Medicaid for Ohioans Needing Assisted Living or Home Health Care

Page 2 of 2 of When Ohio Medicaid Pays for Long-Term Care, Assisted Living, or Home Care

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.

To qualify for any of Ohio’s waiver programs, you must have income at or below 300% of the SSI Federal Benefit Rate, or $2,163 per month in 2014. You also must have less than $1,500 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 do 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 life 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.

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 Ohioians 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 AAA to find out more.

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