Ohio Assisted Living and In-Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Ohio provides long-term care resources to seniors through services and programs administered by the Ohio Department of Aging (DOA). The DOA provides multiple Medicaid Waiver programs to seniors that provide services such as assisted living, in-home care resources, transitional care, and other Medicaid-specific benefits.

In addition, local Area Agencies on Aging, created by the Older Americans Act of 1965, respond to the needs of the elderly in the communities they serve. They are advocates, planners, funders and educators, as well as providers of information and referral services. Area agencies work with public and private partners to respond to the unique needs of older citizens and families in their areas. Ohio hastwelve area agencies, each serving a multi-county planning and service area. Agencies create local plans based on the population and resources in their communities.

Medicaid Waiver Programs for Assisted Living and In-Home Care

Assisted Living Medicaid Waiver Program (HCBS Medicaid Waiver)

This Medicaid waiver program provides services in certified residential care facilities to delay or prevent nursing facility placement. Assisted living promotes aging in place by supporting consumer desire for independence, choice and privacy. The services help preserve the independence of the individual, as well as maintain ties to family and friends.

Services

Services include: 24 hour on-site response, personal care, supportive services (housekeeping, laundry, and maintenance), nursing, and transportation, 3 meals per day and social/recreational programming.

In addition, Community Transition Services are available to individuals leaving a nursing facility to enroll in the Assisted Living waiver and helps them obtain essential household furnishings and other items.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: As a special income limit state, the income and asset limits for Medicaid eligibility are determined by the federal government pursuant to the Social Security Administration. For 2017, an individual can not make more than $2,205 a month in income and may have no more than $2,000 in assets ($3,000 for a married couple) to qualify. Additionally, the non-applicant spouse may keep up to $120,900 in assets and receive up to $3,022.50 in monthly income without affecting the applicant’s financial eligibility. The waiver does allow for a Miller Trust, or Qualified Income Trust, which allows the applicant to place excess income in a trust so that they may meet the income limit and qualify sooner than otherwise.

Practical Considerations

The switch that Ohio made from being a 209(b) state to a Special Income Limit state is very important for Medicaid planning purposes. The income limit can now be worked around using a Miller Trust and opens up more opportunities for people to receive Assisted Living Waiver services. Also, the transition program makes it easy for people to move from a nursing home to assisted living while seamlessly maintaining their institutional Medicaid benefits.

Ohio PASSPORT Medicaid Waiver Program (HCBS Medicaid Waiver)

Ohio's PASSPORT Medicaid waiver program helps Medicaid-eligible older Ohioans get the long-term services and supports they need to stay in their homes. PASSPORT is a two-pronged program. The first part is a pre-admission screening during which interested consumers are screened by telephone to determine preliminary Medicaid eligibility and care needs. They are also provided information about the variety of long-term care options available. The second part of PASSPORT is home care. Once a consumer is determined eligible a case manager works with him or her to develop a package of in-home services to be provided by local service providers. The case manager then monitors the care for quality and changes the care plan as necessary.

Services

Services include: personal care, home delivered meals, adult day care, homemaker, emergency response, medical equipment and supplies, chore, social work counseling, nutritional counseling, independent living assistance, medical transportation waiver nursing and out of home respite care

Eligibility

Generally:

  • Age 60 or older;
  • Financially eligible for Medicaid institutional care (see below)
  1. Health: An applicant must befrail enough to require a nursing home level of care; and be able to remain safely at home with the consent of their physician.
  2. Financial: As aspecial income limit state, the income and asset limits for Medicaid eligibility are determined by the federal government pursuant to the Social Security Administration. For 2017, an individual can not make more than $2,205 a month in income and may have no more than $2,000 in assets ($3,000 for a married couple) to qualify. Additionally, the non-applicant spouse may keep up to $120,900 in assets and receive up to $3,022.50 in monthly income without affecting the applicant’s financial eligibility. The waiver does allow for a Miller Trust, or Qualified Income Trust, which allows the applicant to place excess income in a trust so that they may meet the income limit and qualify sooner than otherwise.

Practical Considerations

The cost of PASSPORT services needed at the time of application cannot exceed 60 percent of the cost of nursing home care. Some costs incurred by the state for PASSPORT care may be subject to estate recovery. All Medicaid services provided to persons age 55 or older are subject to recovery, including physician visits, outpatient visits and home- and community-based waiver services like PASSPORT and all medically related Medicaid services.

The Ohio Department of Medicaid has phased out the Transitions Carve-Out Waiver, effective June 30, 2015. This change resulted in the transition of more than 1,300 individuals from the Transitions Carve-Out Waiver to the PASSPORT Waiver.

To apply, call toll-free 1-866-243-5678 to contact the Area Agency on Aging serving your community for details on how to apply. Interested individuals must complete an application, telephone screen and in-person assessment. Then, your county Department of Job and Family Services will determine financial eligibility. After meeting all eligibility criteria, you will be enrolled (pending slot availability).

Ohio CHOICES Medicaid Waiver Program (HCBS Medicaid Waiver)

On March 1, 2014, consumer directed services became available statewide. Individuals interested in receiving consumer directed services will enroll directly in the PASSPORT program. The Choices waiver program ceased operation on June 30, 2014.

Conclusion

Both the Assisted Living Waiver and the PASSPORT Waiver offer seniors the opportunity to receive Medicaid benefits for long-term care while living in their own community or home. Since Ohio has changed its institutional Medicaid status from a 209(b) state to a Section 1634 state, the use of a Miller Trust and Special Income Limit increase the availability of the program to most seniors.