MI Choice Medicaid Waiver Referral Form

MI Choice Waiver is a home and community-based program for eligible adults that meet program criteria to receive services and remain in a home or residential setting. Residential settings include an individual’s or family member’s home, unlicensed assisted living communities, licensed homes for the aged or licensed adult foster care homes.

Use the HIPAA-compliant form below to make a MI Choice Medicaid Waiver Referral only. Information submitted via this form is secure; encrypted when traveling between systems or at rest.

For all other program referrals, please call 1 (800) 815-1112.