Michigan Medicaid waivers pay for care at home instead of in an institution, and CMS lists five of them, each with its own front door. Seniors and adults with disabilities usually start with the MI Choice Waiver or with Home Help, a separate personal care program MDHHS runs itself. Three more waivers run through the county mental health system, for people with intellectual or developmental disabilities and for children with serious emotional disturbance.

In This Guide

The Five Michigan Medicaid Waivers and Home-Care Pathways

Match the person's age and disability type to the population each program serves.

Program Start here Population Waitlist?
MI Choice Waiver Regional MI Choice Waiver Agency Adults 65+, or 18 to 64 with a disability, at nursing facility level of care Yes, when at capacity (priority categories)
Habilitation Supports Waiver (HSW) County CMHSP Any age, intellectual or developmental disability, ICF/IID level of care Ask your CMHSP
Children's Waiver Program (CWP) County CMHSP Under 18, developmental disability, ICF/IID level of care Openings filled monthly by MDHHS invitation
Children's SED Waiver (SEDW) County CMHSP Children with serious emotional disturbance, under 18 at approval Ask your CMHSP
Home Help Program MDHHS (Adult Services Worker) People with active Medicaid who need hands-on help with at least one ADL Ask MDHHS

MI Choice caps enrollment: the approved waiver limits how many people it serves at any point in a waiver year, from 13,400 in its first year to 14,300 in its fifth. For the three waivers run through the public mental health system, the county CMHSP is the front door: it delivers HSW services locally, it assesses children for the Children's Waiver and SEDW, and for the Children's Waiver MDHHS then fills openings each month by inviting eligible children to apply.

One more waiver appears on CMS's Michigan list: the MI Coordinated Health HCBS Waiver, for people 65 and older and people with physical disabilities ages 21 to 64 who meet a nursing facility level of care. It belongs to MI Coordinated Health, Michigan's integrated plan for people with both Medicare and Medicaid: through it, enrollees who need a nursing home level of care can get help in their own homes instead. In 2026 the plan is open only to residents 21 and older of Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren and Wayne counties and of Upper Peninsula counties other than Chippewa, Gogebic and Menominee; MDHHS said it would expand statewide in 2027.

1. MI Choice Waiver (Seniors and Adults with Disabilities)

Who it serves: MDHHS's participant handbook says MI Choice serves adults aged 18 or older who need services like those provided in a nursing home. If the person is younger than 65, they must have a disability, and they must also qualify for Medicaid. Someone who joins on a physical disability and turns 65 stays eligible by virtue of age.

Administered by: MDHHS, through a network of waiver agencies. The approved waiver application describes twenty waiver agencies, fourteen of which are Area Agency on Aging (AAA) organizations, and MDHHS publishes a Waiver Agency Region Map so you can find the one serving your community.

What it covers: MDHHS's handbook lists adult day health, chore services, community health worker, Community Living Supports, community transportation (medical or non-medical), counseling, home modifications, home-delivered meals, personal emergency response, nursing services, private duty nursing and respiratory care, respite, specialized medical equipment and supplies, supports coordination, and training. Each participant also keeps the basic services Michigan Medicaid covers.

Eligibility: Age and level of care are not the whole test. All applicants must meet nursing facility level of care, assessed by a qualified professional using the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD). The approved waiver also sets the minimum number of waiver services an applicant must need at two, provided at least monthly or, where the need is less than monthly, with regular monthly monitoring documented in the service plan.

How the level-of-care test works: The LOCD is an in-person meeting between a qualified, licensed health professional and the applicant, and it is required for every Medicaid-paid nursing facility admission and every enrollment in MI Choice or PACE. Waiver agencies conduct it, but the State gives the final approval or denial, and it is repeated every 365 days or sooner after a significant change in condition. It screens eight areas, called Doors: activities of daily living, cognitive performance, physician involvement, treatments and conditions, skilled rehabilitation therapies, behavioral challenges, service dependency, and frailty. A person who meets the criteria for none of the doors is not eligible for Medicaid long-term services and supports at that time.

Income, Assets and the Spouse at Home

The income limit for MI Choice is $2,982 a month in gross countable income, three times the $994 federal Supplemental Security Income benefit rate. For the waiver, income eligibility cannot be established with a patient-pay amount or by meeting a deductible, so an applicant over the limit cannot spend down with medical bills to qualify. MDHHS treats a waiver participant as a group of one even when they live with a spouse. The asset limit for the MI Choice category is $9,950 for an asset group of one, effective January 1, 2026. The limit applies to countable assets only. MDHHS excludes one homestead (the principal place of residence, if the person owns more than one home), one motorized vehicle, and household and personal goods. A home the owner has left stays excluded if the owner intends to return to it or is in a long-term care facility, a hospital, an adult foster care home or a home for the aged.

When one spouse applies, the spouse who stays at home is protected. MDHHS's spousal asset rules address waiver clients as well as nursing home residents, and either spouse can request an initial asset assessment on form DHS-4574-B, even before applying, to work out how much of the couple's assets are protected for the community spouse. That protected amount is the greatest of $32,532, one-half of the assessed assets up to $162,660, or, if greater, an amount set at a hearing or by court order. See Michigan spousal impoverishment rules for the income side.

Giving assets away can delay MI Choice. Michigan looks back 60 months for transfers, and a divestment creates a penalty period during which Medicaid will not pay for waiver services such as MI Choice and PACE, Home Help, home health, or nursing home care, though it still pays for other covered services. MDHHS is told not to apply a penalty when it creates an undue hardship. Transfers to a spouse are not divestment.

The MI Choice Waitlist

When the number of people receiving and applying for MI Choice exceeds program capacity, enrollment follows four priority categories, in this order:

  1. Young adults who have aged out of State Plan Private Duty Nursing and still need those services
  2. Nursing facility residents who meet program requirements and want to return to a home or community setting
  3. Applicants diverted from an imminent nursing facility admission, including anyone with an active Adult Protective Services case who qualifies and could benefit
  4. All other qualified applicants

Within each category, applicants are ranked by date of inquiry. Actual enrollment can vary from the ranking: a person lower on the list who is ready to enroll can take an open slot. Ask the agency serving your county to put the person on its list and tell you where the list stands.

Where the Person Can Live

MI Choice is not only for people in their own house. MDHHS's handbook says a participant's home could be a house, apartment, condominium, adult foster care, or a home for the aged, but MI Choice services are not available to people who live in a nursing home. MI Choice does not pay rent or room and board, though. Under the approved waiver, federal funds are not claimed for room and board except as part of respite in a state-approved facility that is not a private residence, and its Residential Services exclude payment specific to room and board. See adult foster care vs. homes for the aged.

Can a Spouse Be Paid Under MI Choice?

Only through one route. MDHHS's Self-Determination guidelines say a participant cannot choose a legal spouse, guardian, or representative as a paid worker, and MDHHS has confirmed that a spouse cannot be hired through a self-determined arrangement such as Agency with Choice. Michigan's CMS-approved waiver application does allow a spouse to be paid as a Community Living Supports provider in limited situations, when:

  • Extraordinary care: the participant needs care beyond what a spouse would ordinarily do in the household for a person of the same age without a disability or chronic illness, and it is necessary to protect their health and welfare and avoid institutionalization.
  • Best interest: the participant's health or mental status limits their acceptance of other caregivers, or no other qualified provider is available, and the participant agrees to receive care from the spouse.
  • Agency hire: a home care agency hires and supervises the spouse.

A live-in Coordinated Caregiving service that could pay a spouse a per diem stipend exists only in a draft waiver amendment MDHHS posted, not approved policy. Ask your Waiver Agency about the Community Living Supports route, and whether Coordinated Caregiving has been approved.

How to Apply for MI Choice

  1. Contact your regional MI Choice Waiver Agency. MDHHS's MI Choice Waiver Program page carries the Waiver Agency Region Map and list.
  2. Apply for Medicaid itself if the person is not already covered: MDHHS takes the MDHHS-1171 Assistance Application, and a MI Bridges online application counts as the same thing. See how to apply for Michigan Medicaid.
  3. Not sure MI Choice fits? The free MI Options line, 800-803-7174 (8 a.m. to 8 p.m., Monday through Friday), offers long-term care options counseling. It is a counseling and referral line, not an application line.

See the full MI Choice Waiver guide.

2. Habilitation Supports Waiver (HSW)

Who it serves: People of any age with an intellectual or developmental disability who would otherwise need the level of care an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) provides.

Administered by: MDHHS oversees it. The regional Prepaid Inpatient Health Plans (PIHPs) manage it under contract with MDHHS, and the county Community Mental Health Services Programs (CMHSPs) or their contracted providers deliver the services.

Eligibility: The approved waiver application sets four requirements: an intellectual or developmental disability, living in a community setting (not a hospital, ICF/IID, nursing facility, correctional facility, or child caring institution) while receiving HSW services, current Michigan Medicaid eligibility, and needing ICF/IID level of care if not for HSW.

Two decision points families miss: The person must need and receive at least one HSW habilitative service every month, and HSW enrollees cannot be on another Michigan 1915(c) waiver, such as MI Choice, at the same time. So an adult who could qualify for both has to pick one. HSW services are additions to regular Medicaid State Plan coverage, not a replacement for it.

Waitlist: Ask your CMHSP whether HSW has an opening in your region and where a new applicant would stand.

How to apply: Ask the CMHSP in your county about HSW, since CMHSPs and their contracted providers deliver HSW services locally.

3. Children's Waiver Program (CWP)

Who it serves: Children under 18 with a documented developmental disability who need medical or behavioral supports at home.

Eligibility: The child's behavioral or medical and habilitative needs at home, on a consistent daily basis, must meet the ICF/IID level of care, and the child must live with a birth or adoptive parent, or with a relative the court has named legal guardian who is not paid to provide foster care. Parent income does not count: for a child enrolled in CWP, Medicaid eligibility looks only at the child's own income and resources. So a family that earns too much for regular Medicaid should not rule CWP out.

Openings: MDHHS says the program serves 669 children a year. When an opening occurs, MDHHS invites eligible children to apply, and openings are filled monthly. A family denied enrollment has the right to appeal.

How to apply: Contact the Community Mental Health Services Program in your county and ask for a Children's Waiver Program assessment.

4. Children's Serious Emotional Disturbance Waiver (SEDW)

Who it serves: Children with a serious emotional disturbance (SED) who meet MDHHS criteria for the state psychiatric hospital for children, or who are at risk of hospitalization without waiver services. It is available in every Michigan county.

Administered by: MDHHS contracts with the regional PIHPs, which run SEDW as a managed care program in partnership with the CMHSPs and other community agencies.

Eligibility: The child must be under 18 when approved, must have or qualify for Medicaid, and must show serious functional limitations, identified using the Child and Adolescent Functional Assessment Scale (CAFAS). The child must also live with birth or adoptive family (or have a plan to return), with a legal guardian, or in a foster home with a permanency plan.

After 18: A child who turns 18 and still meets the other criteria and needs waiver services can stay on the waiver until their 21st birthday, and young adults 18 to 20 may live independently with supports. CWP, by contrast, serves children under 18.

Waitlist: Ask your CMHSP.

How to apply: Through the CMHSP in your county, which assesses potential candidates.

Home Help, the MDHHS Personal Care Program

MDHHS administers Home Help itself and provides personal care to people who need hands-on help with activities of daily living (ADLs) and help with instrumental activities of daily living (IADLs). To qualify, a person must be assessed to need help with at least one ADL ranked 3 or higher. Medicaid funds it, and MDHHS will not authorize payments while the person's Medicaid eligibility is inactive. Ask MDHHS about it while you wait for an MI Choice slot, or if MI Choice is not the right fit.

An MDHHS Adult Services Worker completes the Adult Services Comprehensive Assessment (form MDHHS-5534), MDHHS's primary tool for deciding what services a person needs, in person at the person's home. Since May 1, 2026, the person's medical need must be certified on form MDHHS-6200 or DHS-54A (clinical nurse specialists can now certify), or on VA Form 10-10M completed by a Veterans Health Administration provider.

The person receiving care chooses the caregiver and is the employer, not the State of Michigan. The caregiver must be 18 or older and must pass a criminal history screen before being paid. MDHHS will not pay a responsible relative, meaning a spouse caring for a spouse or a parent caring for a minor child, and a responsible relative must be unable or unavailable to provide the care for the person to qualify for Home Help at all. The Home Help individual caregiver rate is $17.13 per hour for services from January 1, 2026, up from $15.88.

See the full Michigan Home Help Program guide.

Choosing the Right Michigan Medicaid Waiver

Most Michigan families working through senior care decisions are choosing among:

  • Home Help (MDHHS's own personal care program, assessed in person at home; a spouse cannot be paid)
  • MI Choice (waitlist possible; a spouse can be paid only as a Community Living Supports provider hired through a home care agency)
  • PACE (another long-term care option that uses the same LOCD level-of-care test)
  • Nursing Home Medicaid (full nursing facility care; income above $2,982 a month does not by itself rule it out, so ask MDHHS)
  • Private pay (while waiting for MI Choice)

A common pattern: ask MDHHS about Home Help now, and apply for MI Choice at the same time so the person is on the waiting list when a slot opens. Ask both offices how the two programs work together before MI Choice starts. If the person is already in a nursing facility and wants to return home, tell the Waiver Agency: nursing facility residents who meet program requirements are the second of MI Choice's four waiting-list priority categories.

Trying to decide between Home Help, MI Choice, and nursing home care? Chat with Brevy for a recommendation based on your family's situation, timeline, and whether a spouse needs to be the caregiver.

If a Program Says No

A denial is not the end. If an MI Choice Waiver Agency or a CMHSP-PIHP makes an adverse benefit determination, the person must first go through that organization's internal appeal before asking for a state fair hearing, and questions about the internal appeal go to the organization that took the action. For an MDHHS decision to deny, reduce or end Medicaid eligibility, the hearing request form is DCH-0018; for a Medicaid service issue or service level change, it is DCH-0092. The request must reach the local MDHHS office within 90 calendar days of the written notice, and asking before the effective date of a Medicaid cut keeps benefits in place while the hearing is pending. MDHHS's hearings page lists a toll-free number for Medicaid beneficiaries, 1-800-648-3397. See Michigan Medicaid appeals and fair hearings.

How to Find Your Local Contacts

Each program is reached through a local or regional agency.

MI Choice Waiver Agency Screens applicants for the senior waiver, conducts the level-of-care determination, and manages the waiting list; fourteen of the twenty waiver agencies are Area Agency on Aging organizations. MDHHS's MI Choice page has the region map and agency list. www.michigan.gov/mdhhs/assistance-programs/healthcare/seniors/michoicewaiver/mi-choice-waiver-program
County Community Mental Health Services Program (CMHSP) The entry point for the Habilitation Supports, Children's, and SED waivers: it delivers HSW services locally and assesses children for the Children's Waiver and SEDW, while the regional PIHPs manage HSW and SEDW under contract with MDHHS. MDHHS's Medicaid waivers page covers all three. www.michigan.gov/mdhhs/keep-mi-healthy/mentalhealth/mentalhealth/medwaivers
MDHHS and MI Bridges Ask MDHHS about Home Help: an MDHHS Adult Services Worker completes the assessment in person at the person's home. Apply for Medicaid itself online through MI Bridges. newmibridges.michigan.gov
MI Options Line Free long-term care options counseling by phone; an agent can schedule an appointment or refer you to a certified counselor near you. 800-803-7174

Frequently Asked Questions

Which Michigan Medicaid waiver covers seniors?

The MI Choice Waiver serves adults 65 and older, and adults 18 to 64 with a disability, who need services like those a nursing home provides. In some counties, people with both Medicare and Medicaid can also get home care through MI Coordinated Health's waiver.

How long is the MI Choice waitlist?

The approved waiver caps how many people MI Choice serves at any point in the year, and when applicants exceed capacity, they are enrolled by priority category and then by date of inquiry. Ask the Waiver Agency serving your county where its list stands.

Can a married person get MI Choice without impoverishing their spouse?

Yes. MDHHS's spousal asset rules address waiver clients, and an initial asset assessment sets how much of the couple's assets the spouse at home keeps. In 2026 that protected amount is at least $32,532 and, under the half-of-assets test, up to $162,660, or more if set at a hearing or by court order.

Can a spouse be paid as a caregiver under a Michigan waiver?

Not under Home Help, which never pays a spouse caring for a spouse or a parent caring for a minor child. Under MI Choice, a spouse can be paid only as a Community Living Supports provider hired and supervised by a home care agency, in limited situations where the participant needs extraordinary care and the arrangement is in their best interest; self-directed arrangements such as Agency with Choice are closed to spouses.

Learn More

MedicaidMichigan Medicaid Programs for Seniors (Hub)Michigan Medicaid for seniors in 2026: the $9,950 asset limit for MI Choice and nursing homes, the $2,982 income cap, and your options if you're over it. MedicaidMedicaid HCBS Waivers by StateMedicaid HCBS waivers pay for care at home instead of a nursing facility. How 1915(c) waivers work, who qualifies, why waitlists happen, and your state's guide. MedicaidMI Choice Waiver ProgramMI Choice Waiver pays for in-home care, respite and adult day for Michigan adults who need nursing-home care. 2026 income limit $2,982/month; how to apply. CaregiverMichigan Home Help ProgramMichigan's Home Help Program pays a caregiver the client chooses $17.13/hr in 2026. Who can be paid (not a spouse), who qualifies, and how to apply. MedicaidHow to Apply for Michigan MedicaidA complete, step-by-step guide to applying for Michigan Medicaid in 2026: MI Bridges, MDHHS-1171, documents you need, timelines, and how to appeal a denial. MedicaidMichigan Spousal Impoverishment RulesMichigan Medicaid spousal impoverishment 2026: CSRA standards of $32,532-$162,660, a $2,705-$4,066.50 MMNA, the $9,950 asset limit, and hearing options. MedicaidMichigan Medicaid Nursing Home CoverageMichigan Medicaid nursing home coverage in 2026: income and asset limits, the medically-needy spend-down, the 5-year look-back, and estate recovery.
Your next step To start a Michigan waiver or Home Help application, contact the Michigan Department of Health and Human Services (MDHHS) at michigan.gov/mdhhs, where you can find your county's Waiver Agency, CMHSP, or local MDHHS office.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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