Big Changes to the Medicaid Assisted Living Waiver Program in Ohio

Big Changes to the Medicaid Assisted Living Waiver Program in Ohio

The federal government has actually taken some action now to help Ohio residents remain in a more home-like environment when someone needs help with daily living. Used to be that if you needed more long-term health care than available at home, and you went to an assisted living facility, you had to pay privately out of your own pocket. If your money ran out, you were forced into a nursing home, whether you needed it or not or whether you wanted to go or not, simply because you had no money. When you have no money, Medicaid is the only governmental program available to pay, and was at one time only available in the nursing home.

Eventually, Ohio and other states broadened the Medicaid program to allow limited Medicaid benefits to help pay for long-term care at home under the PASSPORT program. There were long waiting lists and 24/7 care was not covered, but it did and still does provide some much needed long-term care options. However, a gap still remained for those individuals too sick for home care but not sick enough for nursing home care, and who did not have many assets.

Several years ago, Ohio began allowing some assisted living facilities to become licensed to be allowed to accept Medicaid benefits for payment. At first, not many facilities went through the effort to become licensed, since it meant spending money to renovate the rooms in a different way. However, the demand for such rooms grew and federal funding became easier to obtain. More and more assisted living facilities began to provide "Assisted Living Medicaid Waiver" (AL waiver) beds. The harsh rules for financial eligibility for Medicaid remained, including some special rules only for the AL waiver rooms. There were limited funds available in the state, so that only a few rooms in each facility could be licensed and a resident had to pay privately for a minimum of 6 months first before the AL waiver was allowable. This requirement still forced people into nursing homes when they ran out of money, since they could not pay for the 6 month waiting time.

BUT, HERE'S THE GOOD NEWS--the federal Centers for Medicare and Medicaid Services (CMS) approved changes to Ohio's Assisted Living Medicaid Waiver, immediately giving more seniors the ability to choose assisted living facilities as a long term care setting. They recently approved the Ohio Department of Aging's revised guidelines for the state's AL waiver, removing the six month residency requirement. Another change allows residents to begin receiving AL waiver services immediately while their Medicaid eligibility is being determined. Currently, nearly 3,200 Ohioans take advantage of the AL waiver program.

Additionally, the U.S. Administration on Aging (AoA) awarded Ohio (along with Georgia, Minnesota and New York) a three-year $3 million grant to provide consumers with simplified and streamlined access to needed services.

"Regardless of age or physical condition, all Ohioans deserve to be respected as vital members of society who continue to grow, thrive and contribute to their families and communities," said Bonnie Kantor-Burman, director of the Ohio Department of Aging. "Ohio is fortunate to have such a dedicated network devoted to ensuring that Ohio is on the leading edge of innovation and responsiveness to the needs of our elders, people with disabilities and their caregivers."