Self-Determination in Michigan Medicaid: Directing Your Own Home Care

Self-determination in Michigan Medicaid means what the name implies: you determine
your own care. You choose who provides it, when it happens, and how it’s delivered. For
families who want a trusted relative — not a stranger — providing daily care, self determination
is the formal mechanism that makes paid family caregiving possible
within the MI Choice Waiver.

What Self-Determination Looks Like in Practice

Under the standard MI Choice model, a supports coordinator develops a care plan and
connects you with service providers from the MI Choice network. You receive services,
but you don’t control who shows up or when.

Under the self-determination arrangement, you receive a budget based on your
assessed needs and you direct how that budget is spent. You choose your caregiver —
including a family member. You set the schedule. You decide what tasks are performed
and in what order. A fiscal intermediary handles payroll and compliance, but the care
decisions are yours.

In our experience, families who choose self-determination describe the shift as going
from passenger to driver. The care plan still defines the boundaries (authorized
services, total hours, budget limits), but within those boundaries, the participant has
real control.

How Self-Determination Differs from Home Help

Both Home Help and MI Choice self-determination allow paid family caregivers, but they
work differently.

Home Help is simpler: the state assesses your needs, authorizes hours, and you name a
family member as your provider. The state pays them directly. No intermediary budget,
no fiscal agent — just a caregiver, timesheets, and a paycheck.

MI Choice self-determination is broader: you receive a budget that covers not just
personal care but potentially adult day services, home modifications, respite, and other
supports. You manage how that budget is allocated, with a fiscal intermediary handling
the administrative side. The family caregiver is paid through the fiscal intermediary
rather than directly by MDHHS.

The right choice depends on your loved one’s needs. Home Help suits families whose
needs are primarily personal care. Self-determination suits families who want a
comprehensive, customized care package with a family member at the center.

Who Can Use Self-Determination

Self-determination is available to MI Choice participants who are willing and able to
manage their own services — or who have a representative willing to do so. The
participant (or representative) takes on real responsibility: choosing providers,
approving timesheets, managing the budget within authorized limits.

In our experience working with Detroit families, self-determination works best when
there’s an engaged family member — often the one who will also provide some of the
direct care — who can take on the management role. It’s not bureaucratically heavy, but
it does require attention and follow-through.

Getting Started with Self-Determination

Contact the Detroit Area Agency on Aging (DAAA) at (313) 446-4444 to inquire about
MI Choice and the self-determination option. DAAA administers MI Choice in the Detroit
area and can walk your family through the assessment and enrollment process.

CareChoice helps Detroit families navigate the self-determination pathway from intake
to first paycheck.

Talk to CareChoice → Contact our Detroit team

Written by Jailah Johnson, Community Engagement Coordinator | CareChoice

Related: MI Choice Waiver → | Home Help Program → | DAAA Resources →