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.
The Ohio Medicaid PASSPORT waiver program allows seniors who require a nursing facility level of care to remain living at home, or the home of a family member, and receive care in that location. Seniors are able to live a higher quality of life, as this program provides them with care services and other benefits to promote independence.
In addition, the state of Ohio saves money by leveraging the caregiving provided by friends, spouses, and family members. Unfortunately, the state caps the amount of money spent on a senior in the program each month. The cost of care provided at home cannot exceed 60% of the cost for that same care if it were provided in a nursing home.
The types of care paid for under PASSPORT include personal care, both at home and in adult day care settings, and independent living support, such as home delivered meals, laundry, housekeeping, etc. Also covered is medical equipment, disposable supplies, and transportation assistance for doctors’ visits and medical appointments.
Under PASSPORT, family members can be hired to provide personal care.
The PASSPORT Program now permits consumer direction of services. This allows the beneficiary to have a degree of control over who provides him or her with care services. Friends and certain family members, excluding one’s spouse or legal guardian, can provide non-skilled care services, such as personal care. Most relevant, the adult children of elders are able to provide care. However, Medicaid only pays a standard rate of between $10 and $15 per hour for their caregiving.
PASSPORT is an acronym for Pre-Admission Screening System Providing Options & Resources Today. This program is under the administration of the Ohio Department of Aging, and is is managed locally by the PASSPORT Administrative Agency.
*Note: Persons who are dually eligible for Medicaid and Medicare and live in a county where the Integrated Care Delivery System (ICDS), also referred to as MyCare Ohio, is available are not eligible for the PASSPORT waiver. Rather, one can receive all of the same services via MyCare Ohio, a mandatory managed care program. Learn more here.
Did You Know?
Ohio residents can receive free quotes for bathroom modifications, such as the addition of a walk-in tub, to help them remain living safely in their homes.
In addition to being an Ohio resident and age 60 or older, this waiver also has disability requirements. Applicants must require the level of care found in a nursing home. This typically means they need significant assistance with the Activities of Daily Living. Persons with dementia or Alzheimer’s do not automatically qualify, although their care needs are assessed under special procedures.
The financial guidelines for the PASSPORT Waiver are the same as Ohio Institutional (nursing home) Medicaid limits. An individual’s gross monthly income must be less than three times the Federal Benefit Rate (FBR), which as of 2022, is $2,523. When both spouses of a married couple need care, the income of each spouse is considered separately. Stated differently, each spouse is allowed up to $2,523 a month in income. Even when just one spouse of a married couple needs care, only income in the name of the applicant is counted toward the income limit.
In some cases, the applicant spouse is also able to allocate some of his or her monthly income to the non-applicant (community) spouse. This is called the Monthly Maintenance Needs Allowance. It is intended to prevent the community spouse from having too little income on which to adequately live. As of 2022, up to $3,435 a month can be transferred to the community spouse from the applicant spouse.
The total value of an individual’s countable assets cannot exceed $2,000. For a married couple with both spouses as applicants, the income limit is slightly higher at $3,000. Unlike with income, assets are considered jointly owned. However, one’s home is not included as a countable asset provided the owner, or his or her spouse, lives in the home and the value of the property does not exceed $636,000.
Another exception to the $2,000 limit is when the individual is married and his or her spouse is not seeking benefits under Medicaid. In this situation, the non-applicant spouse can have up to $137,400 in joint countable assets. This is called the Community Spouse Resource Allowance.
It is possible for persons with income or assets greater than these limits to qualify for the PASSPORT waiver. By getting Medicaid planning help, applicants can re-allocate income into a qualified income trust and assets into Medicaid exempt annuities, burial plans, and other non-countable resources. Learn more about this option.
Persons ineligible for PASSPORT might be able to receive services under Ohio’s Older Americans Act.
Benefits and Services
All applicants are screened to determine their eligibility and which services they might be eligible for. The case manager and the participant work out the details of the care plan together. Possible services include the following:
- Adult Day Care
- Alternative Meals (i.e. restaurants, senior centers, churches)
- Home Maintenance / Chore Services (includes pest control)
- Community Integration / Independent Living Assistance
- Community Transition Services
- Disposable Medical Supplies
- Durable Medical Equipment
- Enhanced Community Living Service
- Home Care Attendant
- Home Delivered Prepared Meals
- Home Modifications
- Homemaker Assistance (such as laundry or housekeeping)
- Nursing Service
- Nutritional Counseling
- Personal Care
- Personal Emergency Response Service
- Respite Care (Out-of-Home)
- Social Work Counseling
- Transportation (medical and non-medical appointments)
Certain, unskilled services are available for self-direction.
How to Apply / Learn More
While this program is available statewide across Ohio, there is a cap on the number of available participants. Approximately 33,000 individuals are provided services simultaneously. However, even at that capacity, the state may run out of slots for qualified persons. Applicants placed on a waiting list will have to wait for a space to open when someone leaves the program.
Ohio residents should contact their local PASSPORT Administrative Agency to apply or call the Department of Aging at 1-866-243-5678. The program webpage provides additional details about this waiver.
Ohio residents may also want to consider the Ohio Medicaid supported Assisted Living Waiver.