Page Reviewed / Updated - March 15, 2020
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 this 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 accessing the program. Assisted Living 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.
This 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.
The Assisted Living Waiver Program is intended for Ohio residents who are 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 to determine their functional abilities and decide whether they qualify. Persons 21 to 64 years of age must by physically disabled, while those 65 and older do not have to be disabled. However, all applicants must require a nursing home level of care. Generally those 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 2020, applicants are permitted a monthly income up to $2,349. This figure is three times the Federal Benefit Rate / Supplemental Security Income Rate, which changes annually.
When a married person’s spouse requires the additional care provided in an assisted living environment, then only his or her spouse’s income is considered when assessing eligibility. If the healthier spouse (also called a community spouse) at home has little income in his or her name, then the applicant’s income may be used to top-up the at-home spouse’s monthly income. As of 2020, this figure may be as much as $3,216 / month. This is called a Monthly Maintenance Needs Allowance and is meant to ensure the community spouse has enough income in which to adequately live.
In assets, single applicants are limited to "countable resources" of $2,000. One’s primary vehicle (used for transportation) and various other personal effects are "exempt assets," and not "countable resources." One's home, given the waiver participant has a spouse living in it, is also considered exempt. However, one exception remains for single applicants; individuals can sign a sworn statement that they have intent to return home after a short-term stay in an assisted living facility.
As with income, there is a spousal asset protection in place for married couples with just one spouse applying for Medicaid waiver services. While all assets of married couples are considered jointly owned, the non-applicant spouse is able to retain up to $128,640 in joint assets. This is referred to as the Community Spouse Resource Allowance. The applicant spouse is still able to keep up to $2,000 in assets.
If a Medicaid applicant is "over income" or "over assets," it is possible he or she 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 qualified income trust. Interested individuals can determine if they are Medicaid eligible and if working with a Medicaid planner is right for them by clicking here.
Please Note: For applicants over the asset limit, it is very important that they not attempt to meet the limit by giving away their assets. This is because of a 5-year Medicaid look-back period in which all past asset transfers are checked to ensure this has not happened. If it has, or if assets were sold for less than they are worth, a period of Medicaid ineligibility is the penalty.
In addition to case management, 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 managed by the Ohio Department of Aging and is available to residents statewide. As previously mentioned, waiting lists for enrollment often exist and not all assisted living communities in Ohio accept the Medicaid waiver. A statewide list of certified residences is available on this webpage, and more general information about the assisted living waiver is available here.