MI Choice Waiver
MI Choice Waiver is a long-term care program offered to older adults and adults living with a disability who medically require and financially qualify to receive a higher level of care. Through MI Choice, adults receive Medicaid-covered care services in the home. Services are coordinated by a Registered Nurse and Licensed Social Worker through Senior Resources and our network of over 100 contracted providers.
“Thank you for everything. I couldn’t have gotten through these last years, and especially the last six months without you and the rest of the team. I will forever remember your kindness.”
– Daughter of MI Choice Waiver participant
“I love it, and my wife loves for me to be here!”
– Charlie, MI Choice Waiver participant in the Evergreen Commons Day Center
MI Choice Waiver Program Available Services and Support
- Adult Day Health (Adult Day Care)
- Home Delivered Meals
- Chore Services
- Nursing Services (Preventative Nursing)
- Community Health Worker
- Personal Emergency Response System
- Community Living Supports
- Private Duty Nursing/Respiratory Care
- Community Transportation
- Respite (In-Home and Out-of-Home)
- Counseling
- Specialized Medical Equipment and Supplies
- Environmental Accessibility Adaptations (Home Modifications)
- Supports Coordination
- Fiscal Intermediary
- Training
- Goods and Services
Who’s Eligible?
- Adults age 65+ and adults age 18-64 who are certified disabled
- Medically eligible for nursing home placement
- Meets both Medicaid income levels (no higher than $2,901 month) and asset requirements (less than $9,660 for a single person) – Senior Resources can help with this process
- Be in need of one or more of MI Choice services listed above
- Reside in Muskegon, Oceana or Ottawa County
What’s the Process?
- Contact an Options Counselor at 231-733-3585 or submit a secure, HIPAA-compliant referral form to initiate contact from an Options Counselor
- Complete an initial care review with an Options Counselor
- Provide name, address, birth date and marital status, medical, and income information
- Conduct an income and asset information review with an Options Counselor
- Supports Coordinators offer assessment services, care planning, service coordination, follow-up and re-assessment.
To comply with the CMS Interoperability and Prior Authorization Senior Resources of West Michigan is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. For questions on the data below, contact: Sheyenne Cole, MI Choice Waiver Director
Reporting Period: Fiscal Year 2025
These are the medical items and services for which we require prior authorization:
- Adult Day Health
- Chore Services
- Community Living Supports
- Fiscal Intermediary Services
- Goods and Services
- Home Delivered Meals
- Nursing Services
- Personal Emergency Response System
- Respite
- Residential Settings
- Supports Coordination
- Specialized Medical Equipment
- Transportation
- Nursing Services
Prior to January 1, 2026, impacted payers are required to send prior authorization decisions within the following timeframes:
- For MA plans and applicable integrated plans, 72 hours for expedited requests (urgent) and 14 calendar days for standard requests (non-urgent)
- For state CHIP FFS programs, 14 days for standard requests (non-urgent)
- For Medicaid managed care plans and CHIP managed care entities, 72 hours for expedited requests (urgent) and 14 calendar days for standard requests (non-urgent)
- For QHP issuers on the FFEs, 72 hours for expedited requests (urgent) and 15 days for standard requests (non-urgent)
There are no Medicaid FFS program required timeframes for either type of prior authorization request prior to January 1, 2026, and there are no CHIP FFS program required decision timeframes for expedited prior authorization requests prior to January 1, 2026.
Beginning January 1, 2026, the CMS Interoperability and Prior Authorization final rule requires Medicaid managed care plans to send prior authorization decisions within:
- 72 hours for expedited requests (urgent)
- 7 calendar days for standard requests (non-urgent)
Standard (non-urgent) Prior Authorization Requests
Requests Approved 826
Request Denied 43
95% of all requests were approved
Expedited (urgent) Prior Authorization Requests
Request Approved 0
Request Denied 0
Time Between Receiving a Prior Authorization Request and Sending a Decision
Adult Day Health 17 days
Chore Services 9.7 days
Community Living Supports 18.6 days
Fiscal Intermediary Services 11 days
Goods and Services 1.5 days
Home Delivered Meals 8.8 days
Nursing Services 10.8 days
Personal Emergency Response System 19.8 days
Respite 0 days
Residential Settings 26.7 days
Supports Coordination 21.1 days
Specialized Medical Equipment 22.74 days
Transportation 13.9 days
Nursing Services 4 days
Grievance and Appeals
Senior Resources received no grievances during FY 2025
Senior Resources received 2 internal appeals during FY 2025
Identified Trends-Senior Resources has not identified any trends related to
Grievances and Appeals. Participants are educated and encouraged to exercise the
right to appeal.
Please Report Medicaid Fraud
There are many types of Medicaid fraud. Medicaid fraud is the intentional providing of false information to get Medicaid to pay for medical care or services. To report Medicaid suspected or identified fraud, waste and abuse, visit michigan.gov or call your local Michigan Department of Health and Human Services (MDHHS) office. You may also call 1-800-442-0054 or email info@seniorresourcewmi.org. All Reports may be made anonymously.