Your consideration of Ohio's 1115 Waiver application is appreciated and if you have any questions or need additional information as you review, please do not hesitate to ask. Sincerely, Ohio Department of Medicaid. Town Street, Suite 400 Columbus, Ohio 4321 5. Medicaid.ohio.gov An Equal Opportunity Employer and Service Provider.
- Ohio Home Care Waiver Application
- Ohio Medicaid Waiver Form
- What Is Medicaid Waiver Program In Ohio 2016
- What Is The Medicaid Waiver Program In Ohio
Ohio Home Care Waiver Application
Through Medicaid, Ohio will pay some of the costs of assisted living and home health care for those who qualify for Medicaid long-term care. Assisted living facilities are generally less expensive and less medically intensive than nursing homes, but Medicaid will still only pay some of the costs. Ohio Medicaid is a bit more generous when it comes to home health care services. Home health care can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning.
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To qualify for any of Ohio’s waiver programs, you must have income at or below 300% of the SSI Federal Benefit Rate, or $2,313 per month in 2019. You also must have less than $2,000 in countable assets (see our article on Ohio Medicaid's coverage of long-term nursing care for more detail). If you are married, Medicaid allows your spouse to keep more income and assets.
Medicaid Coverage of Assisted Living Facilities
For some Medicaid recipients, Ohio's Department of Aging administers the Assisted Living Waiver Program to pay the costs of nursing care in an assisted living facility. To qualify, you must be 21 or older, meet the financial eligibility rules described above, and require a nursing facility standard of care.
To receive any waiver services in Ohio, you must show that you require an intermediate nursing facility level of care. To do that, you must show that you need hands-on assistance with at least two of the following activities: bathing, dressing, eating, grooming, moving around, using the bathroom, and taking your medication. You can also meet the level of care requirement by showing that you need skilled nursing care for a medical condition.
If you qualify, Medicaid will pay for many of the services you receive in an assisted living facility, but you will still have to pay your own room and board expenses.
Medicaid Coverage of Home Health Services
If you already receive Medicaid, the regular Medicaid program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you. If you need ongoing home health services to help you perform activities of daily living or manage your medications, Medicaid will not cover that type of help unless you qualify for one of Ohio’s Medicaid Waiver programs or its PACE Program.
Ohio PASSPORT Waiver
If you meet the above financial and level of care requirements, if you are 60 or over, and if your doctor certifies that you are able to live at home safely with assistance, then you may qualify for Ohio’s PASSPORT Waiver Program. In the PASSPORT Program, you can receive help with chores like laundry, help with personal care like bathing and toileting, home-delivered meals, adult day care, emergency response, medical equipment and supplies, counseling, nutritional counseling, independent living assistance, transportation to medical appointments, and nursing care.
After you apply, an assessor will visit your home and decide how much help you need every month and with which tasks. Medicaid will pay for the cost of those services every month. You can have a case manager hire and supervise your care providers, or you can do it yourself under a consumer-directed option. Depending on your income, you may be required to make a monthly contribution to the cost of your services.
Ohio Home Care Waiver Program
If you are 59 or younger, meet the above financial requirements and require a nursing facility level of care, but can stay in your home if you get assistance, you may qualify for Ohio’s Home Care Waiver Program. You must show that you would have to move to a nursing facility if you did not receive the waiver services in your home. If you qualify, you can receive case management services, nursing services, personal care services, skilled therapy services, changes to your home to make it more accessible, assistive devices, emergency response systems, home-delivered meals, adult day health care, respite care, and transportation.
To find out more about the PASSPORT or Home Care Waiver programs, contact the Area Agency on Aging serving your community.
Ohio has other waiver programs for individuals with developmental disabilities. For more information about those, contact your county’s Board of Developmental Disabilities.
Ohio’s PACE Program
Ohio operates a Program of All-Inclusive Care for the Elderly (PACE), serving the Cleveland area. To qualify for PACE, you must be 55 or older, live in the Cleveland area, meet the nursing home level of care, and be able to live safely in the community (at home) with PACE services. If you do not qualify for Medicaid, you can pay for PACE services on your own.
PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. If you receive Medicaid and participate in the PACE Program, Medicaid pays for all of the services recommended by your care team. If you are interested in the PACE program, contact PACE directly to apply.
Wanting to Move Out of a Nursing Home?
Ohio operates a program called HOME Choice that helps people move out of institutions and into less restrictive settings. If you have lived in an institution for at least 90 days, meet the nursing facility level of care, but want to live in your home or in a community-based setting, then you might qualify for assistance from the HOME Choice program.
Ohio Medicaid Waiver Form
HOME Choice provides funding for things like moving expenses, transportation costs, modifications to your home or vehicle, medical supplies, and other services intended to help you live independently.
To find out more, contact your local Area Agency on Aging.
Supportive Services for Ohioans Who Do Not Qualify for Medicaid
If you don't qualify for Medicaid or don't meet the nursing home level of care, you may still qualify for some personal assistance services if you need help with activities of daily living like eating, dressing, or bathing. Ohio’s Area Agencies on Aging administer various programs that offer services like transportation, meals, and personal care services. Contact your local Area Agency on Aging to find out more.
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Page Reviewed / Updated - Feb. 2019
What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through 'Medicaid Waivers,' which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through 'Medicaid Waivers,' which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Waiver Description
The Ohio Medicaid PASSPORT waiver program allows seniors that require a nursing facility level of care to remain living at home, or the home of a family member, and receive care in those locations. Seniors are able to live a higher quality of life, as this program provides them with care services and other benefits to promote independence. In addition, the state of Ohio saves money by leveraging the caregiving provided by friends, spouses, and family members. Unfortunately, the state caps the amount of money spent on a senior in the program each month. The cost of care provided at home cannot exceed 60% of the cost for that same care, if it were provided in a nursing home.
The types of care paid for under PASSPORT includes personal care, both at home and in adult day care settings, and independent living support, such as home delivered meals, laundry, housekeeping, etc. Also covered is medical equipment, disposable supplies, and transportation assistance for doctors’ visits and medical appointments.
Under PASSPORT, family members can be hired to provide personal care.
The PASSPORT Program now permits consumer direction of services. This allows the beneficiary to have a degree of control over who provides him or her with care services. Friends and certain family members, excluding one’s spouse or legal guardian, can provide non-skilled care services, such as personal care. Most relevant, the adult children of elders are able to provide care. However, Medicaid only pays a standard rate between $10 and $14 per hour for their caregiving.
PASSPORT is an acronym for Pre-Admission Screening System Providing Options & Resources Today. This program is under the administration of the Ohio Department of Aging and is managed locally by the Area Agencies on Aging.
***Persons who are dually eligible for Medicaid and Medicare, and live in a county where the Integrated Care Delivery System (ICDS), also referred to as MyCare Ohio, is available, are not eligible for the PASSPORT waiver. Rather, one can receive all of the same services via MyCare Ohio, a mandatory managed care program. Learn more here.
Did You Know? Ohio residents can receive free quotes for bathroom modifications, such as the addition of a walk-in tub to help them remain living safely in their homes. Learn more.
Eligibility Guidelines
In addition to being an Ohio resident and aged 60 or older, this waiver has both disability requirements and financial restrictions. (Individuals between the ages of 60 and 64 must be physically disabled). In addition, all applicants are assessed to determine if they require the level of care found in nursing homes. This typically means they need significant assistance with the Activities of Daily Living. Persons with dementia or Alzheimer's do not automatically qualify, although their care needs are assessed under special procedures.
The financial guidelines for the PASSPORT Waiver are the same as Ohio Institutional (nursing home) Medicaid limits. An individual's gross monthly income must be less than three times the Federal Benefit Rate (FBR), which as of 2019, is $2,313. When both spouses of a married couple need care, the income of each spouse is considered separately. Stated differently, each spouse is allowed up to $2,313 / month in income. Even when just one spouse of a married couple needs care, only income in the name of the applicant is counted towards the income limit. In some cases, the applicant spouse is also able to allocate some of his or her monthly income to the non-applicant (community) spouse. This is called the Monthly Maintenance Needs Allowance. It is intended to prevent the community spouse from having too little income in which to adequately live. As of 2019, up to $3,160.50 / month can be transferred to the community spouse from the applicant spouse.
The total value of an individual’s countable assets cannot exceed $2,000. For a married couple with both spouses as applicants, the income limit is slightly higher at $3,000. Unlike with income, assets are considered jointly owned. However, one's home is not included as a countable asset provided the owner, or his or her spouse, lives in the home and the value of their real estate does not exceed $585,000. Another exception to the $2,000 limit is when the individual is married and his or her spouse is not seeking benefits under Medicaid. In this situation, the non-applicant spouse can have up to $126,420 in joint countable assets. This is called the Community Spouse Resource Allowance.
It is possible for persons with income or assets greater than these limits to qualify for the PASSPORT waiver. By getting Medicaid planning help, applicants can re-allocate income into a qualified income trust and assets into Medicaid exempt annuities, burial plans, and other non-countable resources. Learn more about this option.
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Persons ineligible for PASSPORT might be able to receive services under Ohio's Older American Act.
Benefits and Services
Worcester bosch highflow 400 rsf problem. All applicants are screened to determine their eligibility and for which services they might be eligible. The case manager and the participant work out the details of the care plan together. Possible services include the following. Certain, unskilled services are available for self-direction.
- Adult Day Care
- Chore Services
- Community Transition Services
- Disposable Medical Supplies
- Durable Medical Equipment
- Home Delivered Prepared Meals and Nutritional Counseling
- Home Modifications
- Homemaker Assistance (such as Laundry or Housekeeping)
- Personal Care
- Personal Emergency Response Service
- Pest Control
- Respite Care (Out-of-Home)
- Social Work Counseling
- Transportation (Medical Appointments and Non-Medical
How to Apply / Learn More
While this program is available statewide across Ohio, there is a cap on the number of available participants. Approximately 35,000 individuals are provided services simultaneously. However, even at that capacity, the state may run out of slots for qualified persons. Applicants placed on a waiting list will have to wait for a space to open when someone leaves the program.
What Is Medicaid Waiver Program In Ohio 2016
Ohio residents should contact their local area agency on aging to apply or call the Department of Aging at 1-866-243-5678. The program webpage provides additional details about this waiver.
What Is The Medicaid Waiver Program In Ohio
Ohio residents may also want to consider the Ohio Medicaid supported Assisted Living Waiver.