Ohio Medicaid's Assisted Living Waiver

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.

Waiver Description

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 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. Although 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 to the program. The reimbursement rate offered by Ohio Medicaid is presumably significantly less than the private pay price for residency at their communities. 

Waiting lists exist at the facility level; these are not statewide. When considering a move to assisted living, or to a new residence, advisers recommend contacting multiple assisted living providers to determine if they have a waiting list, its expected duration, and any other conditions relevant to the accessing the program. 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 program does not cover the complete cost for an elderly or disabled individual to reside in an assisted living community. Federal law bars the state Medicaid program from paying for the cost of room and board in assisted living. Waiver participants, or their families, are expected to pay for this portion of the monthly fee.

 Did You Know?  Three-quarter of assisted living residents are female, their average age is 80 years old and their average length of stay almost two years. 


Eligibility Guidelines

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

The State Medicaid office accesses applicants are accessed to determine their functional abilities and decide whether they qualify. 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.

Financial Requirements

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 2017, applicants are permitted up to a monthly income of less than $2,205.

When a married person’s spouse requires the additional care in assisted living environment, then only their spouse’s income is considered when assessing eligibility. If the healthier spouse at home has little income in their name, then the applicant’s income may be used to top-up the at-home spouse’s income.

In assets, single applicants are limited to "countable resources" of $1,500. One's home, primary vehicle and various other personal effects are "exempt assets," and not "countable resources." 

If a Medicaid applicant is "over income" or "over assets," it is possible they can still qualify by working with a Medicaid advising professional. One can use techniques to "spend down" one's assets to qualify sooner and to 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.

Benefits and Services

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:

  • Personal care
  • Medication reminders and assistance
  • Skilled nursing as required
  • Housekeeping and laundry
  • Recreational activities
  • Transportation

The Assisted Living Waiver can also provide financial assistance to help persons currently residing in nursing homes to transition into an assisted living residence.

How to Apply / Learn More

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 waiver is available here.

To apply for the Waiver, individuals should contact their local Ohio Area Agency on Aging or call 1-866-243-5678. A downloadable program booklet from 2011 is available here.

Ohio residents unable to gain entrance into this program may be interested to know, free assistance is available to help them find assisted living within their budgets. Get help here