Department of Community Health Issues Policy on MiChoice Waiting Lists and Transition Services
of Community Health Issues Policy on
MiChoice Waiting Lists and Transition Services
by Alison Hirschel, MPLP Elder Law Attorney
Effective May 1, 2005, DCH is implementing new procedures for establishing waiting lists for the MiChoice Home and Community Based Waiver Program and for providing limited payments to assist residents who wish to return to the community from nursing homes. MSA Bulletin 05-21, available at http://www.michigan.gov/documents/MSA_05-21_120931_7.pdf. These changes were mandated by the settlement agreement in Eager, et al. v. Engler, et al., a suit that challenged the virtual closure of the MiChoice Program to new applicants in 2001.
Under the new policy, any person who expresses interest in the program must be evaluated by telephone by the staff of the local waiver agent. If the waiver agent has the capacity to admit additional clients, those who are presumed financially and medically eligible based on the telephone screen must be offered a face to face evaluation within seven days of the telephone screen. If the waiver agent is not accepting new clients at the time of the telephone screen, but the individual is presumed eligible based on the truncated screening, the individual's name must be placed on a waiting list. Those who are determined to be ineligible based on the telephone screen may request a face to face screen and may appeal the decision.
Although slots in the waiver program are generally to be assigned on a first come, first served basis by waiver agents, the Department sets forth three priority categories for service. First, children who are aging out of the Children's Special Health Care Services (CSHCS) but continue to need private duty nursing care at the time their CSHCS coverage ends will receive first priority for an available MiChoice slot. Second, the Department will provide each waiver program with a limited number of slots for individuals who are transitioning out of nursing homes and into the community. Until that small quota is filled by the waiver agent, individuals in this situation will be given priority after CSHCS clients. Third, clients with an active Adult Protective Services case whose critical needs can be met by the MiChoice program will be the final priority clients. All other clients will receive services in chronological order from the date they applied for the program (the date they or someone on their behalf called to request services and expressed an interest in the MiChoice program). Clients who are currently on waiver agents' "contact lists"and are presumed eligible for the program will be contacted to determine their continuing interest in services and placed on the waiting list based on their first request for MiChoice services and their priority category.
Each quarter, waiver agents must prepare a report for DCH including the number of persons on their waiting list in each priority category and how long they have been waiting, the number of new admissions from each priority category in the past quarter, and the number of people removed from the waiting list for reasons other than enrollment in the past quarter. This information will help the Department and others gauge the demand for the program and determine whether people are moving off the waiting list at a reasonable pace.
The policy also addresses transition services. Each year, DCH will notify waiver providers of the maximum amount of funds available for them to help transition clients out of nursing homes and back to the community. Up to this annual limit, DCH will reimburse waiver agents both for the cost of staff efforts to return nursing home residents to the community and for some of the costs of transitioning them back to their communities such as housing deposits; utility hook-ups; furniture, appliances, and moving expenses; and cleaning. Waiver agents may spend up to $3,000 for clients who are being transitioned from the nursing home to the MiChoice program; transitions that are anticipated to cost more than $3,000 require prior approval from DCH. Some funding will also be available for waiver agents and centers for independent living that assist residents in leaving nursing homes if the client does not subsequently enroll in the MiChoice program.