Home and Community-Based Services for Older People and Younger Adults with Physical Disabilities in Michigan

This research was supported by Health Care Financing Administration Contract No. 500-96-0005. In this contract, the Urban Institute is a subcontractor to the Lewin Group. The opinions expressed in the report are those of the authors and do not necessarily reflect the position of the Health Care Financing Administration or the Urban Institute.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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Table of Contents

Introduction

The Long-Term Care System in Michigan

Programs and Administrative Structure

Eligibility Criteria and Assessment

Care Management and Service Planning

Services

Consumer Direction

Cost Containment

Quality Assurance

Federalism Issues

Issues for the Future

Introduction

Michigan, a large mid-western state with 9.8 million people in 1999¹, provided home and community services to about 46,600 beneficiaries through its optional personal care benefit and 14,400 people through its Medicaid waiver during state fiscal year 2000. Michigan dramatically increased the number of Medicaid home and community-based services waiver slots from 4,000 in state fiscal year 1998 to 15,000 in state fiscal year 2000, an increase designed to expand home and community services options for people with disabilities. Despite the size of Michigan’s home and community services programs, nursing homes still dominate the state's long-term care system. In 2001, Michigan began implementing long-term care reforms designed to move away from discrete public programs to a coordinated, comprehensive system.

This paper outlines the home and community services system for older people and younger adults with physical disabilities in Michigan, focusing on the state administrative structure, eligibility and assessment, services covered by Medicaid and other programs, cost containment, and quality assurance. This report also summarizes government officials’ and key stakeholders’ opinions about how well the Medicaid and state-funded programs work.

Information was obtained from public documents, state of Michigan web sites, and interviews with nine state officials and key stakeholders including four consumer representatives, and six waiver agents and provider representatives. Interviews were conducted in person in Lansing, Michigan during March 2000. One telephone interview was conducted in the same month. Questions were asked using a structured, open-ended interview protocol. To encourage candor in their answers, respondents were told that they would not be quoted by name or identified by type of respondent within a state (e.g. nursing home industry representative in Michigan).

Notes

1. http://www.census.gov.

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