1915(i) SPA Waiver Background:

Michigan transitioned all the specialty behavioral health services and supports previously covered under 1915(b)(3) authority to a 1115 Behavioral Health Demonstration and 1915(i) HCBS state plan benefit effective October 1, 2019, with full implementation to begin October 1, 2023. The 1915(i)SPA target groups include individual beneficiaries with a serious emotional disturbance, serious mental illness and/or intellectual/developmental disability.

Eligibility for 1915(i) SPA:

In order to be eligible for 1915(i) services, an individual must meet the following (2) needs-based criteria:

1. Have a substantial functional limitation in 1 or more of the following areas of major life activity:

• Self-care
• Communication
• Learning
• Mobility
• Self-direction
• Capacity for independent living
• Economic self-sufficiency; and

2. Without 1915(i) services the beneficiary is at risk of not increasing or maintaining sufficient level of functioning in order to achieve their individual goals of independence, recovery, productivity or community inclusion and participation.

Each beneficiary’s eligibility is evaluated annually to determine if the individual meets the needs-based criteria for the 1915(i) benefit, which includes an array of services (See below). Each individual service within the benefit will be based on the unique needs of the beneficiary in order to achieve their individual goals of independence, recovery, productivity or community inclusion and participation. 

Process for 1915(i) SPA:

It is required that MDHHS review and approve all 1915(i) waiver requests prior to the start of these services. Following the person-centered planning process, each primary case holder will submit a 1915(i) referral form for LifeWays to submit to the state database. Once approved by the state, LifeWays will enter a banner in LEO stating “1915(i)”. Authorizations are submitted to UM according to current procedure, for medically necessary services. UM will review the medical necessity for the service requested and ensure the 1915(i) banner is present prior to approving the authorization. The effective date of the authorization(s) with 1915(i) service(s) may be after the effective date of the IPOS depending on the approval date of the 1915(i) from the state.

Children’s Services for 1915(i) SPA:

Children under 21 would need to be evaluated and enroll in the benefit if there is an assessed need for respite services. The Medicaid program’s benefit for children and adolescents is known as Early and Periodic Screening, Diagnostic and Treatment services, or EPSDT. EPSDT provides a comprehensive array of services for children and adolescents under age 21, as made available outside of the 1915(i) Waiver. The EPSDT benefit is more robust than the Medicaid benefit for adults and is designed to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible.

1915(i) State Plan Referral Process

1915(i) Training:

A thorough training titled “1915(i) State Plan Amendment” has been created in Relias and will be available on Monday, October 2, 2023. A LIVE training will be required for ALL Supervisors of Primary Case Holders and attendance is encouraged for those Primary Case Holders and staff completing treatment plans.

To register for a live training via Microsoft Teams, click here.

To register for a recorded training, click here.

If you do not have a Relias account, please contact Denae Tracy at denae.tracy@lifewaysmi.org to register for a live training or receive a copy of the recorded training.

1915(i) Questions:

David Lowe, 1915(i) Project Lead, Executive Director, Access & Crisis

Phone: 517.789.1298

Email: David.lowe@lifewaysmi.org