Michigan - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Michigan Department of Health and Human Services (MDHHS) authorizes Community Transition Services (CTS) through a §1915(i) State Plan Amendment and the MI Choice §1915(b)/(c) waivers to fund non-recurring household setup expenses for nursing facility residents moving to community living.

Approval to deliver and bill for these services requires an agency to operate as an organized health care delivery system, such as an Area Agency on Aging (AAA) or Center for Independent Living (CIL), or to secure a subcontract with one of Michigan's 20 designated MI Choice waiver agencies. Applicants must enroll in the Community Health Automated Medicaid Processing System (CHAMPS) as an atypical provider and add the specific CTS specialty before rendering services.

1. Service Definition and Scope

Community Transition Services cover non-recurring expenses necessary to establish a basic household for individuals transitioning from an institutional setting to the community. The service is designed to remove financial barriers to independent living.

CTS strictly excludes room and board payments but covers essential setup costs. Services are authorized based on the individual's person-centered service plan.

• Service Name: Community Transition Services (CTS) or Transition Services.
• Target Population: Medicaid beneficiaries residing in a nursing facility who want to explore community-based living options.
• Covered Expense: Housing and security deposits required to secure adequate accommodations.
• Covered Expense: Household needs including furniture, window coverings, food preparation items, and linens.
• Covered Expense: Health and safety needs such as pest removal, allergen control, and cleaning services.
• Covered Expense: Utility service initiation fees for telephone, electricity, heating, and water.

2. Regulatory and Oversight Agencies

MDHHS oversees the Medicaid program and administers the waivers and State Plan Amendments governing CTS. The department manages provider enrollment and contracts with regional waiver agencies.

Regional MI Choice waiver agencies act as Prepaid Ambulatory Health Plans (PAHPs) to administer the program locally and manage provider networks.

• Primary Oversight: Michigan Department of Health and Human Services (MDHHS) (https://www.michigan.gov/mdhhs)
• Medicaid Enrollment Portal: Community Health Automated Medicaid Processing System (CHAMPS) (http://milogintp.michigan.gov)
• Regional Administration: 20 designated MI Choice Waiver Agencies (https://www.michigan.gov/mdhhs/assistance-programs/healthcare/seniors/michoicewaiver)
• Information Resource: Mi ENROLLS third-party vendor for 1915(i) service information (https://www.michigan.gov/mdhhs)

3. Gatekeeping Prerequisites: Who Can Even Apply

Michigan restricts direct CTS enrollment to specific types of organized health care delivery systems. Independent businesses cannot simply enroll as standalone CTS providers without meeting these structural classifications or securing a subcontract.

Providers must navigate regional procurement processes to join a waiver agency's network.

• Entity Type Restriction: Direct enrollment is limited to Area Agencies on Aging (AAAs), Centers for Independent Living (CILs), and other qualified community-based organizations.
• Network Contracting: Providers not operating as a primary CTS Agency must subcontract under one of the 20 MDHHS-contracted MI Choice waiver agencies.
• Waiver Agency Procurement: MDHHS requires each waiver agency to have an open bid process to enroll willing and qualified providers in their network.
• CHAMPS Registration: The applicant must be eligible to register in MILogin to access the CHAMPS enrollment system.

4. Licensure and Certification Requirements

Michigan does not issue a distinct facility or agency license for Community Transition Services. Instead, agencies are certified through their Medicaid enrollment and their contracts with MDHHS or regional waiver agencies.

Staff acting as Transition Navigators must meet specific professional licensing or credentialing standards outlined in the state plan.

• Agency Licensure: No specific state license exists for CTS agencies; approval is based on Medicaid provider enrollment and waiver agency credentialing.
• Transition Navigator Qualification: Must be a Registered Nurse licensed in the State of Michigan.
• Alternative Navigator Qualification: Must be a Social Worker licensed in the State of Michigan.
• Non-Licensed Navigator Qualification: Non-licensed professionals may qualify if they meet specific education and experience standards outlined in the 1915(i) SPA.

5. Medicaid Provider Enrollment

All providers must be screened and enrolled in CHAMPS, Michigan's web-based Medicaid enrollment and billing system, even if they only receive payment through a Medicaid managed care plan or waiver agency.

CTS providers typically enroll as atypical providers because they provide support services rather than clinical healthcare.

• System: Community Health Automated Medicaid Processing System (CHAMPS) (http://milogintp.michigan.gov)
• Provider Category: CTS agencies generally enroll as atypical providers because they provide support services and do not require an NPI.
• Enrollment Action: Currently enrolled atypical providers must submit a modification in CHAMPS to add the CTS specialty.
• Required Instruction Manual: Atypical Agency Modification Instructions or Facility/Agency/Organization (FAO) Enrollment Instructions.
• Fee: There is no application fee to enroll as a Medicaid provider in Michigan.

6. Staffing, Training and Background Checks

Staff delivering CTS must meet baseline qualifications established by MDHHS. Waiver agencies are responsible for verifying these qualifications during the credentialing process.

Background checks and basic safety training are mandatory for all personnel interacting with participants.

• Age Requirement: All workers must be at least 18 years old.
• Relationship Restriction: Workers cannot be a legally responsible relative of the participant.
• Background Screening: Reference and background checks are required for self-determined providers and agency staff.
• Training Requirement: Staff must be trained in universal precautions and blood-borne pathogens.
• Communication Standard: Workers must have the ability to communicate effectively with the participant.

7. Documentation, Policies and Records

CTS providers must maintain strict documentation to justify the one-time expenses and ensure they align with the participant's person-centered service plan.

MDHHS provides specific forms and checklists that agencies must use to document service delivery and participant notifications.

• Service Plan Alignment: All transition expenses must be documented and approved in the individual's person-centered service plan.
• Required Form: CTS DME Checklist for durable medical equipment purchases.
• Required Notice: Community Transition Services Adequate Action Notice.
• Required Notice: Community Transition Services Advanced Action Notice.
• Participant Material: Agencies must provide the CTS Participant Handbook to beneficiaries.

8. Billing, Rates and Claims

Reimbursement for CTS is governed by the MDHHS fee schedule and the specific authorizations granted by the waiver agency.

Providers bill through CHAMPS or submit claims directly to their contracted waiver agency depending on their enrollment structure.

• Rate Setting: Rates and limits are published in the Community Transition Services Program Grid & Fee Schedule.
• Billing System: Claims for direct fee-for-service are submitted through CHAMPS (http://milogintp.michigan.gov).
• Managed Care Billing: Providers subcontracted under a MI Choice waiver agency submit claims directly to that Prepaid Ambulatory Health Plan.
• Coding: Providers must use the Healthcare Common Procedure Coding System (HCPCS) procedure codes specified in the CTS fee schedule.

9. Approval Sequence and Timeline

The approval process begins with establishing the appropriate organizational structure, followed by CHAMPS enrollment and waiver agency contracting.

Timelines depend heavily on the waiver agency's procurement cycle and the provider's ability to complete the CHAMPS enrollment accurately.

• Step 1: Establish the entity as a CIL, AAA, or qualified community-based organization.
• Step 2: Create a MILogin account to access the state's systems.
• Step 3: Complete the Facility/Agency/Organization (FAO) or Atypical enrollment application in CHAMPS.
• Step 4: Submit a modification to add the CTS specialty if already enrolled as an atypical provider.
• Step 5: Respond to an open bid process from a regional MI Choice waiver agency to secure a network contract.

10. Common Denials and Survey Findings

MDHHS and waiver agencies conduct Clinical Quality Assurance Reviews (CQAR) to ensure compliance. Providers face denials or corrective actions if documentation does not match billed services.

Strict adherence to the person-centered service plan is required to avoid recoupment of funds.

• Documentation Mismatch: Findings occur when the service record does not match approved Medicaid encounter data by date, amount, duration, or type of service.
• Service Plan Discrepancy: Denials happen if billed transition expenses are not explicitly included in the person-centered service plan.
• Unqualified Staff: Using Transition Navigators who lack the required RN, Social Worker, or specified non-licensed credentials.
• Prohibited Expenses: Billing for room and board, which is strictly excluded from CTS reimbursement.

11. Key Contacts and Resources

Providers should utilize MDHHS online resources, policy bulletins, and direct contact lines for guidance on CTS enrollment and billing.

The CHAMPS provider support line is the primary resource for technical enrollment issues.

• MDHHS CTS Information Line: (833)-686-7700
• MDHHS CTS Email: [email protected]
• CHAMPS Provider Enrollment: http://milogintp.michigan.gov
• Provider Enrollment Support: 1-800-292-2550
• Policy Resource: Michigan Medicaid Provider Manual (https://www.michigan.gov/mdhhs)

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