Why Some Michigan Care Facilities Don’t Require a License

Some Michigan facilities advertised as assisted living or independent living are allowed to operate under a license exemption rather than an Adult Foster Care (AFC) or Home for the Aged (HFA) license. These facilities may not receive the same state inspections or have violations published through the same public reporting system as licensed AFC and HFA homes.

To be honest, I’m not a lawyer or a licensing expert, so it stumped me at first why they didn't need a license like other facilities. At first, I assumed they were exempt because they didn’t provide personal care, but from the research I’ve done so far, some exempt facilities clearly advertise personal care. In those cases, it appears the housing and care is provided by separate companies, or the facility may be operating under another type of license.

So why can some be listed as "Exempt from Licensing"?

Here is what I found after some more research. An exemption may apply when the room provider and personal-care provider are separate and unrelated, and residents are free to choose their own personal-care provider. Another example is a continuing care retirement community that has multiple levels of care on one campus—such as independent living, assisted living-type services, and a separately licensed nursing home.

Who Oversees Care at License-Exempt Facilities?

With an exempt facility, families need to identify the separate company providing the care and determine which agency or program regulates that provider, rather than relying on one facility-wide licensing system.

Michigan Home Help Agency

For example, if personal care is provided through a Michigan Home Help agency, that agency must be approved by Michigan Department of Health and Human Services (MDHHS) to participate in the program, and MDHHS oversees its compliance with Home Help requirements.

Medicare / Medicaid-certified Home Health Agency

If care is provided by a Medicare- or Medicaid-certified home health agency, Michigan Department of Licensing and Regulatory Affairs (LARA) conducts surveys and complaint investigations on behalf of Centers for Medicare & Medicaid Services (CMS) under federal rules.

Private-Duty / Non-Medical Personal Care Company

If a facility uses a separate private-duty company for help with bathing, dressing, toileting, meals, transportation, or companionship, that company may not have a separate Michigan “home care agency” license just for providing non-medical personal care. Families should ask whether the company participates in Medicaid Home Help or another regulated program, whether its caregivers are individually licensed or certified when applicable, and what complaint process applies.

Licensed Health Professionals

Some care may be provided directly by licensed nurses, therapists, or other health professionals rather than by a facility-wide care company. Those professionals are subject to the licensing requirements of their profession through Michigan’s professional licensing system. For certified home health agencies, Michigan Department of Licensing and Regulatory Affairs (LARA) also conducts federal certification surveys and complaint investigations on behalf of Centers for Medicare & Medicaid Services (CMS).

Investigation of Abuse Regardless of Agency

If the concern involves abuse, neglect, or exploitation of a vulnerable adult, Adult Protective Services (APS) can investigate and coordinate with law enforcement or other agencies.

Takeaway

The law allows these exemptions for a reason, but I’ll admit, it still bothers me a little that some facilities may not be held to the same AFC/HFA licensing standards or have investigation reports published in the same accessible way as other facilities.

I’m definitely not saying exempt facilities are shady. Many independent living communities are exempt simply because they don’t provide the level of supervision or personal care that requires an AFC or HFA license. Some might be operating under a different type of license. For the others, I think families should do a little extra research and decide for themselves. Figure out who oversees the company providing the care, how complaints are handled, and go from there.

My advice is simple: ask every facility AND care company what license they operate under and who regulates. That gives you a much better idea of what rules they have to follow and where you can look if you want to review their history.

These facilities are categorized as SENIOR FACILITY EXEMPT FROM LICENSING on our website.