The Michigan Home Help program, explained

The short answerHome Help is a Michigan Medicaid program, run by the Michigan Department of Health and Human Services (MDHHS), that pays for hands-on help with daily tasks for people who live at home. The person who needs care chooses the caregiver. In some cases that can be a family member. Only the State decides who qualifies and how many hours are approved.

What Home Help is for

MDHHS describes Home Help as a program designed to support people who want to live independently in their own home, as an alternative to an adult foster care home, a home for the aged or a nursing facility. For many families that is the whole point: Mom stays in her own house, and the State helps pay for the help she needs to do it.

What kinds of help it covers

The State splits daily needs into two lists.

• Activities of daily living (ADLs): bathing, dressing, eating, grooming, mobility, toileting and transferring (for example, moving from bed to chair).
• Instrumental activities of daily living (IADLs): housework, laundry, taking medication, preparing meals and cleaning up, and shopping for food and medication.

Home Help pays for these tasks only. It does not pay for general companionship or for care the State does not list.

How the State decides what you get

An Adult Services Worker (ASW) from your county MDHHS office meets the person who needs care and does a functional assessment. For each task the worker scores how much human help is needed, from 1 to 5:

Under State policy, Home Help can pay only for needs ranked 3 or higher, and the person has to need at least one ADL ranked 3 or higher to be eligible. The State then approves time task by task, so the monthly total reflects the person's actual needs rather than a standard number of hours for everyone.

Who can be the caregiver

The client is the employer and picks the caregiver. That can be an individual caregiver or an agency. Individual caregivers must be at least 18, pass a criminal history check, enroll with the State through its CHAMPS system, complete an in-person interview with the caseworker and sign a services agreement with the client before any payment is authorized.

Family members can be paid in many cases. Two common exceptions: a spouse caring for a spouse cannot be paid, and a parent caring for a minor child cannot be paid. A parent caring for an adult child can be. We cover this in detail in Can you get paid to care for your mother?

Individual caregiver or agency?

A family caregiver can enroll alone as an individual provider, or work for a Home Help agency that employs caregivers. With an agency, the client is still the one who chooses; State policy says the client employs the agency provider, not the State. The practical difference is who handles the paperwork, payroll and backup when the regular caregiver is sick. The State sets the hourly rate it pays for each type of provider.

What the process looks like

1. The person who needs care has, or applies for, Michigan Medicaid.
2. A Home Help request is made to the local MDHHS county office, and an Adult Services Worker is assigned.
3. A Medicaid-enrolled medical professional certifies the need for care.
4. The caseworker does the in-person assessment and approves tasks and time.
5. The chosen caregiver is screened, enrolled and interviewed, and the client and caregiver sign the agreement.
6. Care begins, and the caregiver is paid for the approved tasks, through monthly billing the State verifies.

Each step involves a different person or office, which is why families often find this the hard part. The steps are laid out in Who qualifies for Home Help and how to apply.

Things worth knowing before you start

• The person receiving care must not be living in a hospital, nursing facility or licensed foster or aged home.
• Approvals are reviewed on a regular schedule, and a change in condition can lead to a new assessment.
• The caseworker, not the family and not an agency, decides eligibility and hours.

This article is general information about public policy. It is not legal, medical or benefits advice, and it cannot tell you whether a particular person qualifies. Program rules change, so confirm the details with your county MDHHS office.