Page Reviewed / Updated - Apr. 2015
The Assisted Living Waiver Program is an Ohio Medicaid program that covers the cost of certain services provided in assisted living residences for eligible state residents. The program does not cover the complete cost for an elderly or disabled individual to reside in an assisted living community. The most notable exception is the cost of room and board. Waiver participants or their families are expected to pay for this portion of the monthly fee.
The Assisted Living Waiver Program is popular both with the state, as it reduces costs, and with participants as they prefer the flexibility and recreational activities that group living provides. However, that popularity has a downside. The program has a waiting list that can extend for months. Though not unusual for Medicaid waivers to have a waiting list, in Ohio it exists for a different reason. The bottleneck is not with an enrollment cap, instead there exists a limited number of slots because assisted living providers have been slow to come on board the program. This is presumably because the reimbursement rate offered by Ohio Medicaid is significantly less than the private pay price for residency at their communities.
Waiting lists exist at the residency level not statewide. Therefore, it is advisable to contact multiple assisted living providers to determine if they have a waiting list and its expected duration. Providers must be certified by the Ohio Department of Aging. In Ohio, the local Area Agencies on Aging maintain lists of the certified providers in their coverage area.
The Assisted Living Waiver Program is intended for Ohio residents aged 21 and over. In addition to these requirements, applicants are evaluated based on their level of impairment and their financial need.
Level of Impairment Requirements
The State Medicaid office accesses applicants are accessed to determine their functional abilities and decide whether they qualify. Generally speaking, persons who require assistance to complete the activities of daily living such as bathing, eating, mobility and maintaining continence are qualified. However, should their needs be so advanced that it would be difficult to care for them in an assisted living residence, they will be referred to a program that provides a higher level of care.
When considering an applicant's finances, their monthly income, their financial and property holdings and their ability to pay for the care they require are all measured. In 2015, applicants are permitted up to a monthly income of less than $2,199. In assets, single applicants are limited to "countable resources" of $1,500. One's home, primary vehicle and various other personal effects are considered to be "exempt assets," not "countable resources."
It is worth mentioning that if a Medicaid applicant is "over income" or "over assets," it is possible they can still qualify by working with a Medicaid planning professional. There are techniques that can be used to "spend down" one's assets to qualify and income trusts that allocate income over the limit to a special trust. Interested individuals can determine if they are Medicaid eligible and if working with a Medicaid planner is right for them, by clicking here.
This program pays for the cost of assisted living in approved residences but does not include the monthly fees for room and board. Services provided in assisted living include:
The Assisted Living Waiver can also provide financial assistance to help persons currently residing in nursing homes to transition into an assisted living residence.
The Assisted Living Waiver Program is available to residents statewide. As previously mentioned, waiting lists for enrollment often exist and not all assisted living communities in Ohio accept the Waiver. A statewide list of certified residences is available on this webpage and more general information about assisted living in Ohio is available here.