Ohio Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Ohio, Medicaid is also called Medical Assistance. This article focuses on Ohio Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different from regular Medicaid, which is for financially needy people of all ages.

 

Ohio Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Ohio Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Ohio seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Ohio Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Ohio Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

  A Nursing Home Alternative – Ohio Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Ohio’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In Ohio, the MFP program is called HOME Choice.

 

Home and Community Based Services (HCBS) Waivers

Ohio Home and Community Based Services (HCBS) Waivers will pay for long-term care goods and services that help financially limited Ohio seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Ohio residents who live in their home, the home of a loved one, a residential care facility or an assisted living residence. While Ohio’s HCBS Waivers programs will cover some long-term care benefits in those settings, they will not cover room and board costs.

There are three HCBS Waivers programs that will provide long-term care benefits to Ohio seniors:

  1. PASSPORT Waiver – offers long-term care services in the beneficiary’s home or the home of a loved one
  2. Assisted Living Waiver – delivers long-term care services in residential care facilities and assisted living residences
  3. MyCare Ohio Plan (MCOP) – managed care program for Ohio residents who are both Medicaid and Medicare eligible

1. PASSPORT Waiver
Ohio’s PASSPORT Waiver provides long-term care benefits to Ohio residents who require a Nursing Facility Level of Care but instead live in their home or the home of a loved one. The state of Ohio uses the Adult Comprehensive Assessment Tool to determine if that level of care is needed.

PASSPORT Waiver benefits will be made available depending on the individual’s needs and circumstances. These benefits can include adult day care, home modifications, medical equipment, respite care, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These services can be provided by licensed care workers, or the beneficiary can self-direct and choose their own caregiver, including certain family members. Adult children, adult grandchildren, nieces and nephews can all be hired to provide PASSPORT Waiver services, but spouses and legal guardians cannot.

Unlike Nursing Home Medicaid, Ohio’s PASSPORT Waiver is not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for the PASSPORT Waiver, they are not guaranteed by law to receive the benefits. Instead, there are a limited number of enrollment spots (about 36,000 in 2022). Once those spots are full, additional eligible applicants will be placed on a waitlist. Those who need the most care are given top priority on the PASSPORT Waiver waitlist.

2. Assisted Living Waiver
Ohio’s Assisted Living Waiver offers long-term care benefits to Ohio residents who require a Nursing Facility Level of Care but instead live in a residential care facility or an assisted living residence. The state of Ohio uses the Adult Comprehensive Assessment Tool to determine if that level of care is needed. While the Assisted Living Waiver will pay for services and supports in residential care facilities or assisted living residences, it will not pay for room and board in these settings.

Assisted Living Waiver benefits will be made available depending on each individual’s needs and circumstances. These benefits can include nursing care, homemaker services, social activities, medication management, non-medical transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

The Assisted Living Waiver is not an entitlement, which means eligible applicants are not guaranteed by law to receive the program’s benefits. Instead, there are a limited number of enrollment spots (roughly 5,500 as of 2022), and once those spots are full, additional eligible applicants will be placed on a waitlist. The Assisted Living Waiver is unique in that its waitlist is not statewide but instead each residential care facility or assisted living residence has its own list.

3. MyCare Ohio Plan
The MyCare Ohio Plan is a managed care program for Ohio residents who are eligible for both Medicaid and Medicare, otherwise known as dual eligible, and require a Nursing Facility Level of Care. The MyCare Ohio Plan is also called the Integrated Care Delivery System Medicaid Waiver, or the ICDS Demonstration. Program participants can live at home, in the home of a loved one, a residential care facility or an assisted living residence.

This program provides medical care as well as personal care services and supports and delivers all of that through a single Medicaid plan provided by a managed care organization. MyCare Ohio is available in 29 counties across the state, and each county has several plans individuals can choose from. Those counties are Butler, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Delaware, Franklin, Fulton, Geauga, Greene, Hamilton, Lake, Lorain, Lucas, Madison, Mahoning, Medina, Montgomery, Ottawa, Pickaway, Portage, Stark, Summit, Trumbull, Union, Warren, Wayne and Wood.

For dual eligible Ohio residents (people eligible for both Medicaid and Medicare) who live in one of the counties listed above, enrollment in MyCare Ohio is mandatory. That includes people who are receiving Nursing Home Medicaid, the PASSPORT Waiver or the Assisted Living Waiver. All of those people will continue receiving the same benefits they were receiving through Nursing Home Medicaid, the PASSPORT Waiver or the Assisted Living Waiver, but they will receive those benefits through the MyCare Ohio Plan instead. The only exception to this mandatory enrollment is for dual eligible Ohio residents who are enrolled in the PACE Program (see below), which also manages both Medicaid and Medicare benefits.

The MyCare Ohio Plan covers medical care, such as doctor’s visits, lab work and hospitalization. Long term care benefits can include adult day care, housekeeping, home modifications, respite care, non-emergency transportation, personal emergency response systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

While most HCBS Waivers have a limited number of enrollment spots, and eligible applicants will be put on a waiting list once those spots are full, that’s not the case with MyCare Ohio. The state does not cap the number of enrollment spots for the program, so there is never a wait list. If there are more eligible applicants than open spots, the state will create and fund more spots.

 

Aged, Blind, and Disabled Medicaid

Ohio’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially needy Ohio residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

1) ABD Long Term Care Benefits
Eligible Ohio seniors who show a medical need for long-term care services can receive those services through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Ohio seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2) Program of All-Inclusive Care for the Elderly (PACE)
Ohio residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and non-medical personal needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Ohio’s PACE program can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Ohio’s PACE program is is called McGregor PACE and is located in Cleveland Heights. To learn more about PACE, click here.

 

Eligibility Criteria For Ohio Medicaid Long Term Care Programs

To be eligible for Ohio Medicaid, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

 Just For You: The easiest way to find the most current Ohio Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

Ohio Medicaid Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Ohio seniors have to meet an asset limit and an income limit in order to be financially eligible for Ohio Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Ohio Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Ohio Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for Ohio Nursing Home Medicaid is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Ohio Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Ohio has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Nursing Home Medicaid in Ohio is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. This is determined through a state assessment and reports from the applicant’s healthcare providers that take into account the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as their cognitive ability.

 

Ohio Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Ohio residents have to meet an asset limit and an income limit in order to be financially eligible for any of Ohio’s Home and Community Based Services (HCBS) Waivers – PASSPORT Waiver, Assisted Living Waiver and MyCare Ohio. For a single applicant in 2024, the asset limit for HCBS Waivers in Ohio is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Ohio for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Ohio is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Ohio HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Ohio has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers in Ohio is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. Ohio uses the Adult Comprehensive Assessment Tool to determine if that level of care is needed. This tool takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as their cognitive ability.

 

Ohio Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Ohio residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Ohio ABD Medicaid for a single applicant is $943/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants, the 2024 asset limit for Ohio ABD Medicaid is $3,000 combined between the two applicants/spouses, and the income limit is a combined $1,415/month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.

  Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Ohio has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or HCBS Waivers, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirements for receiving basic healthcare coverage through Ohio ABD Medicaid is being aged (65 or over), blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, the state will administer an assessment of the applicants and their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management), as well as their cognitive ability, to determine the kind of long-term care benefits they need and they state will cover.

 

How Ohio Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Ohio Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Ohio and how you can protect your home from it, click here.

 

Applying For Ohio Medicaid Long Term Care Programs

The first step in applying for an Ohio Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one want to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Ohio Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Ohio Medicaid applicant. These documents will be needed for the official Ohio Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Ohio residents can apply for Medicaid online at Ohio Benefits. They can also apply over the phone by calling 1-800-324-8680, or they can apply in person at their county Job and Family Services office.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

 Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

 

Choosing an Ohio Medicaid Nursing Home

After being approved for Nursing Home Medicaid through Ohio Medicaid, you or your loved one has to choose the Medicaid-accepting nursing home that best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available beds. Finding the right facility can be a challenge, especially if you’re looking in a specific location.

Ohio has roughly 950 nursing homes, and most of them accept Medicaid. The facilities are spread throughout the state with clusters around the largest cities. There are about 130 nursing homes within 25 miles of Cleveland, and another 15 around Akron. The Cincinnati area has approximately 100 nursing homes, and there are 75 more in nearby Dayton. And there are about 80 nursing homes in Columbus.

Residents in some Ohio communities regularly cross state lines for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, a senior with Ohio Medicaid would not be covered for nursing homes in Covington, Kentucky, or Fort Wayne, Indiana, even if facilities in those places are well-suited and convenient for the Ohio Medicaid beneficiary.

 TOOLS: To find and compare nursing homes, Ohio residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this Ohio Long Term Care Consumer Guide search tool, which can be filtered by city, county and services offered.

When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The Ohio Long Term Care Consumer Guide can tell you which facilities in your area offer specialized services, such as on-site dialysis, hospice and care for residents with Alzheimer’s disease or other dementia. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating. The healthcare professionals who work with you are another great source of information. And you can contact use this Ohio Department of Aging webpage to contact your local Area Agency on Aging to find out more information about nursing homes in Ohio.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Who are the staff doctors? Does it offer social activities? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data collected from 2019-2022 reveals that 22.3% of residents in Ohio nursing homes had depressive symptoms, which is significantly higher than the national average of 8.1%. That’s not to say all nursing homes have depressed residents, but some of them do, which is why it’s important to do your research before making a final decision.