If your parent needs nursing-home-level care but wants to stay at home, Michigan's MI Choice Waiver is a Medicaid program built to pay for it. It covers personal care, home modifications, respite, adult day health, private duty nursing, and other long-term services on top of regular Medicaid coverage, delivered in the participant's own home or another residential setting.

It is also capped in size. 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, and when applicants outnumber the open places, they wait in a priority order, so the order of the steps below matters as much as the steps themselves.,

In This Guide

What the MI Choice Waiver Is

MI Choice is a 1915(c) Home and Community-Based Services (HCBS) waiver, approved by the federal Centers for Medicare & Medicaid Services (CMS) under section 1915(c) of the Social Security Act, with the current waiver running from December 1, 2023 through November 30, 2028. In plain language, it lets eligible adults who meet income and asset criteria receive Medicaid-covered services like those a nursing home provides while staying in their own home or another residential setting.

The Michigan Department of Health and Human Services (MDHHS) runs the program, but the front-line work is done by regional Waiver Agencies. The approved waiver application describes twenty waiver agencies, fourteen of them Area Agency on Aging (AAA) organizations, and MDHHS publishes a Waiver Agency Region Map so you can find the one in your community.

MI Choice covers services, not room and board. The approved waiver, following federal rules, claims no federal funding for room and board except in narrow cases such as respite furnished in a state-approved facility that is not a private residence. Its Residential Services, for people living in a setting with 24-hour on-site response, exclude room and board too.

Who Qualifies for the MI Choice Waiver?

MI Choice has three tests, and an applicant has to pass all of them: age or disability, Medicaid financial eligibility, and nursing facility level of care.

Age and Disability

The approved waiver serves two groups:

Clinical: Nursing Facility Level of Care via the LOCD

Applicants must meet Nursing Facility Level of Care (NFLOC), established through Michigan's Level of Care Determination (LOCD). The LOCD is an in-person meeting with a qualified, licensed health professional, who gathers information by talking with the applicant and the people who know them well, observing their activities, and reviewing medical records. Once the data is entered in the state's CHAMPS system, CHAMPS applies MDHHS's algorithm, and the state makes the final approval or denial. The LOCD is repeated at least every 365 days, or sooner after a significant change in condition.

The LOCD's criteria are seven domains of need called Doors: Activities of Daily Living, Cognitive Performance, Physician Involvement, Treatments and Conditions, Skilled Rehabilitation Therapies, Behaviors, and Service Dependency. Someone who meets none of them gets a Door 0 (ineligible) result, though MDHHS or its designee can still find a person eligible under Door 8, the Frailty criteria. A Door 0 result can be challenged quickly; see How to Appeal.

MI Choice also needs a minimum level of service. The approved waiver application sets the minimum at two waiver services, provided at least monthly, or with regular monthly monitoring documented in the service plan when the need is less frequent. MDHHS says each participant can receive supports coordination and one or more other waiver services on top of regular Medicaid. So someone who would need only one waiver service doesn't meet the enrollment threshold.

Financial: Income and Asset Tests

For 2026:

  • Income limit: gross countable income of no more than $2,982/month, which is MDHHS's Extended Care/Waiver income limit (3 times the SSI Federal Benefit Rate of $994).
  • Asset limit: $9,950 for an asset group of one and $14,910 for an asset group of two.
  • Couples, one applying: The at-home spouse keeps the greatest of $32,532, half the couple's assets at the initial asset assessment (but not more than $162,660), an amount set at a fair hearing, or assets transferred by court order. So a hearing or court order can protect more than $162,660.
  • MMNA for the at-home spouse: A basic allowance of $2,705.00/month (effective July 1, 2026) and a maximum of $4,066.50/month. That maximum is a standard, not a hard cap: federal law makes it adjustable, and a court support order sets a floor.
  • Home equity cap: $752,000. The cap does not apply when a spouse, a child under 21, or a blind or disabled child lives in the home.

There is no spend-down into MI Choice. MDHHS's eligibility manual says waiver income eligibility can't be established with a patient-pay amount or by meeting a deductible, so gross countable income above $2,982/month rules the applicant out of the waiver. Nursing home Medicaid is different, since Michigan keeps a Group 2 (deductible) pathway for it, so a family over the limit should ask MDHHS which program fits.

The 60-Month Look-Back and Transfer Penalties

MDHHS reviews transfers made during a 60-month look-back period before the baseline date, the same look-back it uses for nursing home care. A gift or other transfer for less than fair value in that window brings a penalty period, not ineligibility. The uncompensated value is divided by $12,216, Michigan's average monthly private long-term care cost for a 2026 baseline date. During the penalty, Medicaid won't pay for MI Choice services but still pays for other covered services. MDHHS doesn't apply a penalty that creates an undue hardship, so ask about that exception.

What Does the MI Choice Waiver Cover?

MDHHS's MI Choice Participant Handbook lists 17 covered service categories, grouped below. Ask the supports coordinator which of them fit your parent's needs and what each would include.

Group Services MDHHS lists
Coordination Supports Coordination
Personal care and daily living Community Living Supports; Home Delivered Meals; Chore Services
Health and medical Nursing Services (Preventative Nursing); Private Duty Nursing/Respiratory Care; Specialized Medical Equipment and Supplies; Counseling; Personal Emergency Response System
Home modifications Environmental Accessibility Adaptations (Home Modifications)
Respite and day programs Respite; Adult Day Health (Adult Day Care)
Getting around and community Community Transportation (medical or non-medical); Community Health Worker
Self-direction support Fiscal Intermediary; Goods and Services; Training

The CMS-approved 1915(c) waiver renewal also names Assistive Technology, Residential Services, Supports Brokerage, and Vehicle Modifications, which the handbook does not list separately, so ask your Waiver Agency which of those four it provides today.

Respite is short-term care furnished because the people who normally care for the participant are away or need relief. It can be provided at home, in another person's home, or in a Medicaid-certified hospital or nursing facility, a licensed Adult Foster Care home or Home for the Aged, or another state-approved facility. Out-of-home respite is capped at 30 days per calendar year, and respite can't be scheduled daily except for longer-term stays at an out-of-home respite facility, since it is meant as intermittent relief for family caregivers. Family members who provide respite must meet the same standards as unrelated providers. Ask your supports coordinator who can be paid to provide it in your parent's case.

Self-Direction: Paying Family as Caregivers

MI Choice supports consumer direction: a participant (or their representative) can self-direct their own care, becoming the employer of their own workers. Payroll, tax withholding, and the associated paperwork are handled by a Fiscal Intermediary, a covered MI Choice service.

Who can be paid depends on who the worker is and how they're hired. MDHHS's Self-Determination in Long Term Care guidelines (last revised in 2019) and the approved waiver set it out this way:

Who As a self-directed worker Through a network home care agency
Spouse No Yes, as a Community Living Supports worker, only when the participant needs extraordinary care
Guardian or the participant's representative No Ask the Waiver Agency
Other family members and friends Yes, if they meet the provider requirements Ask the Waiver Agency

The self-determination bar covers "legal spouses, guardians, or representatives of the participant." The guidelines note the representative acting as employer is typically "a spouse or adult child," so an adult child who is Mom's representative or guardian should not plan on being her paid self-determination worker. They state no hours cap for family workers, the supports coordinator may adjust the budget, and they don't say whether a live-in worker may be paid.

For the spouse route, extraordinary care means care beyond what a spouse would ordinarily do for someone the same age without a disability or chronic illness, needed to protect the participant's health and welfare and avoid institutionalization. The arrangement must also be in the participant's best interest (their condition limits whom they'll accept as a caregiver, or no other qualified provider is available), the participant must agree, and the spouse must meet provider qualifications. MDHHS said, as the waiver was being renewed, that more policy defining these "limited situations" would follow. MDHHS has also posted a draft waiver amendment that would add a live-in Coordinated Caregiving service open to spouses; it is a request for approval, not approved policy, and nothing shows it has been approved or started. Ask your regional Waiver Agency about the agency-hire route, whether Coordinated Caregiving is offered yet, and what it pays self-directed workers before you count on caregiver pay.

Is There a MI Choice Waitlist, and Who Gets Served First?

Because the approved waiver caps how many people it serves at any point in a waiver year, a qualified applicant may have to wait. When applicants exceed capacity, the approved waiver application gives priority in descending order, and within each category applicants are ordered by date of inquiry. Category 1 enrolls first:

  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. Qualified 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, in order of their date of inquiry.

If your parent is in a nursing home and wants to come home, or is about to be admitted to one, tell the Waiver Agency up front. The ranking is still a queue position, not a promise: the approved waiver application states that actual enrollment may vary from an individual's waiting list ranking. If an agency tells you it's full, ask about its waiting list and how long the wait runs for the applicant's category.

MI Choice isn't the only program the LOCD opens. After the evaluation, MDHHS requires that applicants receive information on all the programs they qualify for, and the same LOCD is required for Medicaid-paid nursing facility admission and for enrollment in PACE (the Program of All-Inclusive Care for the Elderly). If you're weighing more than one, ask the Waiver Agency how enrolling in one affects the others.

While waiting, many families look at the Home Help Program. MDHHS runs it with Medicaid funds, providing personal care to people who need hands-on help with activities of daily living. The client chooses and employs the caregiver, though Home Help won't pay a spouse to care for a spouse.

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 for the MI Choice Waiver

MI Choice applications move through five stages, from your first call to your first home visit.

1
Step 1

Find your Waiver Agency

MDHHS publishes a Waiver Agency Region Map and list of Waiver Agencies on its MI Choice Waiver Program page. If you want help weighing options first, Michigan's statewide MI Options line, 800-803-7174, runs 8 a.m. to 8 p.m. Monday through Friday and offers free options counseling, including a referral to a certified counselor near you. For MI Choice itself, MDHHS points families to their Waiver Agency.

2
Step 2

Waiting list

When the program is at capacity, applicants wait, ranked by priority category and then date of inquiry.

3
Step 3

LOCD assessment

A qualified health professional meets with the applicant in person and talks with the people who know them well, so have a family member there to answer questions the applicant can't. The state makes the final level-of-care decision.

4
Step 4

Financial eligibility review through MDHHS

While the Waiver Agency handles the clinical side, the applicant files the Medicaid application: the MDHHS-1171 Assistance Application, or its equivalent online through MI Bridges. A long-term-care applicant already in a nursing facility files the DHS-4574 instead. A married couple can use the DHS-4574-B Assets Declaration to request the initial asset assessment that decides how much is protected for the at-home spouse; MDHHS must mail both spouses a notice within 45 days of receiving it. The caseworker also checks the 60-month look-back. MDHHS must certify approval or denial within 45 days, or 90 days for MA categories in which disability is an eligibility factor.

5
Step 5

Person-centered service plan

Services are worked out in a person-centered planning meeting and written into the person-centered service plan, which the participant and any family member who agrees to provide unpaid help both sign.

How to Appeal a MI Choice Denial or Cut

A denial or reduction of MI Choice services is appealable, and which notice starts the clock depends on who made the decision: the Waiver Agency, or MDHHS.

If the LOCD finds your parent ineligible. You can request a Secondary Review, another medical and functional review through MDHHS's designee, within three business days of the written notice. It is not an appeal, and you can request it, a Medicaid Fair Hearing, or both.

1
Step 1

For a Waiver Agency decision, appeal to the agency first

A recipient enrolled with a MI Choice waiver agency who disagrees with an adverse benefit determination must exhaust that agency's internal appeal before becoming eligible to request a state fair hearing. Once it upholds its decision, federal rules set the window to request a hearing at 90 to 120 calendar days from its notice of resolution, so use the deadline printed on that notice. If the agency misses its notice and timing requirements, you can go straight to a hearing.

2
Step 2

Request an administrative hearing before MOAHR

The Michigan Office of Administrative Hearings and Rules (MOAHR) hears Medicaid appeals. For an MDHHS action, such as a financial-eligibility denial, you have 90 calendar days from the date of the written notice of case action to request a hearing, and the request must be received in your local MDHHS office within that window. MOAHR uses form DCH-0018 to contest an MDHHS eligibility action and DCH-0092 for a Medicaid service issue or service-level change. MOAHR has a toll-free number for Medicaid beneficiaries, 1-800-648-3397, and takes inquiries about the hearings process at 517-335-7519.

Keeping benefits during an appeal of an MDHHS action. For Medicaid, MDHHS must maintain benefits if the beneficiary requests a hearing before the effective date of the action, so a notice terminating coverage effective January 1 leaves until December 31 to file and keep benefits. A request received within 10 days of the date the notice was issued is a timely hearing request, and on a timely request MDHHS reinstates benefits to the former level. There are no benefits pending the hearing when what you are contesting is a denial at application. These are MDHHS's rules for its own actions. MDHHS's hearings manual sends questions about a Waiver Agency's internal appeal to the agency that took the action, so ask the Waiver Agency whether services continue while you appeal its decision.

Common Misconceptions

"A dementia diagnosis guarantees MI Choice approval." The tests MDHHS sets are age or disability, Medicaid financial eligibility, and nursing facility level of care, which the LOCD measures against MDHHS's medical and functional eligibility criteria. Cognitive Performance is one of the LOCD's seven Doors. Ask your Waiver Agency to walk you through how the LOCD reads your parent's situation.

Frequently Asked Questions

Who qualifies for the MI Choice Waiver?

Adults 65 or older, and adults 18 through 64 with a physical disability, who qualify for Medicaid and meet Nursing Facility Level of Care on the LOCD. The approved waiver also requires a need for at least two waiver services. For a single applicant in 2026, gross countable income can't exceed $2,982/month, with no spend-down, and assets can't exceed $9,950.

What's the MI Choice Waiver waitlist like?

The approved waiver caps how many people it serves at any point in a waiver year. When applicants exceed capacity, they're ranked by four priority categories and then by date of inquiry. Nursing facility residents who want to return home and applicants facing an imminent nursing home admission rank ahead of most others, though actual enrollment may vary from the ranking.

Can I hire a family member as a paid caregiver under MI Choice?

Yes, with limits. Under MI Choice self-determination the participant can pick qualified friends or family members as workers. MDHHS's self-determination guidelines bar a legal spouse, guardian, or representative as a self-directed worker, but a spouse can be paid as a Community Living Supports worker hired through a network home care agency when the participant needs extraordinary care. Ask your regional Waiver Agency about that route.

Does MI Choice pay for assisted living?

It can pay for care in some residential settings, but not for the rent. MDHHS's participant handbook says a participant's home could be a house, apartment, condominium, adult foster care home, or home for the aged, and that MI Choice services are not available to people who live in a nursing home. A participant who chooses a provider-owned or controlled residence must live in one that meets federal home and community-based setting rules. The approved waiver's Residential Services cover personal care and supportive services in a setting with 24-hour on-site response, and exclude payment for room and board. Respite in a state-approved facility that is not a private residence is a named exception to the room-and-board bar. Ask the Waiver Agency whether a specific facility qualifies before your parent moves.

Will Michigan recover MI Choice costs from my parent's estate?

It can. Federal law requires states to seek recovery from the estate of a Medicaid enrollee who was 55 or older, including for home and community-based services such as a 1915(c) waiver. Michigan's recovery reaches only assets subject to probate court administration, and MDHHS defers it while a spouse, a child under 21, or a blind or permanently and totally disabled child is living. Recovery is pursued only when MDHHS judges it cost-effective. See Medicaid estate recovery in Michigan for the exemptions.

How long does the MI Choice application process take?

MDHHS's published deadline covers the Medicaid financial determination: MDHHS must certify approval or denial within 45 days, or 90 days for MA categories in which disability is an eligibility factor. The Waiver Agency's intake, the LOCD, the service plan and any wait for an open place add to it, so ask your Waiver Agency to estimate the full timeline.

Where to Get Help

MDHHS points families to their local MI Choice Waiver Agency, so start with the MDHHS region map.

Michigan Department of Health and Human Services (MDHHS) The Waiver Agency Region Map and list of Waiver Agencies on the MI Choice Waiver Program page, the MI Bridges Medicaid application portal, and your local MDHHS office for the financial-eligibility review and hearing requests. michigan.gov/mdhhs
MI Options Line MDHHS's free statewide options-counseling line for long-term care services and supports, 8 a.m. to 8 p.m. Monday through Friday. It can schedule an appointment or refer you to a certified counselor near you. 800-803-7174https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82076

Learn More

MedicaidMichigan's 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. MedicaidHow to Apply for Medicaid in MichiganA 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. 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. CaregiverHow to Get Paid as a Family Caregiver in MichiganSix Michigan programs that pay family caregivers in 2026: Home Help, MI Choice, VA benefits, and more. Who qualifies, what they pay, how to apply. MedicaidMichigan HCBS Medicaid Waivers (Complete List)Every Michigan Medicaid waiver in 2026: who each serves, income and asset limits, the MI Choice waitlist, and how to apply. Covers MI Choice, HSW, CWP, SEDW. MedicaidNursing Home Medicaid Coverage in MichiganMichigan Medicaid nursing home coverage in 2026: income and asset limits, the medically-needy spend-down, the 5-year look-back, and estate recovery.

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. 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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