By Christine Vanlandingham
In Michigan and nationwide, the conversation around long-term care for older adults and people with disabilities is evolving. The traditional reliance on institutional settings, such as nursing homes, is being challenged by the growing recognition of the benefits and cost-effectiveness of home and community-based services (HCBS). Programs like the MI Choice Waiver and the Program of All-Inclusive Care for the Elderly (PACE) are at the forefront of this shift, offering individuals the opportunity to age in the setting of their choice.
Rebalancing Michigan’s Medicaid-funded long-term care system is crucial for improving care quality and financial sustainability. Currently, a significant portion of the state’s Medicaid long-term care budget is spent on institutional care, which is far more expensive than home and community-based services like the MI Choice Waiver. The average annual cost of nursing home care is $85,614 per person, while MI Choice Waiver costs only $34,741 per person.
Shifting more funds to HCBS could save millions, as illustrated by Michigan’s MI Choice Waiver program, which saved Medicaid over $539 million* in 2023, according to Michigan Department of Health and Human Services (MDHHS) data. (*MDHHS, Bureau of Aging and Community Living Supports, Home and Community-Based Services Section, MI Choice Waiver Data Update, 2/20/2024)
Beyond the financial benefits, rebalancing the system aligns with the preferences of older adults and people with disabilities. According to AARP, “90% of adults over 65 want to stay in their homes and communities as they age.” This preference highlights the importance of expanding home and community-based services to meet the needs of this population.
Programs like the MI Choice Waiver and PACE offer person-centered care, enabling individuals to stay at home. These services include personal care, homemaker services, and respite care, tailored to each participant’s needs. HCBS programs deliver nursing home-level care in the comfort of one’s home, providing invaluable flexibility and autonomy, and helping maintain independence and quality of life.
The U.S. Supreme Court’s 1999 Olmstead decision emphasized the right of individuals with disabilities to live in the least restrictive setting possible. Despite this landmark ruling, Michigan currently falls short of compliance by not ensuring equal access to home and community-based care compared to institutional care.
In 2013, the U.S. spent more on home and community-based care (HCBS) than institutional care for the first time. By 2019, HCBS accounted for 59% of national Medicaid spending on long-term services and supports (LTSS). However, Michigan allocates less than 40% of its Medicaid budget to HCBS, ranking among the bottom five states for access to these services.
The MI Choice Waiver program has shown strong results in consumer satisfaction, adherence to care standards, and service coordination. HCBS programs enhance participants’ quality of life by enabling independent living, maintaining social connections, and facilitating community involvement. Caregivers experience lower stress levels and have better access to support services.
To fully leverage the potential of HCBS programs, Michigan must tackle challenges such as the inadequate MI Choice Waiver rates, which impact workforce recruitment and retention. Raising public awareness and advocacy is essential for informing individuals and families about HCBS options. The Michigan Department of Health and Human Services (MDHHS) and state legislators need to prioritize funding for HCBS and support aging-in-place initiatives, including adjusting MI Choice reimbursement rates to align with inflation and care costs. Furthermore, it is critical to address the structural bias in policy that favors institutional care, ensuring individuals have the autonomy to choose their preferred care setting.
Quality nursing homes are important, but over-reliance on them is unsustainable. Investing in HCBS programs can help Michigan create a more sustainable long-term care system that meets older adults’ needs and controls Medicaid costs by prioritizing HCBS over institutional care.
Rebalancing Michigan’s Medicaid-funded long-term care system is both a financial and moral imperative. Programs like the MI Choice Waiver and PACE offer pathways to dignity, independence, and improved quality of life for older adults and people with disabilities. By shifting the focus away from institutional care, Michigan can lead the way in creating a more inclusive and compassionate long-term care system.
A local participant of the MI Choice Waiver program shared, “You don’t have to live in a nursing home. Having a real voice in my care choices and being able to get that care at home instead of moving to a nursing home, is what I like best about the MI Choice Waiver Program. I get to live at home and get the care I need in the home I love.”
If you are interested in discussing your long-term care preferences with state legislators, please attend the legislative forum at the Campus for Creative Aging on April 28 from 2-4 p.m. Your input is important in determining the future of long-term care in Michigan. For more information, visit the Area Agency on Aging’s advocacy page at areaagencyonaging.org/advocacy. If you would like to learn about your care options as you age, call the Aging and Disability experts at 800-654-2810.
Christine Vanlandingham is CEO of Region IV Area Agency on Aging in Southwest Michigan. Questions on age or independence services? Call the Info-Line for Aging & Disability at 800-654-2810 or visit areaagencyonaging.org. The Generations column appears each weekend in The Herald-Palladium.