Michigan, a large mid-western state with 9.8 million people in 1999, 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 Michigans 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.