MI Choice Waiver Program Description

MI Choice is a waiver program operated by the Michigan Department of Community Health (MDCH) to deliver home and community-based services to elderly persons and persons with physical disabilities who meet the Michigan nursing facility level of care criteria. The waiver is approved by the Centers for Medicare and Medicaid Services (CMS) under section 1915(c) of the Social Security Act.

MDCH serves as the single state agency in the operation of the MI Choice program. MDCH contracts with entities, commonly referred to as waiver agencies, to administer the program throughout the state. Certain administrative functions are assigned to the local waiver agencies as defined in the Medicaid waiver application to CMS, as renewed and amended.

The MI Choice program is available to persons 18 years of age or older who meet each of three criteria:

• An applicant must establish their financial eligibility for Medicaid services as described Financial Eligibility subsection of this chapter.
• The applicant must meet functional eligibility requirements through the online version Michigan Medicaid Nursing Facility Level of Care Determination (LOCD).
• It must be established that the applicant needs at least one waiver service and that the needs of the applicant cannot be fully met by existing State Plan or other services.

Waiver agencies are responsible for disseminating waiver information to applicants, assisting applicants with waiver enrollment (which includes assisting applicants with completion of the Medicaid Assistance Application (DHS-1171) to secure financial eligibility), managing waiver enrollment against approved limits, monitoring expenditures against approved limits, conducting assessments and LOCD evaluations, reviewing participant plans of service to ensure that waiver requirements are met, conducting utilization reviews and quality management reviews, recruiting providers, and executing Medicaid provider agreements.

Waiver agencies employ supports coordinators who facilitate access to, and arrangement of, services and support needed and chosen by MI Choice participants. These are detailed and documented in the participant’s plan of service.

Functions of the supports coordinator include, but are not limited to:

• Assessment of the participant
• Development of the plan of service
• Service access
• Follow-up and monitoring of the participant
• Reassessment of the participant
• Social emotional support
• Advocacy for the participant

Supports coordinators use a person-centered approach in working with a participant to determine how their needs will be met. Supports coordinators also monitor the quality of services received and explore other funding options and service opportunities when personal goals exceed the scope of available MI Choice services.

Person-centered planning (PCP) is a process for planning and supporting a participant receiving services that builds on the participant’s desire to engage in lawful activities that promote community life and that honor the participant’s preferences, choices, and abilities. The person-centered planning process involves families, friends, and professionals as the participant desires or requires.

Using a person-centered process, waiver agencies must establish a written plan of service for each participant that identifies the participant's strengths, weaknesses, needs, goals, expected outcomes, and planned interventions. This document includes all services provided to, or needed by, the participant and is developed before services are provided, regardless of funding source. The participant must approve all services and interventions before implementation and the waiver agency must document participant approval.

Self-Determination is an option through the MI Choice Waiver that provides participants the option to direct and control their own waiver services. Not all MI Choice participants choose to participate in self-determination. For those that do,

the participant (or chosen representative(s)) has decision-making authority over staff who provide waiver services, including recruiting staff, hiring staff, orienting and instructing staff in duties, supervising staff, approving invoices and authorizing payments.

Whenever the number of participants receiving services through MI Choice exceeds the existing program capacity, any screened applicant must be placed on the waiver agency’s waiting list. Waiting lists must be actively maintained and managed by each MI Choice waiver agency. The enrollment process for the MI Choice program is not ever actually or constructively closed.