DHS-390 and DHS-54A Forms for Michigan Home Help Program

What Are These Forms and Why Are They Important?

If you're applying to get paid as a caregiver through Michigan Medicaid, you'll need to complete specific paperwork, often called CHAMPS caregiver forms or Medicaid caregiver documents. These forms are required by the Michigan Home Help Program to approve you or your loved one for paid caregiving services.

Below you will find the necessary forms required for applying to the Michigan Home Help Program. Click on the links to view or download the forms, and read the descriptions to understand their purpose. If you have any questions, please feel free to contact us.

Adult Services Application (DHS-390)

This form starts the application process for the Michigan Home Help Program. It must be filled out by the applicant or their legal guardian and submitted to MDHHS.

Medical Needs Form (DHS-54A)

This form certifies the need for personal care services. It must be completed by a Medicaid-approved medical professional.

Common Questions:

  • This form names the caregiver. It's part of the “get paid to care” application and is required by the state. Anyone applying to be a caregiver must submit it . Whether they’re a family member, friend, or roommate.

  • It’s completed by the care recipient’s doctor. This medical form proves that daily help is needed (for things like bathing, cooking, or dressing).

  • You’ll need both forms before a caseworker can visit the home. Care Plan Inc can help answer your questions on both forms.

Need Help Completing These Forms?

We help families every day with the forms and approval process.

Questions? We're Here to Help

If you're confused or unsure about which forms to use or how to submit them, our team can help answer your questions.

👉 Contact us or check your eligibility now to get started.