Why We Stopped Accepting Medicaid in 2019 — And What It Means for SE Michigan Families Today

What this is — and what it isn't

This is not a position paper on Michigan Medicaid policy. I'm not a policy analyst, and we don't track current state reimbursement rates closely enough to comment on where they are today. What I can speak to is the experience of one family-owned home care agency in Southeast Michigan that left the Medicaid vendor system in 2019 — and what that decision has meant for the families who call us since.

If you're a family member trying to understand whether your loved one's care can be covered, the practical answer is at the bottom of this page. The story in between explains why the situation is what it is.

The years before 2019

For roughly two decades, Affordable Home Care was a contracted vendor for the Area Agency on Aging 1-B — the regional aging-services agency now known as AgeWays Nonprofit Senior Services. AgeWays administers state and federal funding for seniors across Oakland, Macomb, Livingston, Washtenaw, Monroe, and St. Clair counties, and they coordinate the Medicaid-funded home care that lets eligible seniors stay home instead of moving to a facility.

As an AgeWays vendor, we delivered Medicaid-reimbursed home care to seniors who couldn't have stayed home otherwise. It was meaningful work. The reimbursement rate was lower than what private-pay families were charged, but the volume made the math work, and we believed deeply in the mission.

What changed by 2019

By 2019, two things had happened in parallel. First, the Medicaid reimbursement rate per hour had not kept pace with the rising cost of delivering home care — particularly the cost of paying caregivers a competitive wage in a tight Southeast Michigan labor market. Second, our private-pay client base had grown to the point where the trade-offs of staying in the Medicaid system were harder to justify on strictly operational grounds.

We could have kept the contract, raised hours-per-week minimums for Medicaid clients, and trimmed elsewhere. Other agencies did. But the model we believe in — small caregiver pools, the same person showing up week after week. Real-time communication with families — costs more to deliver, not less. We weren't going to quietly downgrade the experience for one group of families to keep a contract.

So in 2019 we exited the vendor system. We stayed in the AgeWays resource directory, kept the relationship intact. And continue to receive informational referrals from them every year — but we no longer accept Medicaid as direct payment.

What this means for families calling today

Most of the families who reach out to us are paying privately, through long-term care insurance, or through VA benefits. For those families, the 2019 decision is invisible — they get the staffing model and continuity standards we built the business around. And we cross-link to honest information about paying for home care so they can plan accurately.

For families whose loved one's only realistic funding path is Medicaid, our answer is simple and unchanged: call AgeWays at (800) 852-7795. They maintain the current Medicaid-vendor list for the region and can also screen for MI Choice waiver eligibility, which sometimes opens up options families didn't realize they had. Staying-home options for Medicaid-eligible seniors absolutely exist in Southeast Michigan — just not through our agency anymore.

A note on Medicare

Because Medicaid and Medicare get conflated in nearly every family conversation we have, it's worth saying clearly: Medicare doesn't pay for the kind of home care we deliver. Regardless of whether we accept Medicaid. Medicare pays for short-term, medical-skilled home health services under specific discharge conditions — wound care, IV therapy. Physical therapy ordered by a physician — for a defined period after a qualifying event. It does not pay for ongoing personal care, companionship, or live-in support. Our home health care vs. home care guide walks through the distinction in plain language. And the Medicare Advantage breakdown explains what the new "home support" benefits actually cover (and don't).

Why we wrote this

We get the question every week — usually from families who found us through a hospital discharge planner, a pharmacist, or a friend. And who want to know upfront whether Medicaid is in play. The honest answer deserves to live somewhere public, with the full context, instead of being delivered as an awkward sentence in the first phone call. This page is that public answer.

If your situation is uncertain — for example, you're not sure whether your parent qualifies for Medicaid waiver, whether long-term care insurance will cover home care. Or whether private pay is realistic — we're glad to talk it through and point you toward the right resource, even if that resource isn't us. The hospital-discharge checklist is a useful starting point for families navigating a transition home. And the cost calculator gives a realistic monthly range for the level of care your loved one actually needs.