Inside The Senior Alliance: MI Choice Waiver Program (Part 1) (Ep. 1.3)

Gail Wejrowski, waiver program clinical manager, talks about the MI Choice Medicaid Waiver program, which provides services that help eligible adults remain in a home or residential setting. The program provides personalized support and services in the home rather than in a nursing facility.  Oftentimes, participants experience a reduction in unplanned medical care and their families experience less caregiver burnout.  The program is funded through the Michigan Department of Health and Human Services.

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Transcription

Jason Maciejewski:
Hello, and welcome to the third edition of inside The Senior Alliance. My name is Jason Maciejewski, the chief advocacy and planning officer at The Senior Alliance, which is the Area Agency on Aging, serving Western and Southern Wayne County. Today I’m joined by Gail Wejrowski, waiver program clinical manager at The Senior Alliance to talk about a really impactful program that helps people to remain living in the community. The MI Choice Medicaid Waiver, Gail, welcome to inside The Senior Alliance.

Gail Wejrowski
Thanks for having me.

Jason Maciejewski
Great. So we’re going to get right into the questions today. Now the first one I have for you is, one of the core values The Senior Alliance has is that everyone should be able to live in the community setting they choose. Often that is the home they’ve lived in for decades but could be any type of residential situation. One of the programs we have to assist people reach that goal is the MI Choice Waiver. So, Gail, how does the MI Choice Waiver help people achieve that?

Gail Wejrowski (00:49):
The MI Choice Waiver program helps participants achieve that goal by providing supports and services that a person may need in order to remain in their desired community setting.

Jason Maciejewski (00:58):
So the waiver in the name of the program is a waiver allowing Medicaid to cover services delivered in a person’s home, rather than that person having to be in a nursing facility and receiving the services, correct?

Gail Wejrowski (01:10):
Yes, that’s correct. Participants who have the opportunity to age in place, typically feel more secure and happy, which boosts their physical health. There’s also a sense of freedom. They’re able to do as much or as little as they want on their own schedule, because they aren’t scheduled to eat or participate in certain activities, at certain times. They can make their own decisions. And finally, the supports and services that they receive are more personalized to their specific needs and schedules.

Jason Maciejewski (01:38):
People who participate in the MI Choice Waiver can see improvements in their health too.

Gail Wejrowski (01:43):
Yes. Our services can have a positive effect on our participants and their family members. For example, for some of our participants, we can see a reduction in unplanned medical care and family caregiver burnout, but we also see an improvement in social isolation experienced by our partners.

Jason Maciejewski (01:59):
And for this program, there’s currently no waiting list, right?

Gail Wejrowski (02:10):
Yes. That is also correct.

Jason Maciejewski
Let’s go through the qualifications for MI Choice Waiver. What are the monthly income and asset limits?

Gail Wejrowski
The monthly gross income limit for an individual is $2,349 until January 1st, when it will go up to $2,382 per month. This also excludes any spousal income. The asset limit for this program is $2,000. This excludes one house and one car and any spousal protected assets.

Jason Maciejewski (02:33):
As MI Choice as a Medicaid program, is there a spend-down process for people to reach Medicaid eligibility?

Gail Wejrowski (02:39):
No. Participants who are enrolled in MI Choice Waiver are entitled to full Medicaid benefits.

Jason Maciejewski (02:45):
I know there are medical requirements to be on the MI Choice Waiver too, right?

Gail Wejrowski (02:49):
Yes, that is right. Not only must a person be financially eligible for Medicaid, they must also be medically eligible. To determine medical eligibility, MI Choice Waiver uses the Michigan Medicaid nursing facility level of care determination criteria. This tool has seven different medical eligibility criteria, which are activities of daily living, cognition, medical instability, medical treatment, in home skilled care, behaviors, and service dependency. A licensed nurse or social worker will be evaluating the individual and determining medical eligibility using the tool.

Jason Maciejewski (03:24):
Could you tell me what are activities of daily living?

Gail Wejrowski (03:27):
Sure. Those would include things like getting in and out of bed. How does an individual use the restroom? How do they feed themselves? So just your basic activities of everyday living.

Jason Maciejewski (03:38):
And in this process does a person’s doctor become involved in the MI Choice Waiver application?

Gail Wejrowski (03:44):
Not all the time. But if a person is medically eligible due to medical instability, medical treatments, or service dependency, then yes, the physician would become involved.

Jason Maciejewski (03:55):
And is that a process where the applicant works with the doctor or does The Senior Alliance help with that process?

Gail Wejrowski (04:01):
So, The Senior Alliance would be working on that process with the doctor, but at times we may have the participant, or their family also help with getting some information from the physician.

Jason Maciejewski (04:13):
For people that qualify, what are the services available?

Gail Wejrowski (04:18):
In addition to the other requirements, participants must need at least supports coordination, and one MI Choice Waiver service on an ongoing basis. These services include things like adult day health, tour services, community living supports, community transition services, counseling, home modifications, fiscal intermediary, goods and services, home delivered meals, nonmedical transportation, non-emergency medical transportation, personal emergency response system, preventative nursing, private duty nursing, respite care, specialized medical equipment and supplies, supports coordination, and training.

Jason Maciejewski (04:56):
So that’s a whole lot of services that are potentially available with the MI Choice Waiver. Let’s talk first about one that people might be familiar with, the meals on wheels program. Is that the same program that is commonly known, or is it run differently?

Gail Wejrowski (05:11):
Meals on wheels is a contracted provider for us under our home delivered meals option. It is going to be run as the traditional sense as it’s always run. It’s just that the MI Choice Waiver would be picking up the payment as opposed to the adult and aging services.

Jason Maciejewski (05:27):
Okay. Transportation is another service that you mentioned, what kind of transportation services are available specifically through the MI Choice Waiver?

Gail Wejrowski (05:35):
MI Choice Waiver can provide transportation to doctor’s appointments, dialysis, specialists, any medical transportation that’s needed, but we can also provide just regular transportation for socialization purposes, grocery shopping, anything that would meet our participants’ daily needs.

Jason Maciejewski (05:55):
Okay. And you mentioned nursing services as well. Could you talk about what kinds of nursing services are provided to clients in their home?

Gail Wejrowski (06:03):
Sure. So we have, um, two different categories for nursing services. We have our regular nursing services, which would include more of like a weekly basis of a nurse, could be an LPN or an RN that would be coming to the participant’s home to do things like setting up a medication dispenser, organizing a pill organizer, or doing teaching on different types of disease prevention, potentially even wound care or teaching wound care to a family member. We also provide private duty nursing, which would be given to individuals who are on ventilators, maybe have wounds that require specific treatments, or person who maybe has oxygen that requires titration on a daily basis to keep their oxygen levels in their blood at a specific rate per the doctor’s orders.

Jason Maciejewski (06:54):
You also mentioned community living services. What are those?

Gail Wejrowski (06:58):
Community living services are services we provide to individuals who require assistance with personal care. Um, personal care would be things like dressing, bathing, toileting, and continents care, queuing and reminders to do things like dressing, bathing, toileting, incontinence, care, things like that. It also encompasses our homemaking. So cleaning your home, running errands, doing meal prep. Finally, it also encompasses respite care. So if your family member is your primary caregiver, we would authorize community living supports to allow them to have a break, to be able to do the things that they need to get done in their daily life. While the person that they’re caring for is being taken care of by a caregiver.

Jason Maciejewski (07:41):
So is that the adult day services, is that the same thing?

Gail Wejrowski (07:44):
No. Adult day services are services that are provided in a center. So we contract with two different providers for that service. The center, the adult day center has transportation available to pick up the participant from their home, take them to the adult day center, where they would participate in activities that are geared to their cognitive level, depending on what that is. They also provide meals at the adult day center. They do personal care activities, again, things like toileting and continence care, whatever the participant needs. And then they would bring them home at the end of the day, back to wherever the participant lives. So it, in a sense, it’s a way to provide respite care to a family member as well, if they’re the one providing the service.

Jason Maciejewski (08:28):
One’ of the first services you mentioned was case coordination, and that is something that’s provided by The Senior Alliance directly, correct?

Gail Wejrowski (08:35):
That’s right. Supports coordination is provided by The Senior Alliance. We have nurses and social workers all licensed with the state of Michigan and they provide linking and coordinating to our participants. So their main role is to ensure that the participant is receiving what they’re supposed to be receiving. And if it’s not a service we provide, then they’re linking them to a provider of that service. They’re also assessing our participants and they are helping our participants to develop person centered service plans, which are developed to authorize a service and to find what the participant needs in order to stay home. And, um, again, we can coordinate to get those needs met.

Jason Maciejewski (09:20):
I want to thank Gail Wejrowski, The Senior Alliance’s waiver program clinical manager for joining us on the podcast today. If you want more information about The Senior Alliance’s programs and services, or just to have a question on anything aging related, you can reach 1-800-815-1112 or by email at info@thesenioralliance.org. Our website is thesenioralliance.org. You can also find us on Facebook by searching for The Senior Alliance. Finally, our Twitter handle is @AAA1C.

I’m Jason Maciejewski. Thanks for listening to this edition of Inside The Senior Alliance.

Inside The Senior Alliance is a production of The Senior Alliance and Blazing Kiss Media.