Medicaid waivers allow individuals with disabilities and chronic conditions to receive care in their homes and communities rather than in long-term care facilities, hospitals or intermediate care facilities. These waivers also allow individuals to have more control over their care and remain active in their community.
Individuals must require a specific level of care and meet the financial criteria in order to enroll on an Ohio home and community-based care waiver.
What is “Level of Care”?
A level of care is a non-financial eligibility component of the Medicaid long-term care programs. An individual who wants to be enrolled in a waiver must meet the specific level of care that is required for that waiver.
Nursing Facility (NF) Level of Care: A Medicaid home and community-based services waiver that requires a nursing facility level of care provides services as an alternative to nursing facilities, hospitals or rehabilitation facilities. Individuals must exceed the requirements of a protective level of care, which includes a need for supervision or assistance with activities of daily living (such as mobility, dressing or eating) or medication administration and assistance with instrumental activities of daily living (such as shopping, meal preparation or accessing the community).
In addition, individuals must have either an “Intermediate Level of Care,” which includes assistance with activities of daily living, medication administration, and skilled nursing or rehabilitation, or “Skilled Level of Care,” which indicates a higher need due to an unstable medical condition.
The Ohio Department of Medicaid and the Ohio Department of Aging administer the waivers that require a nursing facility level of care. They include the Ohio Home Care Waiver, PASSPORT Waiver, and Assisted Living Waiver.
Development Disabilities Level of Care: The developmental disabilities level of care is necessary for enrollment into a Medicaid home and community based services (HCBS) waiver as an alternative to an intermediate care facility for individuals with intellectual disabilities.
The Ohio Department of Developmental Disabilities administers the waivers that require a developmental disabilities level of care. They include the Individual Options Waiver, Level 1 Waiver and SELF Waiver.
To be eligible for a “Developmental Disabilities Level of Care,” an individual must meet the following criteria:
For individuals birth through age 9, inclusive, the criteria for a developmental disabilities level of care is met when the individual has a substantial developmental delay or specific congenital or acquired condition; and in the absence of individually planned supports, the individual has a high probability of having substantial functional limitations in at least three major life areas:
1. Self-care, receptive and expressive communication, learning, mobility,
2. Self-direction, capacity for independent living, or
3. Economic self-sufficiency later in life.
For individuals ages 10 and above, the criteria for developmental disabilities level of care is met when the individual meets all the following criteria:
1. The individual has been diagnosed with a severe, chronic disability that is attributable to a mental or physical; impairment or combination of physical and mental impairments, other than an impairment caused solely by mental illness;
2. Is manifested before the individual is age 22; and
3. Is likely to continue indefinitely.
The condition results in substantial functional limitations in three or more of the following areas of major life activities:self-care, receptive and expressive communication, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency.
Nursing Facility Level of Care Waivers:
Developmental Disabilities Level of Care Waivers: