Every Home Help eligibility conversation eventually comes back to one phrase: “Activity of Daily Living,” or ADL. It’s the hinge the whole program turns on — Medicaid enrollment gets your loved one in the door, but a documented ADL need is what actually unlocks paid hours. Here’s exactly what counts, what doesn’t, and how it gets scored.
At a Glance
– Home Help requires hands-on help with at least one ADL: bathing, dressing, eating, toileting, transferring, grooming, or moving around the home.
– “Hands-on” generally means physical assistance — though cueing and redirection for cognitive conditions like dementia often counts too.
– IADLs (meals, medication reminders, transportation, housekeeping) don’t independently qualify someone, but they matter once the ADL threshold is met.
– A county assessor scores each ADL during the in-home visit, and that score sets the weekly hours you’re authorized for.
– Not sure your loved one’s situation counts? A free eligibility check sorts this out in one conversation.
The Seven ADLs Michigan Evaluates
MDHHS assessors evaluate need across seven core activities: bathing (getting in/out of the tub or shower, washing), dressing (selecting and putting on clothing), eating (getting food from plate to mouth, not meal prep), toileting (getting on/off the toilet, cleaning up), transferring (moving between bed, chair, and wheelchair), grooming (hair, teeth, shaving), and mobility (walking or moving safely around the home).
You don’t need difficulty with all seven — documented need with just one, consistently, is enough to meet the ADL threshold. The number and severity of ADLs affected is what drives how many weekly hours get authorized. See the full eligibility criteria for how this fits with the Medicaid and income requirements.
Physical Help vs. Supervision — Why the Distinction Matters
The state draws a real line between someone who needs a hand physically completing a task and someone who just needs a reminder. Standby supervision alone — “make sure Dad doesn’t fall in the shower” — is a thinner case than hands-on help actually washing and drying.
That said, cognitive conditions change the calculus. If dementia or a related condition means your loved one needs to be physically redirected, guided, or hands-on assisted to safely complete an ADL — not just told what to do — that generally counts as a hands-on need, even if the underlying limitation is cognitive rather than physical. This is one of the more misunderstood parts of the assessment, and it’s part of why Mozyne’s dementia-specialized coaching exists alongside the enrollment help.
IADLs: What They Are and Why They Still Matter
Instrumental Activities of Daily Living — meal preparation, medication reminders, light housekeeping, transportation, managing finances — are real caregiving work, but they don’t independently qualify someone for Home Help. You need at least one ADL need in the picture first.
Once that threshold is met, though, IADL needs absolutely factor into the assessor’s overall picture of how much support your loved one requires, which feeds into the weekly hours authorized and, in turn, what you get paid.
How This Gets Scored at Your Assessment
An MDHHS or county adult services worker visits your loved one at home and walks through each ADL, typically asking questions and observing rather than requiring a demonstration. Documentation matters — if your loved one tends to have better and worse days, make sure the assessor sees a realistic picture, not just a good morning. Our step-by-step guide covers how to prepare for this visit so it reflects real, day-to-day needs.
Frequently Asked Questions
Does dementia automatically qualify someone for Home Help?
Not automatically, but it often qualifies indirectly. Cognitive impairment that requires physical cueing or hands-on redirection for tasks like toileting, transferring, or dressing typically satisfies the ADL requirement, especially where safety is involved. Dementia-specific coaching is available once you’re enrolled.
What if my loved one only needs help with meals and medications?
Instrumental support alone (IADLs like meal prep or medication reminders) doesn’t meet Home Help’s eligibility bar by itself — you need at least one hands-on ADL need as well. See the full eligibility criteria.
Who decides which ADLs count for my loved one?
An MDHHS or county case-worker assessor, during an in-home visit, evaluates and documents each ADL. That assessment — not a self-report — is what determines authorized hours.
Can the ADL need change over time?
Yes. As needs increase or decrease, hours can be reassessed. A denial or a low hour count today doesn’t lock in your loved one’s situation permanently — see our guide to denials and appeals if that’s where you are.
Not Sure Which ADLs Apply to Your Situation?
Most families aren’t sure whether what they’re already doing “counts.” That’s exactly what the free eligibility check is for — tell us what a typical day looks like and we’ll tell you honestly where you stand. Call 313-251-1767 or start online.