Medicaid offers a broad set of services for those with special health care needs. Sometimes the best solution for a person with a severe disability or medically unstable condition is care in an institution such as a nursing home or, for people with mental retardation and/or developmental disabilities, an intermediate care facility (ICF-MR).

Nursing homes and ICF-MRs provide care for people who are unable to care for themselves at home and need help with daily activities like dressing, bathing, eating, grooming, and taking medicine.

The Ohio Long-Term Care Consumer Guide is available to help families find appropriate care settings based on specific needs.

There are also alternatives to institutional care. Medicaid has several programs for people with extensive care needs who would prefer to receive services in their home and community.

Thinking about purchasing long-term-care insurance? A new type of long-term care policy offering Medicaid asset protection is now available in Ohio. For more information on qualified policies, please visit ltc4me.ohio.gov.

Application process

When applying for institutional care through Medicaid, applicants will need to show proof of income, resources (or assets), disability, U.S. citizenship or qualified alien status, and other health insurance. Individuals must also meet Transfer of Resources provisions. The Area Office on Aging will conduct the required level-of-care assessment (their phone number is 800.421.7277) to determine if nursing home placement is necessary. If not, they will provide alternative resources.

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 institutional care. This is called the Patient Liability.

How will this affect family members?

If an individual needs institutional care and has a spouse or dependent family members, it is possible some of that individual's income and assets can be kept to support dependents remaining in the home. This is called the Spousal Impoverishment Law, which was established as a provision in the Medicare Catastrophic Coverage Act (MCCA) of 1988.

How it works

A resource assessment is conducted to determine the amount that will be given to the spouse and dependents at home. In 2013 in Ohio, the maximum resource amount a spouse or dependent family member can keep is $115,920, and the maximum monthly maintenance allowance is $2,898 (these figures change annually). In addition, the Spousal Impoverishment Law also allows one year for the institutionalized spouse to transfer assets to the community spouse, after which patient liability is determined.

Anyone can apply for Nursing Home or Institutional Care Medicaid by completing a JFS 07200 Request for Cash, Food and Medical Assistance application. You can submit your application online, fax it to 330.643.7363, mail it to 1180 S. Main Street, Suite 102, Akron, OH 44301-1256, or bring it to the agency.

Medicare Assistance Programs

Medicare Part A (for hospital) and Part B (for medical) have associated premiums, deductibles, and co-payments. The Medicare program was never designed to pay medical costs in full. The Medicaid Program can act as a Medigap payer to help some eligible Medicare recipients with these costs.

QMB

Qualified Medicare Beneficiaries (QMB) whose income (after exclusions) does not exceed 100% of the Federal Poverty Level (currently $958 for an individual and $1,293 for a married couple) are entitled to have the Medicaid program pay their Part B premium ($104.90 in 2014) and all other costs and deductibles not paid by Medicare. Applicants aged 65 who have SSI income and are not eligible for free Part A may be eligible for Medicaid to pay the Part A hospital premium.

SLMB

Specified Low–Income Medicare Beneficiaries (SLMB) whose income does not exceed 120% of the Federal Poverty Level (currently $1,149 for an individual and $1,551 for a married couple) are entitled to have the Medicaid program pay their Part B premium ($104.90 for 2014).

*The current QMB/SLMB resource limit is $7,160 for an individual and $10,750 for a married couple.

Qualified Individual

Medicare-eligible applicants who do not qualify for QMB or SLMB (and whose income is does not exceed $1,293 for an individual and $1,745 for a married couple) are eligible for Medicaid to pay their Part B premium only.

Qualified Working Disabled Individual

Medicare-eligible individuals who do not qualify for QMB or SLMB and who are eligible for Medicare Part A only after having their cash payments from Social Security terminated (and whose income does not exceed $1,915 for an individual and $2,585 for a married couple) are eligible for Medicaid to pay their Part A  premium only.