Ask the Expert: How to Pay with the Ohio Medicaid Assisted Living Waiver

Senior man paying bills.

Dear Jaclyn,

My dad is living at an assisted living community and someone recently told us that the Ohio Medicaid assisted living waiver can help cover the cost. I’ve never heard of this before—could you tell me more about it?

I’m wondering if Dad is eligible and if so, how we can apply.

Sincerely,

Nancy D.

Upper Arlington, Ohio

Dear Nancy,

I’m glad you asked this question. Not many people are aware that the Ohio Medicaid assisted living waiver is available to help pay for assisted living. Not all communities accept it (typically assisted living communities are private-pay), but some communities do and it can be a big help financially for people like your father.

I’ll give you a brief overview of the waiver to get you started!

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Related: Cost Comparison Worksheet: Assisted Living vs. Staying at Home

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What Is a Medicaid Waiver for Assisted Living?

The Ohio Medicaid assisted living waiver provides assistance with the cost of assisted living by covering the cost of care in participating assisted living communities in Ohio. While it doesn’t cover 100 percent of the cost of assisted living, it does help considerably.

To back up a bit, it’s important to understand that paying for assisted living isn’t like paying rent. In addition to room and board, residents are also paying for care services, like assistance with activities of daily living.

So the waiver pays for the care services portion of assisted living, and the residents are then expected to cover the cost of their room and board. That cost is determined by a rate set by the state.

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Related: Ask the Expert: How Do I Pay for Assisted Living?

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Who Is Eligible for the Ohio Medicaid Assisted Living Waiver?

To qualify for the waiver, your parent will need to meet financial requirements and be able to show that they need the type of care provided in assisted living.

The financial eligibility requirements do change, so be sure to check with the Central Ohio Area Agency on Aging (COAAA) for the most up-to-date information. To give you an idea, though, Paying for Senior Care shares the financial eligibility requirements for 2019:

“To qualify for any of Ohio’s waiver programs, you must have an income at or below 300% of the SSI Federal Benefit Rate, or $2,313 per month in 2019. You also must have less than $2,000 in countable assets…. If you are married, Medicaid allows your spouse to keep more income and assets.”

How Do You Apply for the Medicaid Waiver?

To apply, your parent will need to:

  • Apply for Medicaid
  • Complete an assessment by the COAAA to show that they need assisted living services.

Medicaid Application

When you help your parent apply for Medicaid,  you will start by filling out the required paperwork. The paperwork can be provided to you by COAAA or an assisted living community if your parent is currently living in one.

You’ll need to have the proper documents and information as outlined in the application, including:

  • Age and citizenship verification
  • Social Security and Medicare cards
  • Monthly income verification
  • Private health insurance
  • Bank accounts and other liquid assets
  • Life insurance policies
  • Property tax statements
  • Guardianship papers (i.e., power of attorney)

Once completed, the application should be submitted to the county department of Job & Family Services.

Level of Care Assessment from COAAA

The level of care assessment can be completed at the same time as the Medicaid paperwork.

First, you’ll let COAAA know that you need an assessment. They will come and visit your parent, and see if they meet the necessary criteria.

If your parent is already in assisted living, chances are they will meet the requirements. The level of care COAAA is looking for is an intermediate level of care, meaning your parent needs hands-on assistance with at least two of their daily living tasks.

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Related: What Are Activities of Daily Living?

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I should also mention that some assisted living communities accept the assisted living waiver right away and others accept it only after 1-2 years of private pay. The ones that accept it upon admission might have a waitlist.

That’s why I recommend starting the application process sooner rather than later because it can take a while to process depending on the documents requested. It’s best to have it ready so you have assistance for the cost of assisted living as soon as you are able.

Medicaid Waiver Assisted Living Columbus Ohio

Do you know if your parent’s assisted living community accepts the waiver? Not all communities do. To find communities that accept it, you can request a list from COAAA.

Whetstone Rehabilitation Center, Skilled Nursing & Assisted Living in Columbus, Ohio is one such community. We accept the waiver after two years of private pay. Located off Route 315 on Olentangy River Road across from Riverside Hospital, we serve Clintonville, Upper Arlington, Worthington and the greater Columbus area.

If you have any questions about the waiver or assisted living, feel free to contact us!

Jaclyn Spalding
Assisted Living Director
Whetstone Rehabilitation, Skilled Nursing & Assisted Living