The Michigan DHS-390 adult services application is the paper form you use to request Home Help, Adult Protective Services, or Physical Disability Services from the Michigan Department of Health and Human Services. You fill it out, pair it with a DHS-54A medical needs form signed by your doctor, and submit both to the MDHHS office in your county. MDHHS then has 45 days from the date it receives your application to approve or deny it.1Michigan Department of Health & Human Services. DHS-390 Adult Services Application
One scope note before you invest the time: MI Bridges, the state’s online benefits portal, handles food assistance, cash assistance, and healthcare coverage but does not accept the DHS-390. This application is paper only.
Who Qualifies
Two tests govern eligibility: a financial one and a functional one.
On the financial side, you generally need to be enrolled in Medicaid or meet Michigan’s Medicaid income and asset limits. Michigan raised its long-term care asset limit substantially in 2025. For 2026, an unmarried applicant can hold roughly $9,950 in countable assets. These numbers get adjusted, so confirm the current figure with your county MDHHS office or at michigan.gov before you apply.
The functional test asks whether a physical or mental condition keeps you from handling daily life on your own. For Home Help specifically, MDHHS looks at whether you would likely end up in a nursing facility or adult foster care home without in-home support. At least one activity of daily living — bathing, dressing, eating, grooming, mobility, toileting, or transferring — must require hands-on physical help, rated level 3 or higher on the department’s 5-point scale, before Home Help will authorize any hours.2Michigan Department of Health & Human Services. Adult Services Manual – Home Help Comprehensive Assessment
What to Gather Before You Start
Pull these together before you sit down with the form:
- Full legal name, date of birth, and Social Security number for yourself and every person in your household.
- Recent pay stubs, Social Security award letters, pension statements, and anything else showing your monthly gross income. You’ll need to separate earned wages from government benefits.
- Names, addresses, and phone numbers for your primary care doctor and any specialists.
- A current medication list with dosages and frequency.
- If you already have someone in mind to be your paid caregiver, their name and contact information.
You can download the DHS-390 as a Word document from the MDHHS forms and publications page.3Michigan Department of Health & Human Services. Forms and Publications Paper copies are also stocked at any county MDHHS office.
Filling Out the DHS-390
Client Information
Enter your current address, phone number, and date of birth. If you’ll need a translator for later communications, note the language. List every person living at your address along with their Social Security numbers; this is how MDHHS verifies household size and financial eligibility. If you’re applying for someone else as their legal representative, attach proof of your authority, such as a power of attorney or guardianship order.
Income and Financial Details
Report monthly gross income (the amount before any deductions) from each source separately: wages, Social Security, SSI, pensions, rental income, and any other recurring payments. Accuracy matters here, because MDHHS uses these numbers to decide how much help you qualify for and whether you’ll owe a cost share.
Assistance Needs and Preferred Provider
List every task you can no longer do safely on your own: bathing, dressing, meal preparation, laundry, heavy cleaning, managing medications, and anything else that applies. Be thorough. This list shapes the care-hour assessment that comes later. If you’ve already lined up a caregiver (a family member, friend, or aide), put their contact details in the provider section. Naming someone now gives MDHHS a head start on the required background check and provider enrollment.
Authorization and Signature
The authorization section certifies that your information is true and gives MDHHS permission to contact your doctors to verify your medical records. You or your legal representative must sign it.4Michigan Department of Health & Human Services. Adult Services Manual – Adult Services Requirements An unsigned DHS-390 is the single most common reason applications stall at intake. Don’t skip it.
The DHS-54A Medical Needs Form
The DHS-390 doesn’t travel alone. You also need a DHS-54A Medical Needs form filled out and signed by your doctor, nurse practitioner, physical therapist, or occupational therapist. The provider has to be enrolled in Michigan Medicaid.5Michigan Department of Health & Human Services. DHS-54A Medical Needs Form Older references sometimes call this the DHS-391; the current form number is DHS-54A.
Your provider completes several sections:
- Diagnosis and treatment plan, including whether the condition is chronic or temporary.
- How often you need medical appointments, whether the schedule will change, and the expected duration of treatment (or “lifetime” for permanent conditions).
- Mobility and transportation: whether you’re non-ambulatory, need a van with a wheelchair lift, or require an escort.
- A check-off of which daily and complex care tasks you need help with: eating, bathing, dressing, toileting, medication management, catheter care, colostomy care, suctioning, and others.
- The provider signature block, with the date you were last seen, the provider’s printed name and title, their National Provider Identifier, and their signature.
MDHHS won’t process your application if the DHS-54A is missing a signature, date, or provider contact information. Call your doctor’s office early in the process. Depending on the practice, getting the form completed and returned can take a couple of weeks.
Where and How to Submit
Send the completed DHS-390 and DHS-54A together to the MDHHS office in the county where you live.1Michigan Department of Health & Human Services. DHS-390 Adult Services Application You can find the right office through the MDHHS county office directory, which has a searchable listing and an interactive map.6Michigan Department of Health & Human Services. County Offices
You have three delivery options:
- Mail. Certified mail with return receipt gives you proof of delivery if the paperwork ever goes missing.
- In person. Many county offices have secure drop boxes, so you don’t have to wait for a caseworker.
- Fax. Call your local office for the adult services unit’s fax number.
Sending the application to the wrong county office creates delays because the paperwork has to be forwarded through inter-office mail. Some counties also run multiple offices covering different zip codes, so double-check the address first. Keep a photocopy of everything you send.
What Happens After You File
Once your paperwork arrives, an adult services worker schedules a face-to-face visit at your home. The worker verifies the needs you listed on the application by watching how you handle daily activities and interviewing you, your caregiver, and anyone else involved in your care.4Michigan Department of Health & Human Services. Adult Services Manual – Adult Services Requirements The worker fills out a comprehensive assessment that scores each activity of daily living on the 5-point scale. Only tasks scored at level 3 or higher generate authorized care hours.2Michigan Department of Health & Human Services. Adult Services Manual – Home Help Comprehensive Assessment
Be honest and specific during the visit. If you have good days and bad days, describe your worst days. The assessment is meant to capture the help you genuinely need, not a snapshot of your best afternoon. Most Home Help participants qualify for up to 180 hours of care per month, though the actual number depends entirely on what the assessment finds.
MDHHS sends a written determination after the evaluation is complete. An approval notice spells out how many hours were authorized and when services start.
If Your Application Is Denied
If you’re denied, or if you disagree with the number of hours authorized, you have the right to request an administrative hearing.7Michigan Department of Health & Human Services. Bridges Administrative Manual – Hearings You can use the hearing request form that comes with your denial letter, or write a request on any piece of paper and mail it to the State Office of Administrative Hearings and Rules, PO Box 30763, Lansing, MI 48909.8Macomb County Community Mental Health. MDHHS Hearing Request Form The hearing is an impartial review by someone who was not involved in your case, and you can represent yourself or bring anyone you choose to represent you.
Act quickly. The denial letter will state the deadline for requesting a hearing, and missing it forfeits your right to appeal that decision.