Choosing the right care setting is just the first step. For families in Oakland and Macomb Counties, the next, and often most critical, concern is: How will we pay for it?

The cost of long-term care in Michigan can vary by thousands of dollars depending on the setting and the level of medical services required. Furthermore, how each facility charges for care dictates which government benefits—like Medicaid or VA Aid and Attendance—can be used to cover the expense.

As an elder law attorney in Troy, Michigan, I help families navigate the complex rules governing private pay, insurance claims, and government aid. Here is an essential guide to the cost structures and available payment sources for Adult Foster Care (AFC), Assisted Living (HFA), Memory Care, and Skilled Nursing Facilities (SNFs) in Metro Detroit.

The Cost Baseline: Private Pay Rates in Metro Detroit

The vast majority of residents begin by paying for long-term care privately (out-of-pocket). Costs in the Oakland and Macomb County area are typically at or above the statewide averages.

Available Funding Sources in Michigan

When private funds are insufficient, families turn to three primary non-private sources for long-term care: Long-Term Care Insurance, VA Benefits, and Medicaid.

Long-Term Care (LTC) Insurance

How it works: Policies pay a daily or monthly benefit amount once the insured meets the "trigger" criteria, which usually require a medical professional to certify that the individual needs substantial assistance with at least two Activities of Daily Living (ADLs).

Applies to: Any setting—home care, AFC homes, assisted living, or nursing homes—as long as the facility is properly licensed and the services meet the policy's criteria.

Key Consideration: Policies are contracts. Before admitting a loved one, it is critical to confirm that the chosen facility's services and licensing meet the specific policy requirements to ensure a smooth claim process.

VA Aid and Attendance (A&A) Pension

How it works: Aid and Attendance is a tax-free monthly supplement added to a veteran's or surviving spouse's basic VA pension. It is designed to help those who require the aid of another person to perform activities of daily living (ADLs) or are housebound.

Financial Eligibility: A&A is a means-tested benefit with limits on both income and net worth. Importantly, money paid for care services (Assisted Living, AFC, in-home care, etc.) can be deducted from income when determining eligibility, making it easier for veterans paying for high-cost care to qualify.

Applies to: This cash benefit can be used in any setting, including AFC homes, assisted living, and nursing homes, as it is paid directly to the veteran or survivor and can be used for any purpose, including paying a family caregiver.

The current Aid and Attendance pension rates can be viewed at the Department of Veterans Affairs website.

Michigan Medicaid

Medicaid in Michigan has two distinct pathways for long-term care: one for nursing homes and one for community settings.

Medicaid eligibility—particularly for married couples—is highly technical and often misunderstood. As an Elder Law attorney based in Troy, Michigan, I focus my practice on Medicaid planning, crisis Medicaid planning, and Medicaid applications. For many years, I have helped clients navigate these rules strategically and lawfully, with the goal of protecting a healthy spouse and preserving hard-earned savings while securing the care a loved one needs.

Payment Matrix: How Each Care Setting Is Funded

Understanding the cost structure for each facility is key to maximizing available benefits.

Adult Foster Care (AFC) and Assisted Living (HFA)

These are licensed non-medical residential settings. The cost structure is split: Room & Board (housing, utilities, meals) and Services (ADL help, supervision, medication reminders).

Most Adult Foster Care homes and assisted living facilities in Michigan do not participate in the MI Choice Waiver program. As a result, residents typically must pay privately unless they qualify for VA Aid and Attendance benefits or have long-term care insurance that covers this level of care. Without those funding sources, the resident must have sufficient personal resources to pay for care on an ongoing basis.

Memory Care

Since Memory Care is a unit within an AFC or HFA, the funding sources are the same. However, the higher cost requires greater private resources or a higher-paying long-term care insurance policy/VA benefit to cover the increased specialized care fees.

Skilled Nursing Facility (SNF)

Nursing Homes provide 24-hour medical and custodial care and have the most straightforward—but most expensive—payment model.

Final Step: Why Planning is Essential

For families in Oakland and Macomb Counties, high local costs mean proactive planning is not optional—it is critical. If you are considering a transition to long-term care, speaking with an elder law attorney early is the best way to develop a legal strategy that addresses financial eligibility, protects spousal resources, and minimizes out-of-pocket expenses.

Ready to explore your options?

You can contact me, Andrew Byers, now by using the online form or calling me directly at (248) 469-4261. On this initial call, I'll answer your preliminary questions and get some background information to make sure it's a situation I can help with. After that, you can decide if it make sense to schedule a more in-depth consultation.