Restore What We Lost Campaign

The Michigan Law That Eliminated
Adult Autism Day Programs

It wasn’t a federal mandate. It was a gap in one state statute.
That gap has a name.
More importantly…it has a fix!!!

Here is what nobody told you when Michigan’s adult autism day programs disappeared.

Federal law did not require it. The HCBS Settings Rule — the 2014 federal regulation that Michigan cited as justification — explicitly permits facility-based day programs if they meet community integration standards. The Centers for Medicare and Medicaid Services said so in writing, in March 2019: “The HCBS settings rules do not prohibit all facility-based day programs.”

Nine states heard that same guidance and kept their programs. Massachusetts, California, New York, Pennsylvania, Colorado, New Jersey, Connecticut, Maryland, and Wisconsin all maintained operational day programs for adults with Level 2 and Level 3 autism under identical federal requirements. Their programs are open today. Their families have services today.

Michigan’s programs are gone. The question worth asking — the one that the Michigan Department of Health and Human Services has never had to answer publicly — is why. The answer lives in a statute that most Michigan families have never heard of.

Part One: What MCL 400.206-400.210 Actually Is

Michigan Compiled Laws 400.206 through 400.210 are part of Public Act 280 of 1939 — the Social Welfare Act, the foundational Michigan statute establishing the entire framework for welfare and Medicaid services in this state. It has governed social services in Michigan for over 85 years.

Within that broader statute sits MCL 400.109c, the specific subsection authorizing Michigan to establish and operate Home and Community-Based Services Medicaid waivers — the funding mechanism that pays for adult autism supports including day programs, community living, respite care, and behavioral services.

MCL 400.109c does several things clearly and explicitly. It authorizes MDHHS to establish waivers. It sets financial parameters. It requires compliance with federal waiver law. It establishes procedural protections for participants.

What MCL 400.109c does not do is say which services those waivers must include. The statute tells MDHHS it can establish “available services to be provided.” It does not say what those services are. It does not say they must include day programming. It does not say day programming cannot be eliminated. That silence — three words that are simply not there — is the entire problem.

Part Two: How the Gap Was Used Against Families

From 2018 through 2024, Michigan’s adult autism day programs disappeared through a sequence of events that looked, from the outside, like federal compliance and pandemic necessity. But the statutory silence in MCL 400.109c is what made those events irreversible.

In 2018, MDHHS identified day programs as “presumptively institutional” under the federal HCBS Settings Rule and began heightened scrutiny reviews. Rather than providing providers with a compliance pathway — the approach taken by Massachusetts and Colorado — MDHHS conducted reviews that led to closure. In that same year, Tri-County Community Mental Health was directed to close seven “Transitions” day facilities.

In March 2020, the pandemic provided both justification and cover. Programs closed under emergency orders. Unlike nine other states that funded systematic reopening and provided technical assistance to providers, Michigan allowed the closures to become permanent through inaction.

By March 17, 2023 — the federal HCBS compliance deadline — the programs were gone. On October 24, 2024, a CMS site visit confirmed that Michigan’s HCBS settings still lacked “full access to the greater community.” Michigan was placed on a Corrective Action Plan. Not one eliminated program has reopened.

Part Three: What Other States Did That Michigan Did Not

The statutory comparison is not complicated. It is not a matter of interpretation. Massachusetts and Colorado simply did something in their state laws that Michigan has never done.

Massachusetts General Laws Chapter 118E, which governs MassHealth waivers, explicitly lists the service types that must be available. The statute names “Community-Based Day Supports,” “Group Day Supports,” and “Individualized Day Supports” as required service categories. That language means MDHHS in Massachusetts cannot unilaterally eliminate day programs. Doing so would require a legislative amendment. The May Institute opened a new day habilitation facility in January 2025. Massachusetts families have services.

Colorado went further still. Colorado Regulation 8.491 does not merely protect day services — it affirmatively defines “Adult Day Services Centers” and “Specialized Adult Day Services” as HCBS-compliant service types with explicit compliance standards. Colorado assumed day programs could meet federal requirements and wrote the standards that would let them do so. Multiple providers operate day programs across Colorado today.

Michigan has neither protection. MCL 400.109c authorizes MDHHS to establish services without saying what those services must be. When federal compliance pressure arrived, Michigan’s department had complete legal authority to eliminate programs rather than redesign them. The statute gave them that authority. They exercised it. Families paid the price.

Part Four: The Fix Is Specific and Achievable

The good news — and there is good news here — is that the problem is surgical. Michigan does not need to rebuild its entire Medicaid system. It does not need federal permission. It does not need to wait for CMS to change policy. It needs one amendment to one subsection of one existing statute.

The amendment adds explicit language to MCL 400.109c stating that “available services to be provided” must include Community-Based Day Support Services, and that those services “shall not be eliminated, discontinued, restricted, or redesignated except by subsequent legislative action.” That language removes MDHHS’s unilateral discretion to eliminate these services. It replicates what Massachusetts and Colorado already have. It requires only a majority vote in both chambers and the Governor’s signature.

Part Five: Who Decides — and How to Reach Them

Three categories of people have authority over this amendment. Each requires a different approach. All three need to hear from families.

Answering the Objections You Will Hear

When you contact these officials, you will encounter resistance. Here is what they will say — and the factual response to each.