Self-Direction and FMS in Michigan

All states: self-direction map

Michigan self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Michigan offer self-direction?

Michigan has no single self-direction program. The option shows up in at least six places: Home Help, the MI Choice Waiver Program, the MI Coordinated Health waiver, the Habilitation Supports Waiver, the Children's Waiver Program and the wider behavioral health system. The names differ too. MI Choice calls it self-determination, and the behavioral health system calls it self-directed services.

• Home Help (individual caregivers): serves Medicaid beneficiaries who need hands-on help with at least one activity of daily living and live in their own home. The Michigan Department of Health and Human Services (MDHHS) runs it through Adult Services staff in local county offices. The beneficiary employs the caregiver directly, so there is employer authority. Hours are approved by an adult services worker after an in-home assessment, and we did not find a budget that the beneficiary manages. A client may choose an agency provider instead.
• MI Choice Waiver Program (self-determination): serves adults 65 or older, and adults 18 to 64 with physical disabilities, who meet a nursing facility level of care. MDHHS runs it through 20 contracted MI Choice waiver agencies, mostly Area Agencies on Aging. Fiscal intermediary, goods and services, and supports brokerage are covered waiver services. A fiscal intermediary and a waiver agency both describe the participant choosing, hiring and managing workers. We could not confirm budget authority from a state source.
• MI Coordinated Health (MICH) HCBS Waiver: serves adults 21 or older who have both Medicare and Medicaid and meet a nursing facility level of care. MDHHS runs it through contracted health plans that differ by region. It replaced MI Health Link on January 1, 2026. In 2026 it is offered only in Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren and Wayne counties and in the Upper Peninsula except Chippewa, Gogebic and Menominee. Fiscal intermediary is a covered service. MDHHS pages do not describe how self-determination works in this program.
• Habilitation Supports Waiver (HSW): serves people of any age with intellectual or developmental disabilities who meet an ICF/IID level of care (the level of care of an intermediate care facility). MDHHS runs it through the regional and county mental health agencies, called PIHPs and CMHSPs. Financial management services is a covered service. MDHHS says self-direction gives the beneficiary more decision-making authority and direct responsibility for managing services.
• Children's Waiver Program (CWP): serves children under 18 with a developmental disability who meet an ICF/IID level of care and live with a parent or relative guardian. MDHHS runs it through Community Mental Health Services Programs. Financial management services is a covered service. Two fiscal intermediaries say on their own pages that parents or guardians hire and fire staff. The MDHHS program page does not describe the self-directed option.
• Behavioral health self-directed services: serves adults and children with intellectual or developmental disabilities or mental illness in the public behavioral health system, outside the named waivers. MDHHS runs it through PIHPs and CMHSPs, and it is offered during person-centered planning. See the MDHHS Self-Directed Services page.

One more waiver deserves a mention. The federal CMS list of Michigan waivers shows financial management services as a covered service in the Waiver for Children with Serious Emotional Disturbances. We did not find how self-direction works in that waiver.

Employer authority means the participant recruits, hires, schedules and supervises the workers. Budget authority means the participant also manages a set amount of money. We did not confirm budget authority for any Michigan program from a source we could read. Ask the waiver agency, health plan or community mental health agency that serves the person.

Who handles financial management services (FMS) in Michigan?

Michigan has no statewide FMS vendor. In the waivers and in behavioral health, organizations called fiscal intermediaries contract locally with MI Choice waiver agencies, with PIHPs and CMHSPs, and with MI Coordinated Health plans. Home Help has no FMS vendor at all, because Michigan Medicaid pays the caregiver directly.

A fiscal intermediary is the organization that handles the money and paperwork side of self-direction. It runs payroll, taxes and insurance for workers the participant chooses and manages. Michigan uses two names for the same idea. The CMS waiver list shows "fiscal intermediary" for MI Choice and MI Coordinated Health, and "financial management services" for the Habilitation Supports Waiver, the Children's Waiver Program and the children's serious emotional disturbance waiver.

• Home Help: MDHHS defines an individual caregiver as the direct care worker employed directly by the beneficiary. The caregiver enrolls in CHAMPS (the state's Medicaid provider system), passes a background check and submits directly to Michigan Medicaid to be paid.
• Waivers and behavioral health: the participant, or a parent or guardian for a child, hires and manages the workers, and a fiscal intermediary pays them. We did not confirm the state's own wording on who is the employer of record, because it sits in documents we could not read.
• Vendors: we did not find a statewide list of fiscal intermediaries. Two say on their own sites that they work in Michigan. GT Independence lists MI Choice, community mental health waiver programs, the Children's Waiver Program and MI Coordinated Health. Community Living Network, a program of Community Alliance, says it is contracted with 9 local community mental health agencies and serves the Children's Waiver Program. Others may operate in the state.

We did not find a state statement on whether participants choose among fiscal intermediaries. Each waiver agency, health plan and community mental health agency appears to contract its own, so the choices likely depend on where the person lives and which program serves them. Ask that agency or plan which fiscal intermediaries it uses.

Who can be a paid caregiver under self-direction in Michigan?

Family members can be paid in Michigan, with limits that depend on the program. Home Help has the clearest rule: the client picks the caregiver, but the caregiver cannot be the client's spouse or a parent caring for a minor child. For the other programs, most of the rules sit in documents we could not read.

• Home Help: the MDHHS Home Help page says the caregiver must be at least 18, cannot be the client's spouse, cannot be a parent caring for a minor child and cannot be someone who also receives Home Help.
• MI Choice: a person can be paid to care for a loved one through self-determination. A MI Choice waiver agency says there are specific requirements for when a spouse or legally responsible person can be paid, but it does not publish them. Ask the waiver agency that serves the participant.
• MI Coordinated Health, Habilitation Supports Waiver, Children's Waiver Program and behavioral health self-directed services: we did not find a readable state source on whether a guardian, a spouse or a parent of a minor child can be paid. Ask the health plan or the community mental health agency, or write to MDHHS at mdhhs-bhfederalcompliance@michigan.gov for the behavioral health programs.

We did not find confirmed weekly hour caps or overtime rules for self-directed workers in any Michigan program.

Does EVV apply to self-directed workers in Michigan?

Yes. Electronic visit verification (EVV) applies to self-directed personal care in Michigan. The state system is HHAeXchange. As of our last check, payment was not tied to EVV for these services, and live-in caregivers are exempt when the documentation is on file.

• Fiscal intermediaries: a fiscal intermediary that pays direct care workers for EVV-required services in behavioral health, MI Choice or MI Coordinated Health must have a National Provider Identifier (NPI) and enroll in CHAMPS. The individual workers in those programs do not. The fiscal intermediary chooses either the free state HHAeXchange system or its own EVV system connected to it. See the MDHHS EVV program page.
• Behavioral health: EVV covers Community Living Supports and respite when the service starts or stops in the home. Employers of record approve visits in the EVV Services Portal.
• Home Help: individual caregivers have had to use the state HHAeXchange system since September 3, 2024. Home Help is exempt when the client lives with the caregiver, lives in a congregate setting, or receives Home Help and behavioral health services in the same visit. Payment is still based on the older service verification methods until further notice.
• Live-in caregivers: the HHAeXchange Michigan information center says live-in caregivers are exempt when documentation is on file, and that their visits are then left out of the 85 percent compliance calculation.

Michigan was slower to bring self-direction into EVV than agency care. In December 2024, MDHHS told providers that the state system could not yet support self-directed arrangements and that payment and compliance penalties would wait. Onboarding for fiscal intermediaries ran from February to April 2026, and the Services Portal for self-direction is now live. MDHHS has said the soft launch for personal care continues, self-directed arrangements included.

A state bulletin, MMP 26-10, sets a quarterly goal that 85 percent of visits be verified without manual edits, and a health plan's summary says it applies to fiscal intermediaries as well as agencies, with a grace period for new users, and not to Home Help individual caregivers. We did not read the bulletin itself and did not find when that grace period ends. Ask MDHHS or the health plan before you plan around it.

What is changing next for self-direction in Michigan?

As of our last check on October 13, 2026, we did not find a dated, final change to self-direction in Michigan. Several items are in motion without a published date. Check each one with MDHHS before you plan around it.

• EVV and payment: MDHHS has signaled that Home Help payment will be based on EVV in the future and that the personal care soft launch will end. No date has been published for either.
• Behavioral health policy: MDHHS says its Self-Directed Services Technical Requirements and the related Implementation Guide are under review, and it points readers to the Medicaid Provider Manual for current policy.
• MI Coordinated Health: MDHHS has posted draft 2027 amendments to the program's waivers on its MI Coordinated Health page. We did not read them, so we cannot say whether they add counties or change the fiscal intermediary service.
• MI Choice: MDHHS has posted a MI Choice waiver amendment for 2026 on its MI Choice provider page and held a public webinar on Structured Family Caregiving in May 2025. We did not confirm whether the amendment was approved, when it would take effect or what it says about family caregivers.

Michigan self-direction sources

• MDHHS: Self-Directed Services (behavioral health and developmental disability)
• MDHHS: Home Help (independent living services)
• MDHHS: Home Help individual caregivers
• MDHHS: MI Choice Waiver Program (provider page)
• MDHHS: MI Coordinated Health program eligibility
• CMS: Michigan waiver fact sheet
• MDHHS: EVV for behavioral health, MI Choice and MI Coordinated Health
• MDHHS: EVV update on self-directed arrangements (December 9, 2024)
• HHAeXchange: Michigan information center

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Michigan EVV requirements

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.