Michigan DHS Caregiver Forms

If you are applying for the Michigan Home Help Program, there are two key forms you'll need: the DHS-390 and DHS-54A. These forms are required by the Michigan Department of Health and Human Services to assess eligibility and care needs.

DHS-390: Home Help Services Application

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

  • Basic applicant information

  • Description of care needs

  • Contact details for caregivers

This form helps establish a care plan and initiates the caregiver payment process. A caseworker uses it to build a service plan.

You can download the DHS-390 directly from the MDHHS website or complete it with the help of an agency. The form must be submitted to the client’s assigned MDHHS worker.

DHS-54A: Medical Needs Form

The DHS-54A must be completed and signed by a licensed healthcare provider. It certifies that the individual needs assistance with activities like:

  • Bathing

  • Grooming

  • Mobility

  • Medication reminders

This form helps determine how many hours of support the applicant 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.