Assisted Living Overview
General Information
Beginning 7/1/06, the Assisted Living Program became available statewide under a CMS Home and Community-Based Services Waiver. Up to 1,800 participants were enrolled during the first year of operation (state fiscal year 2007). The waiver program pays only for two services: assisted living services and community transition services. The Community Transition service is a one-time payment of up to $1500 for costs associated with establishing a residence for individuals transitioning from a nursing facility. A three tier model is used to establish participant's service needs and provider reimbursement rate ($48.48/day, $58.20/day, and $67.88/day). Maintenance Needs Allowance has been set at $698.00 (Room and Board Payment: $648.00 Discretionary Spending: $50.00 per month.) Total Provider Reimbursement for each level of service: Tier 1: $2200.88; Tier 2: $2502.20; and, Tier 3: $2802.28. An independent evaluation of the waiver was conducted during the initial program year.
Participant Information
Participant eligibility and enrollment is managed by the Area Agencies on Aging. Participants must be 21 years old. Participants must be financially eligible for Medicaid and determined to need a "nursing facility level of care." Participants will select from any ODA certified assisted living provider. Participants are responsible for making Room and Board payment to the provider. If the participant's monthly income exceeds $2,094.00, the participant is responsible for contributing toward the cost of services. This contribution is referred to as a client liability payment. The payment is made directly to the provider.
Provider Information
Upon receipt of the CMS approval of the waiver amendment, individuals are no longer required to be a current nursing facility resident, a resident of a residential care facility for six months, or currently enrolled in a Medicaid waiver in order to request enrollment in the Assisted Living Waiver. (ORC 5111.891).
Effective 9/29/2011, eligible individuals can receive assisted living services pending the determination of Medicaid financial eligibility from the CDJFS when the PAA has determined that the individual meets all the non-financial eligibility criteria and the individual appears to meet Medicaid financial eligibility requirements. (ORC 5111.89 (D)).
Only the PASSPORT Administrative Agency (PAA) shall determine whether or not the individual is eligible for enrollment in the State-funded program.
For more information about these new options, please refer to the following resource materials:
State-Funded Assisted Living Program Fact Sheet
State-Funded Assisted Living: Provider Frequently Asked Questions (FAQ)
Interested providers must make application with the Ohio Department of Job and Family Services (ODJFS) through Ohio's Medicaid Information Technology System (MITS).
ATTENTION: In accordance with Conditions of Participation, you must be “a formally organized business or service agency registered with the Ohio secretary of state that has been operating, providing, and being paid for the same services for which certification is being applied, for at least two adults in the community for a minimum of three months at the point of application.”
For more information:
Ohio Department of Aging
Assisted Living Provider Application Process