How Michigan pays for disability services

Waiver inventory

Excluded as aging or physical-disability programs: MI Choice Waiver (0233.R06.00, nursing facility level of care, 20,196 unduplicated recipients in waiver year 10/1/2024 to 9/30/2025 at $22,557.28 average per participant) and MI Coordinated Health HCBS Waiver (1126.R02.00). Source: medicaid.gov and michigan.gov

SEDW is listed for completeness but serves a serious emotional disturbance population, not an IDD population.

Michigan's Medicaid autism benefit (applied behavior analysis) is delivered through the PIHP system rather than through the HSW. I did not retrieve a document establishing its specific authority, so it is not asserted here.

HSW services (13 to 16 depending on the document generation): Community Living Supports; Out-of-Home Non-Vocational Habilitation; Supports Coordination; Respite Care; Supported Employment (being split into Individual Supported Employment and Small Group Employment); Enhanced Medical Equipment and Supplies; Enhanced Pharmacy; Environmental Modifications; Family Training; Goods and Services; Personal Emergency Response System; Private Duty Nursing; Vehicle Modification (becoming standalone); Financial Management Services (renamed from Fiscal Intermediary). Prevocational Services is being removed with a six-month transition. Source: michigan.gov

State-only funded programs

Not identified with dollar figures. Michigan appropriates state general fund dollars to Community Mental Health Services Programs (CMHSPs) for non-Medicaid services under the Michigan Mental Health Code, which is the principal state-only stream for people with IDD who are not Medicaid eligible or whose needs exceed Medicaid coverage. I could not retrieve the FY2026 MDHHS behavioral health appropriation detail before the web search budget for this session was exhausted.

What I checked: the MDHHS mental health and specialty behavioral health pages (https://www.michigan.gov/mdhhs/keep-mi-healthy/mentalhealth/specialty-behavioral-health-services), the MDHHS Medicaid waivers hub (https://www.michigan.gov/mdhhs/keep-mi-healthy/mentalhealth/mentalhealth/medwaivers), the HSW proposed policy bulletin, and the MI Choice 1915(c) application. None carry a state general fund figure. Michigan House and Senate Fiscal Agency budget analyses would be the right next source.

County / regional / local funding

Michigan is the most county-dependent of these three states. Three distinct sub-state streams:

1. CMHSP / PIHP structure. Services for people with IDD are delivered by county-based or multi-county Community Mental Health Services Programs, which are units of local government created under the Michigan Mental Health Code. CMHSPs are organized into regional Prepaid Inpatient Health Plans that hold the Medicaid capitation contract with MDHHS and receive and allocate HSW slots. Examples of PIHP entities visible in the sources: Community Mental Health Partnership of Southeast Michigan (https://www.cmhpsm.org/hsw), Detroit Wayne Integrated Health Network (https://dwihn.org), Mid-State Health Network (https://midstatehealthnetwork.org). HSW slots are allocated by PIHP region, and MDHHS monitors and reallocates slots against a 95 percent utilization target (https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/Public-Comment/2025/2533-BH-P.pdf).

2. County mental health millages. Voter-approved property tax levies dedicated to mental health, developmental disability, autism, and substance use services. - Washtenaw County Public Safety and Mental Health Preservation Millage. Approved 2017 by a 2-to-1 margin, revenue available January 2019, renewed by voters in 2024 through 2037. Generates roughly $5 million to $7 million annually. Funds crisis response, psychiatric services, housing, youth programs, prevention, substance use treatment, and partnerships with 22 community organizations. Between 2018 and 2023 adults served rose 147 percent and youth served rose 104 percent. Sources: concentratemedia.com (secondary) and chrt.org (secondary). - Ottawa County Community Mental Health Millage. First approved March 8, 2016 with 59.3 percent support, revenue starting with winter 2017 taxes, final payment of the original authorization received December 2025. A renewal and restoration proposal passed on August 5, 2026 with approximately 64 percent support, explicitly covering services for people with mental illness, developmental disabilities, autism, and substance use disorders. Funds services for uninsured residents, jail psychiatric care, Senior Reach, the Holland Drop-In Center, housing assistance, and social recreation programs for adults with disabilities. A $300,000 millage investment in Ottawa Pathways to Better Health leverages over $900,000 from other partners. Sources: miottawa.org and content.govdelivery.com Millage rate in mills and annual revenue were not published on either page. County tax rate tables: miottawa.org

3. County general fund contributions to CMHSPs. The Michigan Mental Health Code has historically required a local match for state general fund CMHSP dollars. I could not verify the current match percentage from a retrieved source, so no figure is given.

Funding scale

• Total annual IDD/DD spending, all funds: Not found. Michigan does not publish an IDD-specific total separate from the behavioral health capitation.
• Medicaid HCBS DD waiver spending: Not found. HSW dollars flow inside PIHP capitation payments rather than as a separately reported waiver expenditure line in the documents retrieved.
• HSW capacity: 7,481 slots statewide at any point in the year, allocated by PIHP region (https://ddi.wayne.edu/mi_ocean/habilitation_supports_waiver_-_parents_group.pdf). CMHPSM describes approximately 7,500 beneficiaries served (https://www.cmhpsm.org/hsw).
• HSW term: Current approval period October 1, 2024 through September 30, 2029; originally approved October 1, 1987 (https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82091).
• State vs federal share and FMAP: Not retrieved from a primary source. One secondary advocacy source states about 70 percent of Michigan Medicaid costs are federally covered and that Michigan generates roughly $3 billion in Medicaid funding through provider taxes on hospitals, nursing homes, and managed care organizations (https://duttonfarm.org/2025/09/04/behavioral-health-services-funding-in-michigan/, secondary, imprecise, not a substitute for the published FMAP).
• Spending per participant, HSW: Not found. For contrast, the aging and physical disability MI Choice waiver averages $22,557.28 per participant in waiver year 10/1/2024 to 9/30/2025 (https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Folder1/Folder71/1915-c_HCBS_Waiver.pdf).
• Waiting list: No statewide HSW waiting list count was found. The HSW is slot-limited rather than open-entitlement, and slots are rationed by a priority system favoring people 21 and older needing private duty nursing, children transitioning off the Children's Waiver Program, and people at high risk of institutional placement (https://ddi.wayne.edu/mi_ocean/habilitation_supports_waiver_-_parents_group.pdf). The Children's Waiver Program is described by MDHHS as a federal entitlement program. Slot scarcity, not a published list, is the operative rationing mechanism.

Residential funding detail

Michigan does not fund residential support as a distinct 24-hour residential waiver service the way Massachusetts and Minnesota do. This is the single most important structural fact about Michigan.

How staffed community living is actually paid. People with IDD in Michigan who need 24-hour support typically live in a state-licensed specialized residential setting (adult foster care home or home for the aged with a specialized program certification) or in their own or family home. The staffing and support is billed as Community Living Supports (CLS), an HSW and 1915(b)(3)-style service, plus state plan services. Out-of-Home Non-Vocational Habilitation is the other HSW residential-adjacent service. There is no per diem residential rate cell structure published statewide.

Payment structure. CLS is generally paid on a 15-minute or hourly unit basis by the PIHP, not as an acuity-tiered per diem. Rates are set by each PIHP, not by MDHHS, because the PIHP holds an actuarially sound capitation and subcontracts with providers under its own published payment schedule. Detroit Wayne Integrated Health Network states plainly that it "operates under a standardized rate for services performed" and that "our providers are paid according to the published payment schedules" (https://dwihn.org/sites/default/files/2026-01/provider_manual-23-24.pdf).

Room and board. Waiver dollars cannot pay room and board. In a Michigan specialized residential setting the resident pays room and board from SSI, and Michigan supplements SSI through a state personal care and residential care supplement administered by MDHHS. I could not retrieve the current supplement amount, so no figure is given here. This is a confirmed gap.

ICF/IID. HSW eligibility explicitly requires the participant not be residing in a hospital, ICF/IID, nursing facility, correctional facility, or child caring institution.

Family and in-home settings. The Children's Waiver Program is designed to keep children in the family home and waives parental deeming; it does not fund out-of-home residential.

Rate structure link. Because rates are PIHP-set, the operative published rate documents are PIHP rate charts. Detroit Wayne posts an I/DD Residential Rate Sheet effective October 1, 2025, an Evidence-Based Supported Employment Rate Sheet effective October 1, 2025, and Children's Waiver and SED Waiver services rate sheets effective October 1, 2025 at dwihn.org The individual PDF file URLs are not exposed on the index page.

Comparable service rates

Every cell reads "not published statewide" because Michigan genuinely has no MDHHS fee schedule for HSW services. Each of the regional PIHPs publishes its own. Detroit Wayne is used here as the illustrative example because it is the one whose rate index I was able to retrieve.

Official rate schedule links

• Detroit Wayne Integrated Health Network rate charts index (I/DD Residential Rate Sheet, Evidence-Based Supported Employment Rate Sheet, Children's Waiver and SED Waiver rate sheets, all effective Oct 1, 2025): dwihn.org
• DWIHN provider manual describing the standardized rate approach: dwihn.org
• MI Choice Waiver 1915(c) application with waiver-year cost projections (aging and physical disability, offered as the only Michigan HCBS document retrieved with per-participant dollar figures): michigan.gov
• HSW proposed policy bulletin 2533-BH-P (service redefinitions and slot management): michigan.gov

No statewide MDHHS fee schedule for HSW services was located.

Notable features and flags

• Oct 1, 2024: The HSW's current five-year approval period began, running through September 30, 2029 (https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82091).
• Dec 20, 2024 approval, effective Oct 1, 2024, with a 2025 policy bulletin implementing it: Significant HSW service restructuring. Prevocational Services is being removed with a six-month transition period, a clear sequel to the federal settings rule and employment-first policy. Supported Employment splits into Individual Supported Employment and Small Group Employment. Vehicle Modification becomes standalone. Community Living Supports eligibility and scope are updated. "Fiscal Intermediary" is renamed "Financial Management Services." Source: michigan.gov
• Same bulletin: Eligibility expands to the TEFRA 134 group, people with disabilities age 18 and younger requiring an institutional level of care, which should widen the child pipeline into the HSW. New screening tools are introduced: WHODAS 2.0 for adults and MichiCANS for children. MDHHS is tightening slot reallocation against a 95 percent utilization target, meaning underused PIHP allocations can be pulled and redistributed.
• Sept 2025 guide dated 9/26/25: Michigan published a Comprehensive Health Care Program (MI CHCP) solicitation and applicant guide (https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Inside-MDHHS/MI-CHCP-SA-Guide-v1---92625.pdf, which returned 404 on direct fetch but appeared in search results). This is Michigan's Medicaid managed care reprocurement and is the vehicle in which any behavioral health and IDD carve-in versus carve-out decision would land. This is the single largest structural risk to the current PIHP arrangement and should be tracked directly.
• Aug 5, 2026: Ottawa County voters approved a Community Mental Health millage renewal and restoration with about 64 percent support, explicitly naming developmental disabilities and autism among covered populations. The original 2016 authorization's last payment arrived December 2025, so this closes a funding cliff (https://content.govdelivery.com/accounts/MIOTTAWA/bulletins/423bb95).
• 2024: Washtenaw County voters renewed the Public Safety and Mental Health Preservation Millage through 2037, roughly $5 million to $7 million annually (https://concentratemedia.com/mental-health-millage-means-help-for-more-people-and-a-healthier-community/, secondary).
• Structural capacity flag: With 7,481 HSW slots statewide against a state population near 10 million, the HSW is a rationed program rather than an entitlement. Slot priority favors people 21 and older needing private duty nursing, children transitioning off the Children's Waiver Program, and people at imminent risk of institutional placement.

Confidence

Solid: the waiver inventory with CMS waiver numbers and approval periods, the 7,481 HSW slot figure, the October 2024 HSW service restructuring including prevocational removal and the supported employment split, the fact that Michigan sets no statewide fee schedule for HSW services, and the existence and general scale of the Washtenaw and Ottawa county millages. Estimated: the approximately 7,500 beneficiary figure from CMHPSM is a provider-side description, not an MDHHS count, and the 7,481 figure comes from a Wayne State training deck rather than an MDHHS publication; both should be re-verified against an MDHHS source. Could not find: any dollar figure for total Michigan IDD spending, HSW expenditure, PIHP capitation for the IDD population, state general fund appropriation to CMHSPs, the Michigan FMAP from a primary source, per-participant HSW cost, Children's Waiver Program enrollment, millage rates in mills for either county, the county local match percentage under the Mental Health Code, and the SSI residential care supplement amount. Michigan is by a wide margin the least transparent of these three states on rates and spending, because the money sits inside PIHP capitation. The right next sources are the Michigan House and Senate Fiscal Agency MDHHS budget analyses, the MDHHS PIHP capitation rate certification prepared by Milliman, and each PIHP's own rate charts. The web search budget for this session was exhausted before those could be located.

---