Q: What is a Medicaid Waiver?
A: Medicaid Waivers are programs that make services available so that an individual may remain at home instead of living in an institutionalized residential setting, such as a nursing home or facility for people with mental retardation.

Q: Why are they called Waivers?
A: “Waiver” refers to an exception to federal law that the Centers for Medicare and Medicaid Services (CMS) grants to Ohioans.  These waiver programs “waive” certain federal Medicaid regulations so Ohioans can try programs with limited enrollment, locations, and eligibility requirements.

Q: Are there different types of Medicaid Waivers?
A: Yes.  Ohio offers eight different Waivers: Ohio Home Care Waiver, Transitions MR/DD (Mental Retardation/Developmental Disability) Waiver, Transitions Carve-Out Waiver, Assisted Living Waiver, Choices Waiver, PASSPORT, Level One Waiver, and Individual Options Waiver.  Not all Waivers are always available; the state may close a particular Waiver to new enrollment or impose a waiting list.

Q: How do these Waivers differ?
A: The Waivers vary according to which agency administers it: the Ohio Department of Job and Family Services, Ohio Department of Aging, or the Ohio Department of Developmental Disabilities (DD), formerly known as the Ohio Department of Mental Retardation and Developmental Disabilities.  Waiver programs also have differing eligibility requirements.  For example, to qualify for the Ohio Home Care Waiver, you must be 59 years old or younger, while the Individual Options Waiver is eligible to individuals of all ages.

Q: Who is eligible for a Medicaid Waiver?
A: To be eligible, a person must qualify both medically and financially. In order to be medically eligible, the individual must require a certain “level of care” (LOC).  The LOC needed depends on the type of Waiver being requested.  For example, Ohio Home Care Waiver is available to individuals who require an intermediate LOC (needs help to perform activities of daily living, such as bathing, dressing, eating, toileting, etc.), or skilled LOC (needs a nurse or therapist to provide daily skilled services for an unstable medical condition). 

To be financially eligible, a person must meet certain income requirements and Medicaid’s resource limit.  In 20089 a person’s resources cannot be more than $1,500 (not including exempt resources such as a home, vehicle and prepaid funeral arrangements).
 
A parent’s income and resources are not included when assessing a minor child’s eligibility for Waiver, and there may be other eligibility requirements depending on the type of Waiver needed.

Q: How do I apply for a Medicaid Waiver?
A: Contact your local county department of job and family services and request an application.  A caseworker will assess your financial eligibility and a case management agency will determine if you meet the level of care requirements.  You may also wish to contact your local DD board to learn about the Level One Waiver or the Individual Options Waiver, or contact your local area agency on aging to learn about the Assisted Living Waiver, Choices Waiver, or PASSPORT.

Q: My adult daughter has a Medicaid Waiver.  If she receives money from an inheritance, personal injury settlement, etc., will she lose her Medicaid Waiver?
A: She could lose her eligibility for Waiver if she receives money, depending on the amount and where it came from.  You should notify the caseworker that her income has increased.  If she keeps the money past the last day of the month in which she received it, it is considered a “resource.”  She may wish to spend the money within that month or set up a “special needs trust” to keep her Waiver eligibility.  You may need to contact an attorney to discuss her available options.

Q: What services does a Medicaid Waiver provide?
A: Each Waiver provides different services, which may include nursing care, homemaker/personal care, home-delivered meals, respite care, adult day care, supported employment services, environmental accessibility and adaptations, emergency response systems, and/or supplemental transportation.

Q: I am not sure if I am eligible for a Medicaid Waiver.  What should I do?
A: Contact your local county department of job and family services, DD board, and/or local area agency on aging to discuss your specific needs and to request information and an application.

10/19/2009

This “Law You Can Use” column was provided by the Ohio State Bar Association (OSBA).  It was prepared by attorney Janet L. Lowder, a partner in the Cleveland firm of Hickman & Lowder Co., L.P.A.