home clients who want to leave the nursing home. Often, local centers for independent living and local long term care ombudsman staff can be very helpful to these transition clients. They may be able to arrange transitions more quickly than waiver staff and be aware of resources in the community of which waiver agents are unaware.

Currently, there are approximately 2400 people on the waiting list for waiver services across the state. While nursing home residents should not be put on a waiting lists because waiver agents are supposed to transition them (under the new plan) quickly, applicants from the community often have to wait a long time for services. In some areas, applicants encounter an average delay of approximately six weeks before services are provided. In other areas, applicants may remain on the waiting list for a year.

Advocates whose clients are denied access to the program, denied adequate waiver supports and services, or unable to transition promptly out of the nursing home are encouraged to contact Alison Hirschel at MPLP at

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