Care in an Institution

The Medicaid program offers a broad set of services for those who have special health care needs. Sometimes, the best solution for a person with a severe disability or medically unstable condition is care in an instution such as a nursing home or an intermediate care facility for people with mental retardation and/or developmental disabilities.

Application Process

When applying for institutional care through Medicaid, applicants will need to show proof of income, resources, disability, citizenship (if not a U.S. citizen) and other health insurance. Individuals must also meet Transfer of Resources provisions. Once it is determined that financial requirements are met, a level of care assessment will be conducted to identify the appropriate type of long-term care Medicaid will provide.

Once the care needs of the individual are determined, an additional computation is completed to establish how much of their income will be applied to the cost of care in the institution. This is called the Patient Liability.

How this will affect the family members

If an individual is in need of care in an institution has a spouse or dependent family members, it is possible that some of that person’s income and assets can be kept to support those who remain at home. This is called Spousal Impoverishment and was established as a provision in the Medicare Catastrophic Coverage Act (MCCA) of 1988. Its purpose is to protect the community spouse from becoming “impoverished”.

How it works

A resource assessment is conducted to determine the amount that will be given to the spouse and dependents at home. In Ohio, the maximum amount a spouse or dependent family member can keep is $109,560. and the minimum is $21,912. In addition, the spousal impoverishment law also allows one year for the institutionalized spouse to transfer assets to the community spouse. From here, the patient liability is determined.

What long-term care services are available?

ABD Medicaid provides long-term care services in nursing facilities and ICF-MRs. 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 (JFS 7200) form and submitting it to your county department of job and family services (CDJFS). You can get the form at your CDJFS or at http://jfs.ohio.gov/ofam/pdf/7200.pdf .