Those who cannot care for themselves at home may need care in a long-term care setting. In Ohio, long-term care can be provided in the home, community or in a nursing home setting. Because this type of care can be costly, Ohio’s Medicaid program helps eligible Ohioans pay for long-term care.
Who is Eligible?
To be eligible for long-term care services paid by Medicaid, an applicant must:
- Be an Ohio resident
- Have (or get) a Social Security Number
- Meet Citizen requirements
- Need an institutional level of care (care in a nursing home or other long-term care setting for at least 30 days)
- Meet certain financial and non-financial requirements
What is an Institutional Level of Care?
Level of care refers to the amount of help a person needs to live in a healthy and safe way. A person must have an intermediate or skilled level of care to require care in a long-term care setting. For example: an individual with care needs that require help with getting dressed, cooking meals, eating and rehabilitation.
A level of care determination is completed when a person enters a nursing home or other long-term care setting.
Ohio Medicaid requirements are based on both gross income (before taxes) and resources. The resource limit for anyone applying for Medicaid coverage for long-term care is $1,500 ($2,250 for a couple). Examples of income include Social Security benefits, pensions, cash-assistance, earnings from rental property, etc. Examples of resources include trusts, annuities, stocks, bonds, checking and savings account, CDs (certificate of deposits), etc.
Transfer of Resources
After income and resource amounts are established, the caseworker will review resources and look for any resources that were transferred to another party up to five years prior to the date of the application (in most circumstances). There are certain resource transfers which are proper and other which are improper.
If the applicant is married, the community spouse (the spouse that lives at home) is allowed to keep some resources and still get Medicaid coverage for his or her spouse’s long-term care. This is done to protect the spouse from becoming impoverished or living in poverty.
The community spouse can keep his or her monthly income and may be able to keep some of the institutionalized spouse’s income too. The community spouse does not have to use his or her income to pay for the institutionalized spouse’s nursing home care.
Resource limits are updated every January. In 2013 the minimum spousal impoverishment is $23,184 and the maximum is $115,920.
A patient’s liability is the amount of the nursing home cost the Medicaid consumer must pay directly to the nursing home. Deductions for health insurance premiums, past unpaid medical bills and monthly personal needs (usually $40) are made before the patient liability is determined.
Get an application from the forms bin above, (form JFS 07200 Application for Benefits), or get one from the local county Department of Job and Family Services (CDJFS) or online. Also, complete a request for Medicaid and Community Based Services from the forms bin above, (form JFS 02399 Home Care Services), if interested in home care services.
Complete, sign and date the application. If an individual cannot complete the application, an authorized representative can do so on their behalf. Anyone age 18 or older can be an authorized representative, including a family member, friend, business or non-profit organization. The county office may appoint an authorized representative, if necessary.
Return the application by fax, mail or by taking it to the local county office.
If available, attach copies of income, resources, disability and other health insurance information (e.g., Medicare). Incomplete applications will be accepted if they contain contact information, a date, name and signature. (Please note: proof of U.S. citizenship or alien status may be requested.)
Within five days, the caseworker will schedule a face-to-face interview to get more information about the applicant and his or her resources. If the applicant does not speak English, an interpreter will be provided by the county office at no cost.
In addition, Medicaid applicants can have their eligibility explored for the three months prior to the date of application. If eligible, Medicaid will pay for Medicaid-covered services provided within that time period that were not covered by Medicare or other insurance. The application process is usually complete within 30-45 days.
What should applicants bring to the interview?
If not already provided, caseworkers ask applicants to bring documents to the interview to confirm the information on the application is accurate. The caseworker can assist applicants in obtaining the necessary documents.
The following lists show a list of requirements the caseworker may ask applicants to prove. (*This is not a complete list.)
- Social Security Number
- Must be an Ohio resident
- Provide proof of citizenship, other medical insurance (e.g., Medicare), age and/or disability
Proof of Financial Status*
- Saving and/or checking account statements
- Value of trusts, annuities, stocks and bonds
- Benefits check or letter
- Income from property
- Motor vehicle title
- Insurance policies
- Written statement of cash on hand
*Many documents are accepted and/or requested to verify financial status; caseworkers can provide more detailed information
What long-term care services are available?
ABD (Aged, Blind or Disabled) Medicaid provides long-term care services in nursing facilities and ICF-MRs (intermediate care facilities for mental retardation persons). Home and community-based services waivers provide home health care to individuals who wish to stay in their home but otherwise need institutional care. The number of consumers that can be enrolled in a waiver program at any one time is limited.
There are several types of waivers:
- Ohio Home Care Waivers meet the home care needs of individuals, up to age 60, whose medical condition would otherwise require them to live in a nursing home or other institution.
- PASSPORT Waivers provide in-home services to individuals age 60 and older.
- Individual Options and Level One Waivers provide support services for individuals with developmental disabilities.
- Assisted Living Waivers offer more supervision and services than what may be available in a traditional home setting and allows consumers to have more independence and fewer restrictions than a nursing facility.
How to Apply
You may apply for ABD Medicaid online by going to http://ODJFSBenefits.Ohio.gov or by filling out the Request for Cash, Food and Medical Assistance using the forms bin above, (form JFS 07200 Application for Benefits), and submitting it to your county Department of Job and Family Services (CDJFS).