As Michigan’s population ages, hundreds of thousands of adult children, spouses, and family caregivers find themselves confronting a painful emotional and logistical dilemma: an aging parent or loved one needs extensive daily medical supervision, physical therapy, and personal care, but institutional nursing home placement is the last thing anyone wants.

According to demographic studies, over 90% of older Michiganders strongly prefer to “age in place” in the comfort and familiarity of their own family homes.

To make community-based elder care feasible and affordable, Michigan operates one of the nation’s most robust Program of All-Inclusive Care for the Elderly (PACE) networks. Jointly administered by the Michigan Department of Health and Human Services (MDHHS) and the federal Centers for Medicare & Medicaid Services (CMS), PACE provides full-spectrum medical, therapeutic, and social care designed to keep frail seniors out of nursing homes.

This caregiver guide details the statutory eligibility standards for PACE in Michigan, compares PACE against the MI Choice Waiver, and outlines how seniors can access federal Extra Help (LIS) to eliminate prescription medication costs.

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1. What Is PACE and How Does It Work?

PACE is not typical health insurance that simply pays third-party medical claims; it is a fully integrated provider system. When a senior enrolls in PACE, the organization assumes 360-degree legal, clinical, and financial responsibility for the participant’s well-being.

The Interdisciplinary Care Team (IDT)

Every PACE participant is assigned a comprehensive team that convenes regularly to tailor a personalized care plan: * Primary Care Physicians and Nurse Practitioners specializing in geriatrics. * Physical, Occupational, and Speech Therapists. * Registered Dietitians and Nutritional Counselors. * Social Workers and Case Managers. * Home Care Coordinators and Certified Nursing Assistants (CNAs). * Van Drivers and Transportation Specialists.

The PACE Day Health Center

Participants visit the local PACE Day Center between one and five days per week depending on their clinical need. The center features a full primary care clinic, physical therapy rehabilitation gym, recreation rooms, and a commercial dining hall serving hot, nutritious lunches. Door-to-door, wheelchair-accessible vans pick participants up in the morning and return them home in the afternoon.

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2. Operating PACE Organizations Across Michigan

Michigan is home to an extensive network of regional PACE organizations covering major population centers across both peninsulas:

Regional PACE Organization	Michigan Service Area	Center Locations
PACE Southeast Michigan	Wayne, Oakland, Macomb, Washtenaw & Monroe Counties	Detroit, Southfield, Warren, Eastpointe, Pontiac, Sterling Heights, Dearborn
Care Circles (PACE West Michigan)	Kent County & surrounding Grand Rapids regions	Grand Rapids
LifeCircles PACE	Muskegon, Ottawa, and Allegan Counties	Muskegon, Holland
Senior Comm-Unity Care of Michigan	Ingham, Eaton, and Clinton Counties	Lansing
Genesys PACE of Genesee County	Genesee County and surrounding Mid-Michigan	Flint
Great Lakes PACE	Saginaw, Bay, and Midland Counties	Saginaw
Thome PACE	Jackson, Lenawee, and Hillsdale Counties	Jackson
Community PACE at Home	Berrien, Cass, and Van Buren Counties	New Buffalo

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3. Four Statutory Eligibility Requirements

To enroll in Michigan PACE, an applicant must satisfy four mandatory statutory criteria under state and federal law:

1. Age 55 or Older: The program is open to older adults starting at age 55 (unlike standard Medicare which begins at 65).
2. Nursing Facility Level of Care (NFLOC): The applicant must be evaluated by an MDHHS-certified assessor and found to require assistance with Activities of Daily Living (ADLs)—such as bathing, dressing, medication management, mobility, or meal preparation—to the degree that institutional nursing home placement would be required without support.
3. Live in a PACE Service Territory: The participant’s primary legal residence must fall within the specific ZIP codes authorized in the organization’s state charter.
4. Community Safety Standard: The clinical team must determine that the individual can safely reside in their home environment with PACE support services in place.

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4. PACE vs. MI Choice Waiver: Key Program Distinctions

Families frequently ask whether to apply for PACE or the MI Choice Home and Community-Based Services Waiver:

                               ┌────────────────────────────────┐
                               │ Senior Meets NFLOC Care Need   │
                               └───────────────┬────────────────┘
                                               │
                        ┌──────────────────────┴──────────────────────┐
                        ▼                                             ▼
       ┌────────────────────────────────┐            ┌────────────────────────────────┐
       │     Michigan PACE Model        │            │     MI Choice Waiver Model     │
       ├────────────────────────────────┤            ├────────────────────────────────┤
       │ • Must use PACE doctors/clinic │            │ • Keep your own outside doctors│
       │ • Integrated Day Center visits │            │ • In-home aide agency vouchers │
       │ • All meds/rides managed by IDT│            │ • Traditional Part D rx plans  │
       │ • Zero waiting lists in region │            │ • May have regional wait lists │
       └────────────────────────────────┘            └────────────────────────────────┘

• Choose PACE If: The senior needs social stimulation, adult day center activities, comprehensive medical coordination, and seamless wheelchair transit to clinical appointments.
• Choose MI Choice If: The senior has a deeply trusted, long-standing private primary care doctor or specialist whom they refuse to change, as PACE requires utilizing internal staff physicians.

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5. Federal Extra Help (LIS) for Senior Prescription Medications

For Michigan seniors who do not require comprehensive nursing-level care but struggle with the high price of prescription drugs, the federal Extra Help (Low-Income Subsidy / LIS) program provides critical relief:

Income & Asset Limits

• Income Limit: Up to 150% of the Federal Poverty Level (approx. $22,590 for an individual; $30,660 for a married couple).
• Resource Limit: Countable assets (bank accounts, stocks) up to approximately $17,220 for an individual ($34,360 for a couple), excluding your primary home, vehicles, and personal belongings.

Extra Help Benefits

• Eliminates the monthly Medicare Part D plan premium.
• Eliminates the annual prescription drug deductible ($0 deductible).
• Caps copays at nominal statutory amounts: $4.50 or less for generic drugs, and $11.20 or less for brand-name formulary drugs.
• Completely eliminates late-enrollment penalties.

Applications can be submitted directly through the Social Security Administration at ssa.gov/medicare/part-d-extra-help or by contacting your regional Michigan Area Agency on Aging (AAA).

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Frequently Asked Questions (FAQ)

What is the PACE program in Michigan?

The Program of All-Inclusive Care for the Elderly (PACE) is a comprehensive, capitated healthcare model funded by Medicare and Michigan Medicaid. PACE coordinates and provides all medical, social, nutritional, and rehabilitative care—including adult day health centers, in-home personal aides, prescription medications, and door-to-door transportation—enabling nursing-home-eligible seniors to continue living independently at home.

Who is eligible for Michigan PACE?

To qualify for PACE in Michigan, an individual must: (1) Be at least 55 years of age; (2) Be certified by the state as meeting the Michigan Nursing Facility Level of Care (NFLOC); (3) Reside within the designated geographic ZIP-code service territory of an operating Michigan PACE organization; and (4) Be able to live safely in a community setting with PACE support services at the time of enrollment.

How much does the PACE program cost in Michigan?

For seniors who qualify for both Medicare and full Michigan Medicaid (‘dual eligibles’), PACE is 100% free with zero monthly premiums, zero deductibles, and zero copays for any approved medical visit, medication, or therapy. Seniors who have Medicare only or private funds can participate by paying a monthly private-pay capitation fee.

What is the difference between Michigan PACE and the MI Choice Waiver?

Both programs serve nursing-home-eligible seniors living at home. The key difference is that PACE provides all medical care directly through its own dedicated interdisciplinary clinical teams, physicians, and day health centers. The MI Choice Waiver, by contrast, operates as a traditional Medicaid waiver where an Area Agency on Aging funds in-home personal care aides while you keep your existing community physicians.

What is Medicare Extra Help for Michigan senior prescription drugs?

Extra Help (also known as the Low-Income Subsidy or LIS) is a federal program that helps Medicare beneficiaries with limited income and assets pay for their Part D prescription drug premiums, deductibles, and copays. Under expanded eligibility rules, qualifying seniors pay no more than nominal copays (under $5 for generics and around $11 for brand drugs) with zero coverage gap expenses.