Michigan Medicaid 2026: Eligibility, MI Choice, Nursing Home

Michigan Medicaid pays for long-term nursing and home care through a segmented managed-care system, and it does not publish a gross-income cutoff for that care. The 2026 long-term care asset limit is $9,950 for a single applicant, well above the $2,000 Michigan still applies to its other SSI-related categories.

Michigan Medicaid is administered by the Michigan Department of Health and Human Services (MDHHS). Acute care flows through Medicaid Health Plans (MHPs); long-term services through the MI Choice Waiver and regional Waiver Agencies; behavioral health is carved out to regional Prepaid Inpatient Health Plans (PIHPs); and dual eligibles in select counties can choose MI Coordinated Health (MICH), which replaced MI Health Link on January 1, 2026.1 This guide maps each key question to the dedicated article that answers it.2

Eligibility and Income Limits

The key 2026 figures, from the MDHHS Bridges Eligibility Manual:2

• Income: there is no Michigan gross-income cap to quote. MDHHS runs institutional and waiver long-term care through its Group 2 (medically needy) pathway, then computes patient-pay separately under BEM 546. No MDHHS source we hold states an income ceiling for nursing facility or PACE coverage, so treat no figure as a cutoff, and do not conclude a parent earns too much before MDHHS has looked.2 MI Choice is the one program with a stated standard: the special home and community-based group at 42 CFR 435.217, with a special income level of up to 300% of the SSI Federal Benefit Rate.3
• Asset limit: $9,950 for a single applicant effective January 1, 2026, up from $9,660 in 2025. Exempt assets include the primary home, one vehicle, household goods, personal effects, and a prepaid burial plan within limits.2
• Home equity limit: the home is not excluded when homestead equity exceeds $752,000 (effective January 1, 2026); the cap does not apply when a spouse, a child under 21, or a blind or disabled child lives there.2

When one spouse enters long-term care, federal spousal impoverishment rules protect the community spouse, and in Michigan both headline figures are standards, not ceilings.2

• Protected spousal amount (CSRA): BEM 402 sets it as the greatest of three things, only the first a dollar figure: one-half the couple's assessed assets but not more than $162,660, subject to a $32,532 minimum resource standard (both effective January 1, 2026); the amount determined in a BAM 600 hearing; or the value of assets a court has ordered transferred to the spouse. So $162,660 bounds the one-half alternative, not the protection.2
• Monthly Maintenance Needs Allowance (MMNA): basic allowance $2,705.00/month, shelter standard $811.50/month (both effective July 1, 2026), to a maximum of $4,066.50/month. That maximum is a standard too: a fair hearing can raise the allowance, and a court order for spousal support sets a floor beneath it.2

Medically needy spend-down (the Michigan distinction). A Group 2 applicant over the income limit can incur or pay qualifying medical expenses to spend down to the Protected Income Level (PIL), which for a fiscal group of one runs $341 to $408 a month by county shelter area (RFT 240).2 MI Choice is carved out: its applicants may not spend down to reach the waiver's income limit.3

Personal Needs Allowance. A nursing facility resident in long-term care or a hospital for the entire benefit month keeps $60/month ($90 for a veteran receiving a VA Improved Pension, which the VA rather than MDHHS awards). A resident not expected to remain the entire month gets the RFT 240 protected income level for one. VA Aid and Attendance income is not excluded from patient-pay.4

Penalty divisor (transfer of assets). A 60-month look-back applies to asset transfers for less than fair market value, and an uncompensated transfer creates a penalty period: the transferred value divided by Michigan's average monthly private-pay long-term care cost, $12,216 for a 2026 baseline date. The divisor that applies is the one for the client's own baseline date, not the current year: BEM 405 sets $11,842 for a 2025 baseline and $10,871 for 2024.4 Worked examples: Long-Term Care: Nursing Home Medicaid.

A transfer inside the look-back is not automatically a penalty, and the divisor read alone is the most misleading number on this page. BEM 405 lists transfers that are not divestment at all: to the client's spouse, or to another solely for the spouse's benefit; to the client's blind or disabled child of any age; to a trust solely for the benefit of a disabled person under 65; and money placed in an irrevocable prepaid funeral contract. The homestead has its own list, including a transfer to a child 21 or over who lived in the home for at least two years immediately before the client's admission and provided care that would otherwise have required it, or to a sibling who part-owns the home and lived in it for at least a year before that admission.4 The full tables are in Long-Term Care: Nursing Home Medicaid.

Medicaid Health Plans (MHPs)

Most Michigan Medicaid members get acute care through a Medicaid Health Plan (MHP), Michigan's name for the managed-care organizations in its Comprehensive Health Care Program. Nine MHPs appear across MDHHS's county listing, which is published county by county, and no plan covers the whole state. Work from the current listing rather than a nine-name roster: MDHHS warns that new service areas may be approved monthly. The program is federally authorized as a 1915(b) waiver through the end of 2028.6

Two major carve-outs sit outside the MHPs:

1. Behavioral health and substance use disorder services, run under MDHHS contracts with regional Prepaid Inpatient Health Plans (PIHPs). That structure is being re-procured, with a service start date of October 1, 2026, so the PIHP serving your region may change.7
2. MI Choice Waiver services, delivered through the participant's regional waiver agency, which MDHHS enrolls as a Prepaid Ambulatory Health Plan, while acute care continues through the MHP.3

To choose or switch a plan, or ask which plans serve your county, call MI ENROLLS at 1-888-367-6557.6 For the full comparison and switching mechanics, see Managed Care Plans.

MI Choice Waiver

The MI Choice Waiver is Michigan's §1915(c) home and community-based services waiver. It pays for personal care, home modifications, respite, adult day health, private-duty nursing, and more, so Medicaid-eligible adults can get nursing-facility-level care at home, in adult foster care, or in a Home for the Aged.

Key structural facts:

• Enrollment is capped, not an entitlement. Each waiver agency gets a set number of slots per fiscal year; once capacity is reached, a screened applicant goes on the MI Choice waiting list, ordered by priority category and then by request date. Being at capacity is not a closed door: MDHHS states the enrollment process is never actually or constructively closed, and each agency must actively maintain the list. Priority goes to young adults aging out of State Plan private duty nursing, nursing facility residents returning to the community, and applicants being diverted from an imminent admission, including anyone with an active Adult Protective Services case.3
• Eligibility has five parts, not two. You must be 65 or older or an adult with a disability 18 or older; meet the nursing facility level of care through the online LOCD; establish financial eligibility; be categorically eligible as aged or disabled; and need at least two waiver services, one of them supports coordination. MI Choice sits in the special home and community-based group at 42 CFR 435.217, with a special income level of up to 300% of the SSI Federal Benefit Rate, and applicants may not spend down to reach it.3 The $9,950 asset limit applies.2
• MI Choice does not pay room and board. Community Living Supports excludes room-and-board costs, and respite excludes them too, except when the respite is furnished in an MDHHS-approved facility that is not a private residence.8
• A spouse can be paid, but only through an agency. The route is Community Living Supports, hired through a home care agency in the traditional arrangement, when the participant requires extraordinary care: the CMS-approved waiver elects payment to legally responsible individuals (a category that expressly includes a spouse) for agency-operated arrangements only. What is closed is the self-directed route, where MDHHS's Self-Determination in Long Term Care guidelines bar a participant from choosing their own legal spouse, guardian, or representative as a paid worker. "Extraordinary care" means care beyond what a spouse would ordinarily do for someone of the same age without a disability, necessary to protect the participant's health and welfare and avoid institutionalization. Ask your regional waiver agency, by name, about being paid as a Community Living Supports provider through one of its network home care agencies.9

While waiting for a slot, families often use Home Help for immediate paid care, then move to MI Choice when one opens. Applications go through the regional waiver agency serving your county, not the MI Options line; MDHHS publishes a Waiver Agency Region Map.3

Waiver agency directory and service catalog: MI Choice Waiver.

MI Coordinated Health (Dual Eligibles)

MI Health Link has ended. Michigan's Medicare-Medicaid Plan demonstration closed December 31, 2025 and was replaced on January 1, 2026 by MI Coordinated Health (MICH), a Highly-Integrated Dual Eligible Special Needs Plan (HIDE SNP). If you are searching for MI Health Link, MICH is where that coverage went; enrollees moved over with no break.1

MICH covers all Medicare benefits and most Medicaid benefits, including long-term services and supports, but excludes certain behavioral health and community transition services. It is for residents 21 or older enrolled in both Medicare and Medicaid, who do not live in a state-operated veterans' home and are not in hospice. Nine health plans hold contracts; for 2026 MICH runs in ten named counties plus most of the Upper Peninsula, going statewide in 2027.1

Outside the 2026 MICH counties, the alternatives are a Dual-Eligible Special Needs Plan (D-SNP), Original Medicare plus Medicaid as secondary, or PACE for participants 55 and older in select areas. Eligibility and the county list: MI Coordinated Health.

HCBS Waivers

Besides MI Choice, Michigan operates several other HCBS pathways.

• Habilitation Supports Waiver (HSW), for people with intellectual or developmental disabilities at an ICF/IID level of care, run through the regional PIHP/CMHSP system.
• Children's Waiver Program (CWP), for children with developmental disabilities, and the SED Waiver, for children with serious emotional disturbance.
• Home Help Program, a Medicaid state-plan personal care benefit, not a §1915(c) waiver. Because it is a state-plan benefit rather than a capped waiver, it is an entitlement with no cap and no waitlist: any Medicaid-eligible adult needing hands-on help with at least one activity of daily living must be offered services.10 See the Caregiver Pillar.

The full catalog: HCBS Waivers.

Long-Term Care: Nursing Home Medicaid

Nursing home Medicaid requires countable assets at or below $9,950 (single), a nursing facility level of care determination (LOCD), and residence in a Medicaid-certified facility.2

Once eligible, the resident contributes most monthly income toward the facility cost. Under BEM 546 patient-pay is total income minus total need, and the need items are a closed list: the home maintenance disregard, guardianship or conservator expenses, a children's allowance, health insurance premiums, the community spouse income allowance, and a family allowance. One item families expect is not on it: ordinary medical expenses, including the cost of long-term care itself, never reduce patient-pay. The only medical-bill relief is a discretionary offset for pre-eligibility medical expenses from the three months before the application, requested within one year after eligibility is established and before the first redetermination.4

The CareScout 2025 Cost of Care Survey puts Michigan's nursing-home median at about $11,254 a month for a semi-private room and $11,969 for a private room, above the national medians of $9,581 and $10,798. These are industry-survey medians, not government figures.11

Estate recovery is probate-only. Michigan's Estate Recovery Program reaches only assets subject to probate court administration; non-probate assets (jointly-titled property with right of survivorship, payable-on-death accounts, life insurance with named beneficiaries, and assets in certain trusts) are generally outside it. It applies to recipients who were 55 or older and received long-term-care services on or after September 30, 2007. Note what happens once an estate is subject to it: the MDHHS Estate Recovery FAQ says the claim then pursues all services after the member's 55th birthday, long-term care and not. Read the survivor protections (spouse, child under 21, disabled child, caretaker survivor, co-owner sibling) as deferrals: the claim revives once none of them qualifies. Undue hardship defers it too, on a means test and a 60-day application clock.4 Those conditions and deadlines: Michigan Medicaid Estate Recovery.

LOCD criteria and PASRR: Long-Term Care: Nursing Home Medicaid.

Medicare Savings Programs (MSPs)

Michigan administers Medicare Savings Programs (MSPs) paying Medicare costs for low-income beneficiaries: QMB (Part A and Part B premiums plus all Medicare cost-sharing, about $1,350/month single), SLMB (the Part B premium, about $1,616), and QI (the Part B premium, about $1,816, first-come first-served from a capped federal allocation). Federal 2026 resource limits are $9,950 for one person and $14,910 for a couple, and states may disregard income and resources, so apply rather than self-screen.12

Federal law bars providers from billing a QMB enrollee for any Medicare cost-sharing. A person with full Medicaid cannot also hold QI, and QI must be reapplied for every year. Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help (the Part D Low-Income Subsidy).12 The fourth MSP (QDWI) and how to apply: Michigan Medicare Savings Programs.

Covered Services

Michigan Medicaid covers the federally mandated state-plan benefits: inpatient and outpatient hospital, physician, lab and X-ray, nursing facility, home health, FQHC and rural health clinic, family planning, and transportation to medical care, which is mandatory, not optional. Michigan has also elected optional benefits: hospice, personal care, private duty nursing, prescribed medicine, dental, vision, hearing and speech, podiatry, therapies, chiropractic, medical supplies, and mental health and substance use disorder treatment. Some are limited, may not be covered at age 21 and older, and may require prior approval. Coverage is not always free: people 21 and older may owe a small co-pay per the MDHHS co-pay chart.7

Behavioral health and MI Choice services are carved out of the MHPs, as above.6 The full list: Covered Services.

Dental Coverage (April 2023 Expansion)

Michigan made two changes: a rate policy effective January 1, 2023 paying dental providers 100% of the Average Commercial Rate, and, effective April 1, 2023, an expanded adult dental benefit for beneficiaries 21 and older covering deep teeth cleanings, sealants, root canals, crowns, and gum care. Nobody lost benefits, but the delivery route moved: a beneficiary 21 or older enrolled in a Medicaid Health Plan, an Integrated Care Organization, or PACE now gets dental through that plan's own network, so start with the plan rather than MDHHS.7 Detail: Dental Coverage.

What Makes Michigan Medicaid Different

1. The architecture is segmented: acute care through Medicaid Health Plans, behavioral health through regional PIHPs, MI Choice through regional waiver agencies.6

2. The money rules run in the applicant's favor compared with most states: a $9,950 long-term care asset limit, a medically needy spend-down instead of a gross-income cutoff, and probate-only estate recovery.2,4

3. Michigan does not license assisted living as a separate category. The LARA Bureau of Community and Health Systems licenses Adult Foster Care homes and Homes for the Aged instead, and a community marketed as assisted living is generally one of those two.13

How to Apply for Michigan Medicaid

Long-term care Medicaid follows a defined sequence.5

If you disagree with a decision, you have 90 calendar days from the date on the written notice of case action to request a hearing before the Michigan Office of Administrative Hearings and Rules (MOAHR): the full window 42 CFR 431.221(d) allows.14,15 The clock starts on the notice date, and your request must be received inside those 90 days, so one mailed on day 89 can still arrive too late.14

If a plan denied your care rather than MDHHS, appeal to the plan first. A member of a Medicaid Health Plan, a behavioral-health PIHP, or a MI Choice Waiver agency must exhaust that organization's internal appeal before requesting a fair hearing from MOAHR. That track runs on its own clock: once the plan's notice of resolution arrives, you get no less than 90 and no more than 120 calendar days to request the fair hearing, on form MDHHS-5617. If the plan fails the notice and timing requirements of 42 CFR 438.408, you are deemed to have exhausted its appeal and may go straight to a fair hearing.14

Keeping benefits while you appeal runs on a much shorter clock. MDHHS must maintain your benefits if you request the hearing before the effective date of the action, so work backward from that date, not from the appeal deadline. A request is "timely" when MDHHS receives it within 10 days of the notice date (if day 10 falls on a weekend or holiday, the next workday counts), and a timely request reinstates benefits to the former level. One limit bites hardest: benefits do not continue at all when what you are contesting is a denial at application.14

A form-by-form checklist: How to Apply for Michigan Medicaid.

Keeping Michigan Medicaid Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency. Michigan Medicaid must first try to renew your coverage automatically from information it already holds;16 if it does need paperwork, it must give you at least 30 days from the date on the renewal form.16 And if coverage closes because a form went unreturned, the agency must reconsider your eligibility without a new application if you return the form within 90 days of the termination.16 Both duties cover eligibility based on modified adjusted gross income (MAGI); if you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Michigan may offer the same windows but is not required to, so ask MDHHS what applies to you.16 See Michigan Medicaid Recertification and Renewal for the full cycle.

Where to Get Help

Michigan Medicaid FAQ

Learn More

Find personalized help with Michigan Medicaid programs 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.