Michigan DHS Caregiver Forms: Get Approved for Home Help

If you are applying for the Michigan Home Help Program, there are two key forms required by the Michigan Department of Health and Human Services (MDHHS) to assess eligibility and care needs. These forms help determine medical necessity and establish services under the Home Help Program.

DHS-390: Home Help Services Application

The DHS-390 form is used to apply for participation in the Michigan Home Help Program. It requires:

  • Basic applicant information

  • Description of care needs

  • Caregiver contact information

This form initiates the Home Help process and allows MDHHS to assign a caseworker to review eligibility and develop a service plan.

The completed form must be submitted to the client’s assigned MDHHS worker.

MDHHS-6200: Adult Services Medical Needs Certification (replacing DHS-54A)

The MDHHS-6200 form is a new medical needs certification form issued by the Michigan Department of Health and Human Services. It is replacing the DHS-54A and must be completed and signed by an approved, Medicaid-enrolled medical provider.

This form certifies that the individual requires assistance with daily living activities, such as:

  • Bathing

  • Dressing

  • Grooming

  • Mobility

  • Meal preparation

MDHHS uses this form to determine medical necessity and the level of Home Help services an individual qualifies for.

Tips for Filling Out These Forms

  • Use clear, accurate details

  • Attach any supporting medical documents

  • Double-check contact info

  • Include the Medicaid ID number if available

  • Submit all forms together to avoid delays

Where to Submit

Once completed, submit the forms to your local MDHHS office. You can also mail or fax them, depending on your county. Be sure to keep copies of everything submitted.

Get Help with Your Forms

We offer step-by-step support to ensure these forms are filled out correctly, helping you avoid delays in getting approved for paid care. If you need help obtaining the forms or scheduling your doctor’s certification, we can assist you right away.

Having the correct forms filled out is a vital step to receiving caregiver payments through the Michigan Home Help Program. Don’t let paperwork stand in the way of the support you deserve.

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