Michigan Medicaid for Seniors & Long-Term Care

Michigan's primary alternative to nursing facility placement is the MI Choice Waiver, authorized under Section 1915(c) of the Social Security Act. MI Choice serves individuals who meet nursing facility level of care but prefer — and can safely receive — services in a home or community setting. MDHHS administers MI Choice through regional waiver agents, often Prepaid Inpatient Health Plans (PIHPs).

Demand for MI Choice frequently exceeds available waiver slots, and a waitlist exists in some Michigan regions; MDHHS processes requests in the order received. Nursing facility placement does not require a waiver slot — it is available to anyone who meets the clinical and financial criteria.

PACE — the Program of All-Inclusive Care for the Elderly — is available in several Michigan counties, including Wayne, Oakland, Macomb, Ingham, Genesee, and Kent, among others. PACE serves individuals age 55 and older who meet nursing facility level of care and can safely live in the community with PACE supports. PACE replaces both Medicare and Medicaid for enrolled members — the PACE organization becomes the single point of care, providing primary care, specialist care, hospital care, therapy, prescription drugs, meals, transportation, and personal care through one coordinated plan.

Many Michigan seniors qualify for both Medicare and Medicaid — called dual eligibles. As of January 1, 2026, Michigan replaced its former MI Health Link demonstration (which ended December 31, 2025) with MI Coordinated Health (MICH), a Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP) that coordinates medical care, behavioral health, and long-term services for dual eligibles in participating counties. Most former MI Health Link enrollees were automatically transitioned to MICH; dual eligibles can opt out if they prefer to keep separate Medicare and Medicaid coverage.

When one spouse enters a nursing facility and the other remains at home, Michigan applies spousal impoverishment protections. The community spouse can retain a Community Spouse Resource Allowance (CSRA) — a portion of the couple's combined assets above the nursing facility enrollee's $9,950 limit — set under federal law and updated annually. The community spouse also retains a Minimum Monthly Maintenance Needs Allowance from the institutionalized spouse's income.

MDHHS may file a claim against the estate of a deceased Medicaid recipient who received nursing facility services, home and community-based waiver services, or related long-term care. Estate recovery applies after the death of the recipient (and, if applicable, a surviving spouse), and Michigan is required to pursue it under 42 U.S.C. § 1396p. Michigan recovers costs from the probate estate of enrollees who were age 55 or older when receiving services; hardship waivers are available for surviving spouses, minor children, blind or disabled children, and siblings with equity interest who resided in the home for at least one year before institutionalization.

The table below summarizes Michigan's key long-term care financial rules for individuals and married couples.

Michigan offers several pathways for seniors and adults with disabilities who need long-term care, ranging from home-based services to nursing facility placement.