If you or a senior loved one is looking for long-term senior care or senior living in Ohio, it’s important to know all of the relevant Ohio Medicaid programs. These programs, including Ohio PASSPORT Waivers, Assisted Living Waivers, and MyCare Ohio, can help Ohio seniors and their families pay for some or all of the cost of senior living and senior care. To learn more about Ohio’s Medicaid programs, including what they cover and who is eligible, read more below or reach out to the Sunbound team to learn more.

Ohio PASSPORT Waivers

Ohio’s PASSPORT Waivers program is a Ohio program offering home and community-based services (known as HCBS waivers) for eligible Ohio seniors. Like HCBS waivers in other states, Ohio PASSPORT Waivers are designed to provide senior care for elderly seniors in order to help seniors from entering nursing homes prematurely. The OHIO PASSPORT Waiver system provides a variety of long-term and senior care options for seniors to continue to live either independently in their own home or in the home of a loved one (a senior may also receive care through the Ohio PASSPORT system either in adult day care or in a short-term respite care facility). The Ohio PASSPORT system provides a number of long-term care services for services, including not only home modifications like making a home wheelchair accessible or adding an emergency response system, but also by providing in-home care services like homemaker services, meal delivery, or nursing services.

Ohio Medicaid Financial Eligibility 

In order to be eligible for Ohio PASSPORT Waivers an Ohio resident must ether be 60-64 years of age and physically disabled or at risk of needing nursing home care, or 65 years or older. In addition to these basic criteria, senior applicants must also meet certain medical and financial criteria (as is the case with most state Medicaid programs). The financial criteria is twofold, focusing on both an income limit and an assets limit. In 2023 the income limit for a senior applicant is $2,742, regardless of whether the applicant is single or if both spouses are applying (in which case each spouse’s income is considered individually). When only one spouse is applying, Ohio allows the applicant spouse to transfer up to $2,288.75 of income to the non-applicant spouse. This allows the applicant spouse to reduce their income in order to be eligible for Ohio PASSPORT Waivers, while making sure that the non-applicant spouse can be taken care of and not have to artificially reduce their income for their spouse to qualify for senior care.

In addition to the income limit, in order to qualify for Ohio PASSPORT Waivers seniors applicants must also satisfy the asset threshold. In 2023, the asset limit is $2,000 for a single applicant and $3,000 for married couples where both spouses are applying. While these limits may seem low, many large assets are not included in this limit including the applicant’s primary home (including furnishings and appliances) and the couple’s vehicle. And just as is the case with income, where only one spouse is applying for Ohio PASSPORT Waivers the non-applicant spouse can count 50% of the couple’s assets for the purposes of the asset calculation, or 100% of the assets if the non-applicants assets are under $29,724. 

Ohio Medicaid Medical Eligibility 

In addition to the above financial thresholds, in order to be eligible for Ohio PASSPORT Waivers a senior applicant must also demonstrate that they require a Nursing Facility Level of Care. In Ohio, this determination is made using the Adult Comprehensive Assessment Tool which assesses the extent to which the senior applicant is able to accomplish their Activities of Daily Living and their Instrumental Activities of Daily Living.

Assisted Living Waivers

Ohio's Assisted Living Waiver program offers long-term care services for seniors and adults with physical disabilities who require help with daily living activities, such as bathing and personal hygiene. The program is designed to provide care in a homelike environment, delaying or preventing the need for nursing home care. Services include meals, housekeeping, laundry, around-the-clock staff response, personal care assistance, and specialized memory care units for individuals with Alzheimer's disease or dementia. However, participants must be able to pay for their room and board, as Medicaid does not cover these costs, and not all assisted living residences accept Medicaid as payment.

The Assisted Living Waiver program is a Home and Community Based Services (HCBS) Medicaid Waiver, meaning that it is not an entitlement program, and eligibility does not guarantee immediate receipt of program benefits. There is a limited number of participant enrollment slots, and each residential care facility maintains its own waitlist. The program offers benefits such as 24-hour staff response, social and recreational activities, medication management, non-medical transportation, and community transition services to assist individuals moving from a nursing home to an assisted living residence.

MyCare Ohio

MyCare Ohio is a managed care program that provides Medicare and Medicaid benefits to elderly or disabled "dual eligible" Ohioans. The program also offers home and community-based services (HCBS) for those who are at risk of being admitted to nursing homes. The services and supports that participants receive are based on their individual needs and circumstances. Managed Care Organizations (MCOs), which are private healthcare companies, provide beneficiaries with a single Medicaid plan. The MCOs have a network of care providers, and program participants receive services through them. Participants can receive Medicare benefits through MyCare Ohio, but it is not required.

The program offers flexibility in terms of providers for persons receiving home and community-based services. Consumer-directed benefits, such as homemaker services and personal care assistance, allow program participants to hire their own caregiver. A Financial Management Services Agency handles the financial aspects of employment responsibilities, such as withholding tax and issuing payments. MyCare Ohio is available in 29 counties and is mandatory for eligible persons. Program participants can choose from several managed care plans based on the county in which they live. The program is also known as the Integrated Care Delivery System (ICDS) Medicaid Waiver or the ICDS Demonstration.

MyCare Ohio offers a variety of long-term care services and supports, including adult day care, alternative meals service, assisted living/memory care services, care management, community integration service, community transition services, enhanced community living service, home care attendant, home maintenance/chore, home medical equipment/assistive devices, home modifications, homemaker services, meal delivery, non-emergency transportation, nutritional consultation, nursing facility care, nursing services, personal care assistance, personal emergency response system, respite care, and social work counseling. Participants can live in their own home, the home of a loved one, an assisted living residence, or an adult foster care home.

Just like with Ohio’s Assisted Living Waivers, MyCare Ohio follows the same Medicaid eligibility requirements listed above for Ohio PASSPORT Waivers.

Program of All-Inclusive Care for the Elderly (PACE)

The Program of All-Inclusive Care for the Elderly (known by its popular acronym PACE) is a Medicaid-funded program for senior services that is available in some states throughout the country, including Ohio. Participants receive all Medicare and Medicaid benefits through PACE, as well as additional benefits like dentistry and ophthalmology. The program aims to prevent unnecessary nursing home admissions, and offers home and community-based services and supports, including in-home personal care assistance, homemaker services, and adult day care. Although nursing home care is covered, only about 5% of PACE participants reside in nursing homes. PACE is a voluntary program, but highly desirable for those who qualify, especially those with conditions requiring high levels of non-medical care assistance, such as Alzheimer’s or Parkinson’s disease.

Ohio seniors are eligible for PACE if they satisfy either Medicare eligibility requirements, or Ohio’s Medicaid eligibility requirements listed above.

To learn more about how Sunbound can help make senior living more affordable for you or your loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and is on a mission to make senior living affordable for everyone.