COMMUNITY BASED MEDICAID

We all want to stay out of a nursing home and age independently.  Some individuals can afford to privately pay for caregivers, while others are fortunate enough to have family members capable of providing care.  What happens to those who do not have the family support or financial means to pay for care?  One option is Community Based Care through MI Choice Waiver and PACE Programs.

Mi Choice Waiver (the “Waiver”) is a Michigan Medicaid program that provides in-home care to individuals who meet certain medical and financial qualifications.  These individuals must need a nursing home level of care (assistance 24 hours per day/7 days per week) but want to remain in their home.  There are also some assisted living facilities which accept the MI Choice Waiver.  The goal of the MI Choice Waiver program is to allow seniors and disabled individuals, age 18 and over, to receive skilled nursing services in home and prevent them from transferring into a nursing facility.

THE MI CHOICE WAIVER PROGRAM HAS SPECIFIC ELIGIBILITY REQUIREMENTS

An applicant must meet all eligibility requirements to qualify for benefits under the program:

  • Over the age of 65 or over the age of 18 and disabled
  • Gross monthly income of the applicant must not exceed $2,382.00
  • Medicaid’s countable asset limits for married and single individuals applies ($2,000.00 countable assets for the single applicant)
  • Require medical assistance determined by a health-care professional completing the nursing home level of care determination (LOCD)

The Waiver Program and the PACE Program are managed by the Michigan Department of Health and Human Services.  There are no out of pocket cost for these programs.

The Waiver program is available throughout the State of Michigan. Enrollment begins by contacting your local Waiver Agent and requesting to be placed on the waitl-ist for services. In Southeast Michigan, there is currently a wait-list of 2-3 months.  You may be offered a complimentary Life Alert Service while waiting to reach the top of the list.

The PACE Program (Program for All-Inclusive Care for the Elderly) has similar eligibility requirements as the MI Choice Waiver, but provides services in a different way.  PACE picks up the individual from their home Monday-Friday in a bus and brings them to a PACE Center.  While at the PACE Center, they receive care, meals and medical treatment.  The PACE Center also offers a variety of group and individual activities for entertainment throughout the day.  As an individual’s needs increase, PACE remains involved and coordinates additional care services, transition into a nursing home, and end of life care.

In order to be eligible for the PACE program you must

  • Meet the income and financial requirements of the MI Choice Waiver Program
  • You must be age 55 or older
  • Require medical assistance determined by a health-care professional completing the nursing home level of care determination (LOCD)
  • Live within a designated PACE Service Area
  • You must be safe in the community with the assistance of the PACE program

Seeking the advice from an Elder Law Attorney is crucial in making the right decisions about long-term care needs.  Often times, individuals receive the wrong advice from neighbors and friends that actually hinder the process of applying for these benefits.

  • An Elder Law Attorney can review your situation to determine if planning is available to help you qualify for these programs.
  • Once a determination has been made, an Elder Law Attorney can assist you to develop a plan to meet your goals.
  • An Elder Law Attorney can also help you to identify other programs and services to help meet your needs.

While we are all experiencing changes during the COVID Pandemic, the MI Choice Waiver and PACE Programs continue to be fully operational and care is being provided throughout the community.

 

More Elder Law Information

Elder Law – Medicaid

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