The MI Choice Waiver is Michigan's primary Medicaid program for adults who need nursing-facility-level care but want to stay at home, in an assisted living facility, or in an adult foster care home. It pays for personal care, home modifications, respite, adult day health, private duty nursing, and 20+ other long-term services that regular Medicaid doesn't cover.

It is also one of the most valuable, most complex, and most waitlisted senior programs in Michigan. This guide explains who qualifies, what's covered, how the application process works, and what the Self-Determination Option means for paying family caregivers.

By Brevy Care Team · Last verified April 16, 2026

What the MI Choice Waiver Is

MI Choice is a 1915(c) Home and Community-Based Services (HCBS) waiver authorized under Section 1915(c) of the Social Security Act. In plain language, it's a Medicaid benefit that "waives" the federal rule that long-term care be provided in a nursing facility, so Michigan can pay for equivalent services in the home and community instead.

MDHHS administers the program, but the front-line work is done by roughly 20 regional Waiver Agencies, most of which are Area Agencies on Aging (AAAs). Each Waiver Agency handles intake, assessments, care planning, and provider management for a specific geographic region.

Two facts about MI Choice set it apart from regular Medicaid:

  • MI Choice is not an entitlement. The CMS-approved waiver is capped at approximately 20,543 annual participant slots. When slots fill, regional waitlists form. This is the single biggest structural difference from Nursing Home Medicaid, which is an entitlement with no cap.
  • MI Choice covers services in residential settings, not room and board. If a participant lives in an adult foster care home or home for the aged, MI Choice pays for the care services the person needs. The resident still pays room and board from their own income.

Who Qualifies

MI Choice has three eligibility gates: age/disability, clinical (level of care), and financial. All three must be met.

Age and Disability

MI Choice serves two populations:

  • Adults age 65 and older
  • Adults age 18 to 64 with a disability meeting Social Security's disability standard

Clinical: Nursing Facility Level of Care via the LOCD

Applicants must meet Nursing Facility Level of Care (NFLOC), determined in Michigan using the Level of Care Determination (LOCD) tool. The LOCD is completed by a Waiver Agency nurse or social worker during an in-person assessment at the applicant's home or hospital room.

The LOCD scores the applicant across:

  • Activities of Daily Living (ADLs): transferring, mobility, eating, toileting, bathing, dressing
  • Cognitive abilities: daily decision-making, short-term memory, ability to communicate
  • Behavioral concerns: wandering, refusing care, inappropriate behavior that requires supervision

A dementia diagnosis alone does not automatically qualify. The LOCD is a functional assessment; the assessor is looking at actual daily-life impact, not a chart diagnosis.

Critically, MI Choice enrollment requires Supports Coordination plus at least one other waiver service. If a potential participant would only need one service (say, PERS), they don't meet the enrollment threshold.

Financial: Income and Asset Tests

For 2026:

  • Single applicant income limit: $2,982/month (300% of the SSI Federal Benefit Rate).
  • Single applicant asset limit: $9,950.
  • Couples, both applying: Each spouse has their own $2,982/month and $9,950 allowance.
  • Couples, one applying: The at-home spouse keeps up to $162,660 in countable assets under the Community Spouse Resource Allowance. Minimum CSRA is $32,532.
  • MMNA for the at-home spouse: A minimum of $2,643.75/month, up to $4,066.50/month if shelter costs justify it.
  • Home equity cap: $752,000. The primary residence is an exempt asset if the applicant (or spouse, or a disabled or minor child) lives there or documents intent to return.

Michigan is a medically-needy state. If the applicant's income exceeds $2,982/month, they can use the spend-down pathway: excess income is applied to medical expenses to reach the Protected Income Level. A Miller Trust is not required in Michigan.

Covered Services

MI Choice covers 20+ service categories. The care plan is built around what each participant needs, not everyone receives everything.

Required

Supports Coordination (case management). Every participant is assigned a supports coordinator who assesses needs, builds the individualized care plan, arranges services, monitors quality, and coordinates with the participant's medical providers. The supports coordinator is the single most important point of contact.

Personal Care and Daily Living

  • Community Living Supports: help with bathing, dressing, toileting, transferring, eating, meal preparation, shopping, and other ADL/IADL tasks.
  • Home-Delivered Meals: up to two meals per day.
  • Chore Services: heavy housekeeping, lawn mowing, snow removal, window washing.

Health and Medical

  • Nursing Services (intermittent skilled nursing).
  • Private Duty Nursing and Respiratory Care for participants with complex medical needs.
  • Specialized Medical Equipment and Supplies.
  • Assistive Technology.
  • Counseling Services.
  • Personal Emergency Response System (PERS).

Environmental and Accessibility

  • Home Modifications: ramps, grab bars, widened doorways, accessible bathrooms.
  • Vehicle Modifications.

Respite and Day Programs

  • Respite Care: in-home or out-of-home, short-term care to give a family caregiver a break.
  • Adult Day Health Care: supervised, structured daytime care at a community center for at least 4 hours per day.

Transportation

  • Non-Emergency Medical Transportation.
  • Non-Medical Transportation to the community center, grocery store, pharmacy.

Community Living

  • Community Health Worker services to help connect with community resources.
  • Independent Living Skills Training.
  • Residential Services: care (not room and board) delivered in an Adult Foster Care Home or Home for the Aged.

Self-Direction Support

  • Supports Brokerage and Financial Management Services for participants who choose the Self-Determination Option (see below).
  • Goods and Services: a flexible budget line for one-time purchases that promote independence.

The Self-Determination Option: Paying Family as Caregivers

MI Choice's Self-Determination Option (SDO) is the MI version of consumer direction. Under SDO, the participant (or their representative) becomes the employer of their own caregivers, with help from a Financial Management Services (FMS) agency that handles payroll, tax withholding, and background checks.

The critical feature for families: under SDO, the participant can hire relatives, including adult children, siblings, and spouses, as paid caregivers. This is a major structural difference from Texas CDS, which prohibits spousal caregivers under most programs.

SDO pay rates are set by the Waiver Agency and vary by region; workers typically earn $13 to $17 per hour for personal care in 2026. The FMS agency fee is deducted from the total service budget before the worker is paid.

Families with capacity to manage scheduling, timesheets, and electronic visit verification will find SDO a meaningful income source. Families without that capacity should take the agency-directed route, which trades some control for simplicity.

The Waitlist Reality

Because MI Choice is capped, most regions maintain waiting lists. Wait times vary significantly by Waiver Agency and by priority category:

  • High-priority applicants (nursing-home residents wanting to transition home, imminent risk of institutionalization) are often served within weeks.
  • Standard applicants may wait months. In some high-demand regions historically, wait times stretched over a year.
  • Low-priority applicants (stable home situation, no crisis) can be waitlisted longer still.

The Waiver Agency will tell you your region's current wait time on intake. While waiting, many families enroll in the Home Help Program (no waitlist, lower functional threshold) to get some level of paid care started.

Michigan also operates Nursing Facility Transition (the state's name for the federal Money Follows the Person program). Residents currently living in a nursing facility who want to return to the community can often bypass the regular MI Choice waitlist through this pathway.

Thinking about MI Choice but worried about the waitlist? Chat with Brevy and we'll map out your fastest path: Home Help now, MI Choice application started today, and a practical plan for the gap.

How to Apply

MI Choice applications have six stages:

  1. Find your Waiver Agency. Call the statewide entry point at 1-800-803-7174 or use the MDHHS Waiver Agency map at michigan.gov/mdhhs. Each county is served by one Waiver Agency.
  2. Phone screening. A Waiver Agency staff member will ask basic questions about age, disability, general functional need, and household income. If the applicant appears to meet the criteria, they move on to intake. If the region has a waitlist, the applicant is placed on it at this stage.
  3. LOCD assessment. A Waiver Agency nurse or social worker visits the applicant's home or hospital room to complete the Level of Care Determination tool. This is a 1 to 2 hour visit, ideally with a family member present to answer questions the applicant can't.
  4. Financial eligibility review through MDHHS. While the Waiver Agency handles the clinical side, the applicant files the Medicaid application (MDHHS-1171 and DHS-4574 series) with the county MDHHS office. The caseworker reviews income, assets, and the 60-month look-back.
  5. Person-Centered Plan of Service (PCPS). Once both clinical and financial eligibility are confirmed and a slot is available, the supports coordinator builds an individualized care plan with the participant and family.
  6. Service start. The supports coordinator arranges providers, and services begin. The participant typically receives their first visits within two to four weeks of enrollment.

Expect the full process to take 3 to 6 months from initial phone screening to services starting, longer if there's a regional waitlist.

Appeals and Rights

A denial or reduction of MI Choice services is appealable. Participants receive a written notice that must state the specific reason and cite the policy.

The appeal pathway:

  1. Internal appeal to the Waiver Agency within the timeframe listed on the notice (typically 30 days for service reductions).
  2. Administrative hearing at MOAHR (Michigan Office of Administrative Hearings and Rules). File within 90 days. Beneficiary line: 1-800-648-3397.
  3. Continued services during the appeal can be requested within 12 days of the notice if the applicant is already receiving MI Choice and the notice is for a reduction or termination.

Common Misconceptions

"MI Choice and Home Help are the same program." They're not. Home Help is Michigan's state-plan personal care option with no waitlist and a lower functional threshold. MI Choice is a full 1915(c) waiver with capped enrollment, higher clinical requirements, and far broader services (home modifications, adult day, private duty nursing, meals, etc.). Many families start with Home Help and add MI Choice once a slot opens.

"MI Choice pays for my parent's assisted living rent." It doesn't. MI Choice pays for care services delivered inside an Adult Foster Care home or Home for the Aged. The resident still pays room and board from their own income or Social Security.

"I can't qualify because my mother has too much income." Michigan's medically-needy pathway means spend-down is usually available. You don't need a Miller Trust. An elder-law attorney can help structure the spend-down correctly.

"A dementia diagnosis guarantees MI Choice approval." The LOCD assessment looks at functional impact, not diagnosis alone. Early-stage dementia with intact ADLs often does not meet NFLOC. Moderate or late-stage dementia with wandering, safety concerns, or inability to manage medications typically does.

"I have to take the Waiver Agency's assigned caregivers." Under the Self-Determination Option, the participant can hire their own workers, including family members. Ask the Waiver Agency about SDO at intake.

Frequently Asked Questions

MI Choice serves adults 65+ and adults 18-64 with a disability who meet three tests: age/disability, Nursing Facility Level of Care (determined by the LOCD assessment), and financial eligibility ($2,982/month income and $9,950 asset limit in 2026 for a single applicant). Enrollment also requires Supports Coordination plus at least one other waiver service.

MI Choice is capped at approximately 20,543 annual participant slots, so most regions maintain waiting lists. High-priority applicants (nursing-home residents transitioning home, imminent risk of institutionalization) are often served within weeks; standard applicants may wait months. Families waiting for MI Choice commonly enroll in the Home Help Program in the meantime.

Yes — under the Self-Determination Option (SDO), the participant can hire relatives including spouses, adult children, and siblings as paid caregivers. This is a meaningful difference from Michigan's Home Help Program, which does NOT allow spouses to be hired. SDO pay rates are set by the Waiver Agency and typically run $13-$17/hour for personal care in 2026.

MI Choice pays for care services (personal care, supports coordination, respite, etc.) delivered inside an Adult Foster Care Home or Home for the Aged — but never for room and board. The resident pays room and board from their own income (Social Security, pension), often supplemented by VA Aid & Attendance or family contributions.

Expect 3 to 6 months from initial phone screening to services starting, longer if there's a regional waitlist. The six stages are: phone screening with the Waiver Agency, LOCD assessment, financial eligibility review through MDHHS, Person-Centered Plan of Service, provider arrangement, and service start. The statewide entry point is 1-800-803-7174.

Learn More

Find personalized help navigating the MI Choice Waiver at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. MI Choice eligibility, services, and waitlists change. Always verify with your regional Waiver Agency, MDHHS, or an elder-law attorney. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.