Quick Summary

Here’s a summary of a growing trend in long-term care.

More older adults and people with disabilities are receiving care at home instead of moving into nursing homes.

Medicaid — the government program that helps pay for long-term care when someone has limited income and assets — has been expanding coverage to provide for in-home support services and services short of the nursing home (think assisted living and memory care communities). In Michigan, these programs are commonly known as MI-Choice Waiver and the Program of All-Inclusive Care for the Elderly (PACE).

These services can include help with bathing, meals, medications, and daily living needs.

This shift reflects what most families want: care at home or somewhere more “homey” than skilled nursing homes whenever possible. But the long-term future of this trend is uncertain.

Why This Matters

For many years, nursing homes were the primary form of long-term care covered by Medicaid.  Care outside of nursing homes was limited and often harder to access. That has been changing.

Today, a larger share of Medicaid long-term care funding is going toward home- and community-based services. These programs allow people to stay in familiar surroundings while still receiving help with daily needs. For families, this can feel more comfortable and more personal than institutional care.

But there are challenges.

Home care programs depend on caregivers — and there is already a shortage of workers. Costs are rising. State budgets are under pressure. As demand continues to grow with an aging population, there is uncertainty about how sustainable these programs will be.

Another reality families should understand is that access to home care services can vary. Even when programs exist, there may be waiting lists, staffing shortages, or administrative hurdles. The rules on paper don’t always match what happens in real life.

That’s why planning ahead matters. Medicaid planning is not just about qualifying financially — it’s also about understanding how care is actually delivered in your community and what options are realistically available.

Families are often surprised to learn that long-term care planning is really about preserving flexibility. The earlier planning happens, the more choices families usually have.

Simple Lesson

Planning for long-term care is really about protecting options for where and how care happens.

Action Step

Talk with your family about long-term care preferences — especially whether staying at home as long as possible is important — and review your planning strategy to support that goal.

If this topic raises questions for you or your family, feel free to call (517) 548-7400 or contact us online: https://www.michiganestateplans.com/contact-us