Purpose. To advocate for the rights of elders and educate members of the State Bar, as well as the public, so that all elders can have access to quality legal services.

1. Statutory Background. Michigan statutes governing the Medicaid program are in the Social Welfare Act, MCLA 400.105 et seq., MSA 16.490(15) et seq. The few administrative rules promulgated by the Michigan Family Independence Agency FIA on the Medicaid program are found at 1979 AC, R 400.3351 et seq.

2. Policy Manual. The policies governing eligibility for Michigan's Medicaid program are in the following series of FIA manuals:

a. The Program Eligibility Manual (PEM) contains eligibility criteria and instructions to caseworkers on how to apply them.

b. The Program Administrative Manual (PAM) contains the procedures for handling a person's Medicaid application and ongoing case. Subjects include the application process, verification of eligibility, the legal rights of clients and their representatives, and hearing procedures.

c. The Program Reference Manuals (PRMs) are a set of four manuals containing tables, schedules, forms, publications, reports, computer codes, a glossary, and an index that are cross­referenced in PEM and PAM.

3. Other Important Addresses and Phone Numbers. For questions about a local office's interpretation or application of policies in the manuals, call or write to

a. Michigan Department of Social Services
Office of Financial Assistance Programs
235 South Grand Avenue, Suite 1305
Lansing, MI 48909
(517) 373­2535

b. The manuals are in looseleaf binders and are updated frequently by new and replacement pages. They are available for inspection at each local MDSS office. To obtain information about subscribing to the manuals and their updates, call or write to

Michigan Department of Social Services
Office Services Division
235 South Grand Avenue
P.O. Box 30037
Lansing, MI 48909
(517) 373­0005

c. Information about benefits and coverage under Michigan's Medicaid program is available from

Michigan Department of Social Services
Medical Services Administration
Capitol Commons Center
P.O. Box 30037
Lansing, MI 48909
1­800­638­6414.

4. Forms. The FIA has created other forms to implement the assessment process and to ensure that the asset allowance is determined as of the date of admission. They are

• DSS­4574B, Asset Declaration -­ Nursing Home Resident and Spouse;
• DSS­4585, Initial Assessment and Community Spouse Resource Allowance Record;
• DSS­4586, Community Spouse Resource Allowance Notice; and
• DSS­4588, Initial Assessment Notice.

To obtain copies of the forms, contact your local FIA office or order copies from

Michigan Department of Social Services
Inventory Control, Forms
235 S. Grand
P.O. Box 30037
Lansing, MI 48909
(517) 373­6703

B. The Long Term Care Ombudsman Program

1. Handling Problems and Abuses. One of the best resources for handling problems and abuses with licensed long­term­care facilities is the Michigan Long Term Care Ombudsman Program. Mandated by both the federal Older Americans Act, 42 USC 3001 et seq., and the Older Michiganians Act, MCLA 400.581 et seq., MSA 2.638(51) et seq., the ombudsman program is the advocate for long­term­care facility residents and a public information clearinghouse for anyone with questions about the long­term health care system.

The state ombudsman program's address and telephone numbers are:

Michigan Office of the Long Term Care Ombudsman
Sarah Slocum, State Long Term Care Ombudsman
7109 West Saginaw Highway
P.O. Box 36076
Lansing, MI 48909-8176
Phone: (517) 335-1560

2. Regional Office. Eight regional offices serve the entire state. More than 40 educational brochures on everything from "How to Choose a Nursing Home" or an AFC home to "Medicaid Nursing Home Eligibility for Residents With a Spouse at Home" are available from the ombudsman offices. Each ombudsman office maintains the state­produced statements of deficiency on nursing homes from both survey and complaint investigations.

Southeastern Michigan Area: CITIZENS FOR BETTER CARE 4750 Woodward Ave, Suite 410 Detroit, MI 48201 (313) 832-6387 (800) 833-9548 Fax (313) 832-7407 Counties: Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw, and Wayne	Western Michigan: CITIZENS FOR BETTER CARE 700 36th St SE, Suite 104 Grand Rapids, MI 49548 (616) 245-9451 (800) 782-2918 Fax (616) 245-9409 Counties: Allegan, Berrien, Cass, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa, and Van Buren
Saginaw/Flint Area: CITIZENS FOR BETTER CARE 6722 Curtis Rd, Suite 2 Bridgeport, MI 48722-9726 (989) 746-9216 (800) 284-0046 Fax (989) 746-9251 Counties: Bay, Clare, Genesee, Gladwin, Gratiot, Huron, Isabella, Lapeer, Midland, Saginaw, Sanilac, Shiawassee, and Tuscola	Traverse City Area: CITIZENS FOR BETTER CARE 1609 Park Dr P.O. Box 5946 Traverse City, MI 49596 (231) 947-2504 Fax (231) 947-2518 Counties: Antrim, Benzie, Charlevoix, Emmet, Grand Traverse, Kalkaska, Leelanau, Manistee, Missaukee, and Wexford
Western Michigan: CITIZENS FOR BETTER CARE 700 36th St SE, Suite 104 Grand Rapids, MI 49548 (616) 245-9451 (800) 782-2918 Fax (616) 245-9409 Counties: Allegan, Berrien, Cass, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa, and Van Buren	Lansing/Jackson Area: CITIZENS FOR BETTER CARE 4700 Ardemore, Suite 102B Okemos, MI 48864 (517) 347-7398 Fax (517) 381-8922 Counties: Clinton, Eaton, Hillsdale, Ingham, Jackson, and Lenawee
Alpena Area: NORTHEAST MICHIGAN COMMUNITY SERVICE AGENCY 2375 Gordon Rd Alpena, MI 49707 (989) 356-3474 ext 320 Fax (989) 354-6913 Counties: Alcona, Alpena, Arenac, Cheboygan, Crawford, Iosco, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle, and Roscommon	Upper Peninsula: UPCAP SERVICES P.O. Box 606 Escanaba, MI 49829 (906) 786-4701 (800) 328-7227 Fax (906) 786-5853 Counties: Alger, Baraga, Chippewa, Delta, Dickerson, Gogebic, Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Memominee, Ontonagon, and Schoolcraft

Any person may submit a formal complaint for possible violations of state or federal law to Patients' Rights Investigations and Special Services Unit (called the complaint unit) of the MDPH Bureau of Health Systems. The complaint unit must conduct an unannounced investigation of the allegations within 15 days of receipt of the complaint and report its findings to the complainant within 30 days. MCLA 333.21799a, MSA 14.15(21799a). Because complaints necessitate unannounced visits, they provide the MDPH with the most accurate information about the ongoing quality of care and life within a nursing home.

Complaints should be submitted in writing to
Patients' Rights Investigations and Special Services Unit
Bureau of Health Systems
Department of Public Health
3423 N. Logan
P.O. Box 30195
Lansing, MI 48909
or by calling (517) 335­8511 or (800) 882­6006.

The Bureau of Health Systems can provide other information, such as a directory of all licensed health facilities in the state, copies of statements of deficiencies, and information about construction and life safety standards.

The Medical Services Administration (MSA) of the Michigan Department of Social Services operates the Medicaid enrollment and payment system for nursing homes. The MSA is charged with assuring that only homes that meet state and federal standards are certified to participate in Medicaid.

To report problems with Medicaid bills or payments, call or write
Client Medical Assistance Line
Medical Services Administration
Michigan Department of Social Services
P.O. Box 30037
Lansing, MI 48909
(800) 638­6414

The HCFA of the Department of Health and Human Services operates the Medicare program directly and supervises the states' administration of the Medicaid program.

Health Care Financing Administration
Department of Health and Human Services
Region V
105 West Adams Street, 15th Floor
Chicago, IL 60603­6201
(312) 886­6432

The National Citizens Coalition for Nursing Home Reform (NCCNHR) is a consumer­based nonprofit organization of local and state member groups and individuals. The NCCNHR's major purpose is to improve health care and quality of life for the nation's 1.5 million nursing home residents.

The NCCNHR has a wealth of information about federal and state nursing home regulation. It publishes a quarterly newsletter, The Quality Care Advocate, as well as extensive technical assistance materials on the implementation of the federal nursing home reform law provisions in OBRA '87, Pub L 100­203, 101 Stat 1330­182 (1987).

The address and telephone number are:
National Citizens Coalition for Nursing Home Reform
1424 16th Street NW, #202
Washington. DC 20036­2211
(202) 332­2275
Fax: (202) 332­2949

The National Senior Citizens Law Center (NSCLC) is the federally funded support center for legal services programs on issues affecting the elderly. The NSCLC provides information and technical assistance on a wide variety of legal issues affecting nursing home residents and the regulation of nursing homes. For example, the NSCLC has extensive information on the legality of cosigner requirements, the federal requirements for eviction, and various forms of Medicaid discrimination. The staff people assigned to nursing home issues are Toby Edelman and Patricia Nemore.

To discuss nursing home issues, contact NSCLC's Washington office at:
National Senior Citizens Law Center
1815 H Street NW, Suite 700
Washington, DC 20006
(202) 887­5280
Fax: (202) 785­6792

ElderLaw Report (Little, Brown & Co., Law Division, 34 Beacon St., Boston, MA 02108, (617) 227­0730, (800) 759­0190 ext. 573) (monthly).

NSCLC Washington Weekly (National Senior Citizens Law Center, 1815 H St. NW, Suite 700, Washington, DC 20006, (202) 887­5280) (weekly).

Krauskopf et al., Elder Law: Advocacy for the Aging (West Publishing Corp., 610 Opperman Drive, P.O. Box 64526, St. Paul, MN 55164-0526, (612) 687­7000, 2d ed 1993).

Regan, J., Tax, Estate and Financial Planning for the Elderly (Matthew Bender & Co., 11 Penn Plaza, New York, NY 10001, (212) 967­7707, (800) 833­9844, 1985) (looseleaf, updated semiannually).

Senior Citizens Resource Handbook (State Bar of Michigan Young Lawyers Section and Sixty Plus Elderlaw Clinic, Fall 1991)

Strauss, P., R. Wolf & D. Shilling, Aging and the Law (Commerce Clearing House, Inc., 4025 W. Peterson Ave., Chicago, IL 60646, (312) 583­8500, (800) 835­5224, 1995).

Financial and Estate Planning (Commerce Clearing House) (looseleaf service).

Irish, M., & J. Martin, Michigan Will Drafting (Institute of Continuing Legal Education, 1020 Greene St., Ann Arbor, MI 48109­0444, (313) 764­0533, 1988; Supps 1990, 1991 & 1993).

Stevens, R., G. Maxfield, S. Lind, D. Calfee, Federal Estate and Gift Taxation (Warren Gorham Lamont, Park Square Bldg., 31 St. James Ave., Boston, MA 02116, (212) 971­5000, 6th ed 1991).

Prince, P., et al., Taxation of Estates and Trusts: A Michigan Practitioner's Guide to Post­Death Administration (P. Prince & C. Karr, eds., ICLE, 1994).

Weinstock, H., Planning an Estate (Shepard's/McGraw­Hill, Inc., 555 Middle Creek Pkwy, P.O. Box 35300, Colorado Springs, CO 80935-3530, (719) 488­3000, 3d ed 1988).

Medicare and Medicaid Guide (Commerce Clearing House) (looseleaf service).

Michigan Department of Social Services, Program Eligibility Manual (Forms and Publications, 235 S. Grand, P.O. Box 30037, Lansing, MI 48909, (517) 335­0754) (looseleaf service).

West's Social Security Reporting Service (West Publishing Corp.).

Technical Assistance (National Citizens Coalition for Nursing Home Reform, 1424 16th St. NW, #202, Washington, DC 20036­2211, (202) 332­2275) (subscription service).

Meisel, A. The Right to Die, (Wiley Law Publications, 605 Third Ave., New York, NY 10158, (212) 850­6000 ext. 2497, (800) 225­5945, 1989; Supp 1994).

Choice in Dying, Right to Die Law Digest (200 Varick St., New York, NY 10014, (212) 366­5540) (fact sheets summarizing significant cases, listings of state laws, periodic bulletins).