When the hours are authorized and nobody shows up

Nobody denied anything. That is the part that makes this so hard to fight. Your daughter’s Individual Plan of Service authorizes 28 hours a week of community living supports. Person centered planning produced that number. A clinician signed off on medical necessity. Michigan Medicaid is obligated to fund it. And on Tuesday, and again on Thursday, and for most of last month, nobody came, because the agency cannot hire anyone at the rate it is paid and the person who used to cover those shifts now works at a warehouse for four dollars more an hour with no lifting requirements and no behavioral crises.

There is no denial notice for this. There is no appeal deadline. There is a voice on the phone saying “we’re having staffing issues,” which is true, and which is also the sound a system makes while it transfers 28 hours a week of skilled labor onto you at no cost to itself.

The category error at the center of it

Michigan’s entire due process architecture is built around denials. Adverse benefit determination, written notice, appeal rights, timelines, administrative law judge. It is not a bad system. It works reasonably well for the problem it was designed for.

The problem it was designed for is a state that says no. The problem families actually have in 2026 is a state that says yes and then does not deliver. Those are different failures and only one of them has a form.

The practical consequence is that the largest service failure in Michigan’s developmental disability system generates no data. Denials are counted because appeals count them. Undelivered authorized hours are counted by exactly nobody, statewide. When a legislator asks MDHHS how bad the problem is, there is no number to hand them, so the answer comes back qualitative and the appropriation comes back unchanged.

What Waskul actually did, and what it did not

The Waskul litigation against Washtenaw County Community Mental Health and the state produced a settlement approved by the federal court in January 2025, and it is the most important thing to happen to Michigan community living supports in a decade.

The self-direction CLS rate went from $20.44 an hour to $31, an increase of about 52 percent. Overnight health and safety support moves to 70 percent of the new CLS rate. The settlement requires at least $22 million a year in additional expenditures and more than $110 million across its five year term. When the term ends in 2029, individualized costing out procedures take effect, meaning each person’s self-determination budget has to be built from what that person actually needs rather than from a regional average.

That last provision is the sleeper. Costing out means a budget line has to be defensible person by person. It is the mechanism most likely to survive the settlement itself.

Here is what Waskul did not do. It did not create workers. A rate that finally approximates the labor market is necessary and it is not sufficient, because the people who left this field between 2020 and 2024 took jobs, got trained, got benefits, and are not sitting by the phone. Rate repair works on a multi year lag. Your family is living in the lag.

The four moves that actually change something

Move one: write it down, weekly, forever. Date, scheduled hours, delivered hours, who you told. One page. I cannot overstate how much this changes the conversation. Priya’s eleven weeks of frustration became actionable in week twelve for exactly one reason, which is that she switched from calling to emailing and every email contained a number.

Move two: request an IPOS review in writing, citing undelivered services. Person centered planning is not a once a year ritual, and you can request a review when circumstances change. Chronic non delivery is a change in circumstances. The review forces the CMH to document, on the record, what it intends to do about a plan it cannot execute. Sometimes what it intends to do is add a second provider, which it would not have done if you had not made it write something down.

Move three: file a Recipient Rights complaint. Every Michigan CMH is required to maintain an Office of Recipient Rights that accepts complaints, investigates, and issues written findings. Families almost never use this for service non delivery because they assume it is only for abuse and neglect. Failure to provide services in the plan of service is within scope. Even when the finding does not fix your staffing, it creates an official document stating that authorized services were not delivered, and that document is the raw material for everything that comes after.

Move four: ask about self-direction, seriously. Under self-determination you control the budget and recruit your own staff. This is not magic. There is no hidden pool of direct support professionals waiting for you to find them. What it does change is who is doing the recruiting and what network they are recruiting from. Families routinely hire people the agency would never have reached: a neighbor, a former aide, a relative, someone from church who already knows your son. Waskul’s rate increase applies here, and $31 an hour recruits differently than $20.44 did.

Why Oakland County is the tell

For years Oakland County was the answer when somebody asked whether any Michigan county had this figured out. Relatively strong funding, strong provider network, no waiting lists.

The Arc of Oakland County’s executive director now describes waiting lists in every aspect of a person with a disability’s life: vocational services, community living supports, respite, residential placement. Providers report that management and leadership regularly work direct care shifts themselves because there is nobody else. Workers cross county lines for marginally better rates, which means counties now compete with each other for a workforce that is too small in aggregate for any of them.

When the best resourced county in the state runs waiting lists, the diagnosis is not local mismanagement. It is a rate structure and a labor market that no county can solve alone. Which is exactly why this has to go past your case manager and into budget and legislative channels, and why the log you start tonight has a second job beyond your own family.

The honest closing

I am not going to tell you that the escalation ladder in this post gets your 28 hours staffed. Sometimes it does. Often what it gets you is a second provider covering part of the gap, a plan review that adds respite, or a documented record that wins you something eighteen months later.

What it always does is convert your family’s private catastrophe into a countable event. Right now Michigan has no idea how many authorized hours go undelivered every week, and that ignorance is load bearing. It is the reason the budget can fund wages and call the job done.

Start the log. Send the email. File the complaint. You are not being difficult. You are creating the only data anyone will ever have.