At the heart of the matter are the people receiving the care. These are adults with disabilities — often a developmental disability that has impaired them since birth. Often they are the adult children of the caregivers, though they may also be an aged parent. The Anderson Economic Group reports that according to a 2005 survey, “75% of providers stated they had become a home care worker because a family member or close friend was in need of care.”[16]

It has been the policy of Michigan and the rest of the United States that these care recipients get the care that they need in the least restrictive setting available. The United States Supreme Court, in 1999,[17] held that any public policy favoring institutionalization of the disabled amounted to discrimination, and that government agencies should seek the least restrictive living arrangement available. The Supreme Court stated, “[C]onfinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.”[18] This least-restrictive setting means that state public policy favors the disabled continuing to live in the general community — often in their family homes.

In Michigan, there has long been a program that helps people who qualify for Medicaid assistance to receive in-home nonmedical care from nonprofessional caregivers. This is called the Home Help Program:

Home help services (HHS) are provided to enable functionally limited individuals to live independently and receive personal care services in the most preferred, least restrictive settings. Individuals or agencies provide HHS. The services that may be provided consist of unskilled, hands-on personal care for twelve activities of daily living (ADL), (eating, toileting, bathing, grooming, dressing, transferring, mobility) and instrumental activities of daily living (IADL), (taking medication, meal preparation and cleanup, shopping and errands, laundry, housework).[19]

The HHP program has been in place since 1981. Neither the MQHCC, which would be created if Proposal 4 passes, nor its predecessor, the MQC3, is new in this regard. The home-based care program was in place 23 years prior to the creation of the MQC3 and 31 years before Proposal 4 was approved for the November ballot.

In order to qualify for the HHP, a potential recipient needs to first be certified by a physician and then apply to the Medicaid program through the Michigan Department of Human Services.[20] If these requirements are met, a representative of the Department of Human Services conducts an in-home visit with the care recipient.[21] The representative determines which of the 12 activities of daily living — eating, toileting, bathing, etc. — the recipient needs assistance with and whether the applicant caregiver can provide that particular assistance.