Publication Credit: This article was authored by the Area Agencies on Aging Association of Michigan (4AM) and originally published in September 2026. It is republished here by Senior Resources, an Area Agency on Aging serving West Michigan, to help inform older adults, caregivers, community partners, and the public about issues affecting Michigan’s aging network. Policy priorities, recommendations, and advocacy positions expressed in this article are those of the Area Agencies on Aging Association of Michigan. Download the original article here.
Michigan’s Top Public Policy Priority for Meeting Future Long-Term Care Needs
- Michigan’s aging population is accelerating beyond the capacity of our long-term care system. Baby Boomers began turning 80 in 2026, and demand for services is surging faster than current infrastructure can respond.
- Michigan must confront and eliminate waiting lists for home and community-based services and nutrition support. Every delay leaves vulnerable older adults without essential care.
- Strengthen and expand the MI Choice program. Where older adults live and receive services must remain their choice. MI Choice delivers a nursing-facility-level of care at less than half the cost of institutional placement, enabling independence at home and in the community. State policy must drive MI Choice expansion, guarantee stable rates, and foster a regulatory environment that empowers efficient service delivery and administration.
- Commit to planned growth of older adult services. Michigan ranks near the bottom nationally in the percentage of Medicaid long-term care funding directed to home and community-based services. A bold, specific plan is required to modernize and expand Medicaid and Older Americans Act services.
- Elevate support for Michigan caregivers. Respite, education, and resources must be prioritized to sustain the unpaid workforce that is the backbone of Michigan’s long-term care system.
- Expand Medicaid home and community-based services beyond nursing facility level of care. Michigan should seize the state option included in HR 1 to extend services to individuals who need support but do not yet require institutional-level care. This waiver option is called 1915(c)(11). CMS will issue formal guidance to states in 2027 and begin to accept and review applications on July 1, 2028.
Executive Summary: Home and Community-Based Services — Michigan’s Top Priority
Michigan’s aging population is outpacing the capacity of our long-term care system. With Baby Boomers entering their 80s, the state must act decisively to expand home and community-based services.
Eliminating waiting lists, strengthening the MI Choice program, and modernizing Medicaid and Older Americans Act services are essential to ensure older adults can remain in their homes and communities at half the cost of institutional care.
Michigan must also elevate support for caregivers—the unpaid workforce sustaining our system—and seize federal options to broaden access to services for those who do not require nursing facility care.
Without bold action, Michigan risks falling further behind; with it, we can build a sustainable, person-centered long-term care system that honors choice, independence, and dignity.
Michigan Area Agencies on Aging
Serving Older Adults at Home, Supporting Caregivers
Michigan’s aging population is growing faster than our long-term care system’s ability to respond. Area Agencies on Aging are proven, cost-effective partners that keep older adults at home, reduce Medicaid spending, and support caregivers, but only if Michigan invests strategically now.
This document outlines who AAAs are, what they deliver, and the investments needed to eliminate waiting lists, strengthen MI Choice and support caregivers.
Quick Facts
- Statewide reach: Sixteen AAAs serve regions covering all 83 Michigan counties.
- Strategic planning: AAAs conduct Community Needs Assessments to identify local priorities and gaps, then develop area plans outlining programs and service delivery strategies.
- Coordinated networks: AAAs oversee local providers to deliver person-centered services for older adults and caregivers.
- Mission-driven: The core mission of AAAs is rooted in the federal Older Americans Act of 1965 and the Older Michiganians Act of 1981.
- Proven leadership: For 50 years, AAAs have planned, developed, and funded coordinated home and community-based services (HCBS) that enable aging in place.
- Trusted partners: Known for efficient operations and innovative resource leveraging to meet local needs.
Michigan’s Population Is Aging
Michigan is experiencing a demographic shift that will transform health and long-term care needs for decades to come.
Key Facts
- Rapid growth: Michigan’s population age 60+ grew from 1.8 million in 2010 to 2.5 million in 2025, now representing 25.3% of the state’s population (U.S. Census Bureau).
- Fastest-growing segment: People aged 65 and older are Michigan’s fastest-growing population group.
- Baby Boomer wave: Nationally, 10,000 people turn 65 every day—and in 2026, they begin turning 80, driving unprecedented demand for in-home and community-based services.
This demographic shift is not a future challenge—it’s here now. Michigan must act to ensure older adults can age with dignity, choice, and access to care.
Area Agency on Aging Services
AAAs deliver a comprehensive network of programs that promote independence, support caregivers, and advocate for older adults across Michigan. These services can be grouped into five key categories:
1. Planning & Advocacy
- Local planning to strategically address the needs of older adults & caregivers
- Advocacy on issues impacting older adults
- Elder justice initiatives
2. Access & Navigation
- Information and Assistance call centers
- MI Options – independent Medicare enrollment assistance and long-term care options counseling
- MI Long Term Care Ombudsman program
3. Home & Community-Based Supports
- In-home living support (MI Choice Medicaid Waiver)
- Integrated care at home
- Community living supports
- Case management/supports coordination
- Nursing facility-to-community transitions
- Home modifications
- Mobility aids and assistive technology
- Medical equipment and supplies
- Nursing services, including private duty nursing
4. Nutrition & Daily Living
- Home-delivered and congregate meals
- Transportation
- Adult day programs
- Friendly caller program
5. Caregiver & Workforce Support
- Caregiver education and resources
- Respite care
- Health and wellness workshops
- Volunteer engagement
- Senior Community Service Employment Program
Together, these services strengthen Michigan’s aging network, reduce healthcare costs, and improve quality of life for older adults and caregivers statewide.
MI Choice
Where you live and receive services should always be an individual choice—and Michigan’s MI Choice program makes that possible.
MI Choice delivers nursing facility level of care at less than half the cost of nursing home placement. This program provides a fiscally responsible alternative to nursing home care, allowing people to remain in their homes and communities while receiving the support they need.
Why MI Choice Matters
- Honors individual choice: Serves Medicaid-eligible adults age 18+ who need a nursing home level of care but prefer to live at home.
- Reduces hospitalization and emergency care.
- MI Choice serves more than 16,000 individuals annually.
Challenges
- Strategic investment needed: State and federal governments must prioritize cost-effective programs like MI Choice to meet rising demand for home and community-based services (HCBS).
- Rates lag behind inflation: This limits program expansion and makes it difficult to offer competitive wages to direct care workers.
MI Choice honors individual choice, reduces long-term care costs, and helps thousands of older adults and adults with disabilities age at home with dignity.
The Michigan Model — Braiding Resources to Deliver Choice, Independence, and Cost-Effective Care
Michigan’s aging network is nationally recognized for its innovative approach to funding and service delivery.
By braiding multiple funding streams—Older Americans Act (OAA), Older Michiganians Act (OMA), Medicaid, private pay, and local resources—AAAs deliver person-centered home and community-based care regardless of Medicaid eligibility.
This Robust Model
- Keeps people at home and delays or avoids institutional placement.
- In some cases, prevents Medicaid enrollment altogether, reducing state costs.
- Delivers care at a per diem cost less than half that of nursing home placement.
Funding Sources
Aging network services are supported by:
- Older Americans Act (OAA): $67.8 million*
- Older Michiganians Act (OMA): $49.6 million*
- Medicaid / MI Choice: $557.6 million*
- Local funds leveraged by state and federal dollars
- Senior millages
- Private pay
- Local fundraising
- Other sources
* FY2026 MDHHS appropriation act (Public Act 22 of 2025)
No Wait State — Delivering on the Promise
No older adult should have to wait—or worse, die—while waiting for essential care. Yet across Michigan, waiting lists persist for critical services that keep people healthy and independent.
The Reality
- Waiting lists exist for MI Choice, home and community-based services for adults not eligible for Medicaid, and for nutrition and meal programs.
- Lives are at risk: Delays in access to care lead to premature decline and, in some cases, preventable deaths.
Why It Matters
- Michigan ranks near the bottom nationally for the percentage of Medicaid long-term care funding spent on home and community-based services.
- Older adults overwhelmingly prefer to remain at home, and these services are far more cost-effective than institutional care.
The Path Forward
- AAAs strongly advocate for funding to make Michigan a true No-Wait State.
- Set progressive rebalancing targets for Medicaid long-term care spending to expand home and community-based services statewide.
Investing in timely access to care saves lives, reduces costs, and fulfills Michigan’s promise to honor choice and dignity for older adults.
Supporting Michigan Caregivers
Michigan’s 1.7 million caregivers are the backbone of our long-term care system—providing unpaid support that saves billions in public spending. Yet these caregivers face enormous challenges, and without stronger support, the system they sustain is at risk.
The Reality
- 1.7 million caregivers provide vital support to millions of Michiganders.
- They deliver an estimated 1.2 billion hours of unpaid care annually, saving the state billions in institutional care costs.
- Despite their critical role, caregivers face burnout, stress, depression, and financial hardship.
Why It Matters
- Communities, states, and the federal government depend on unpaid caregivers to meet home and community-based service needs for our growing aging population.
- Caregiver support is a national Older Americans Act priority, yet funding remains minimal.
The Path Forward
- Caregivers need assistance, resources, and respite to remain effective and healthy.
- AAAs urge high-priority investment and additional funding for caregiver support programs delivered through Michigan’s aging network.
Supporting caregivers isn’t optional—it’s essential to sustain Michigan’s long-term care system and protecting the health and dignity of older adults and those who care for them.
AAA Appropriations Priorities
To deliver on Michigan’s promise of choice and timely access to care, strategic investments are needed in the following areas:
1. Eliminate Waiting Lists
- $8 million to clear waiting lists for non-Medicaid home and community-based services, ensuring older adults can access essential supports without delay.
- $2 million to eliminate waiting lists for home-delivered meals, a lifeline for nutrition and independence.
2. Support Michigan Caregivers
- $5 million to expand AAA caregiver support programs, providing respite, education, and resources to sustain the unpaid workforce that underpins Michigan’s long-term care system.
3. Strengthen MI Choice
- Improve MI Choice rates to enable competitive wages for direct care workers and expand program capacity, ensuring more Medicaid-eligible adults can remain at home rather than in costly institutional care.
4. Expand Access to Medicaid Home and Community-Based Services
Federal H.R.1 contains an option for states to expand home and community-based services (HCBS). States that apply will be able to offer Medicaid HCBS to individuals without requiring an institutional level of care (ILOC).
- AAAs strongly urge the MI Department of Health and Human Services to take action to bring expanded access to HCBS to Michigan.
- CMS will issue guidance to states in 2027 and begin to accept and review applications on or after July 1, 2028.
- The new waiver option for states is referred to as 1915(c)(11).
These investments will reduce waiting lists, strengthen Michigan’s aging network, and deliver cost-effective care that honors choice and dignity for older adults and caregivers statewide.
Aging Network
Michigan’s Aging Network is a statewide system working together to support older adults and caregivers. It includes:
- State leadership: The State Commission on Services to the Aging and the state unit on aging (MDHHS).
- Regional planning, development and coordination: Sixteen Area Agencies on Aging serving all 83 counties.
- Community partners: More than 1,300 local organizations contracting with AAAs to deliver services.
- Direct care workforce: Over 20,000 direct care workers providing essential in-home services and supports.
Area Agencies on Aging Association of Michigan
The Area Agencies on Aging Association of Michigan (4AM) is the statewide voice for Michigan’s sixteen Area Agencies on Aging.
Together, AAAs help older adults and people with disabilities live with optimal health, well-being, independence, and dignity—right in their own homes and communities.
What 4AM Does
- Represents and advocates for Michigan’s AAAs at the state and federal levels.
- Supports collaboration and innovation across regions to strengthen aging services.
- Advances policy and funding priorities that promote aging in place and caregiver support.
Contact Information
Jason Maciejewski, CEO
The Senior Alliance, AAA Region 1C
President, Area Agencies on Aging Association of Michigan
jmaciejewski@thesenioralliance.org
David LaLumia, Executive Director
Area Agencies on Aging Association of Michigan
Davelalumia@4ami.org
Jenn Dubey, Operations and Project Manager
Area Agencies on Aging Association of Michigan
jenn@4ami.org
www.4ami.org
September 2026
About This Article
This content was authored by the Area Agencies on Aging Association of Michigan (4AM) and is republished by Senior Resources, an Area Agency on Aging serving West Michigan, for informational and educational purposes.
Senior Resources did not originally author this material. References to advocacy priorities, legislative actions, funding recommendations, and public policy positions reflect the positions presented by the Area Agencies on Aging Association of Michigan in its September 2026 publication.
