Ohio Medicaid Facts

The State of OhioOhio Medicaid Resources:

Ohio Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 358,300 people with disabilities covered by Medicaid in Ohio. Ohio spent $15,674 on each Medicaid recipient with a disability in 2007.

17% of all people covered by Medicaid in Ohio have a disability, while the national percentage of people covered by Medicaid who have a disability is 15%.

Ohio spends 47% of all the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.

Ohio Basic Medicaid Programs

The State of OhioState Plan Amendment for full-risk managed care program:

Ohio’s program will cover health care services for adults and children with disabilities, with some exceptions. These are people participating in an HCBS waiver, living in a nursing or intermediate care facility, under age 21 receiving SSI, also eligible for Medicare, or those who have to “spend down” to be eligible.

  • Community Community: transportation
  • Health Health: nurse practitioners, chiropractors, dental, developmental therapy, durable medical equipment, early and periodic screening, diagnosis, and treatment, family planning, federally qualified health centers, hearing, hospice, immunization, hospitalization, mental health, substance abuse treatment, laboratory, midwife services, occupational therapy, pharmacy, physical therapy, physician, podiatry, private-duty nursing, rural health clinics, skilled nursing facilities, speech therapy, vision, x-ray
  • Home Home: home health care
  • Social Services Social Services: case management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to an approved PACE center to be eligible.

  • Community Community: day care, health-related transportation
  • Health Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs,
  • Home Home: home health care, home and environmental modifications
  • Social Services Social Services: social services

Ohio HCBS Waiver Programs

The State of OhioTransitions DD waiver:

This waiver provides community-based services to individuals with developmental disabilities who do not want to enter residential care facilities and to those who want to move into the community. This waiver covers people of all ages.

  • Community Community: adult day care, out-of-home respite, transportation
  • Health Health: emergency response systems, supplemental adaptive and assistive services, nursing services
  • Home Home: personal care aides, home delivered meals, home modifications

Transitions II Aging Carve-Out waiver:

This waiver provides services targeted to older adults and older adults with disabilities. It is designed to help people move out of residential care facilities or avoid or delay moving into them.

Ages: 65 and older for people with or without disabilities, 60 and older for people with disabilities

  • Community Community: adult day services, out-of-home respite care, transportation
  • Health Health: emergency response services, adaptive and assistive technology and services, and nursing services
  • Home Home: personal care services, home care attendants, home delivered meals, home modifications

Choices waiver:

This waiver applies to people who have physical disabilities. The waiver will provide home and community-based services instead of the person moving into a nursing home.

Level of Care: nursing

  • Health Health: nursing services, personal emergency response systems
  • Home Home: daily living services and personal care, home delivered meals

Home Care waiver:

This waiver applies to persons with all kinds of disabilities, but is targeted to people with intellectual and developmental disabilities. It provides support services in the home or in the community.

  • Community Community: transportation
  • Health Health: habilitation, therapies, prescription drugs
  • Home Home: residential and personal care

Individual Options (IO) waiver:

This is one of two waivers offered by the Ohio MR/DD agency, along with the Level One waiver. This waiver provides an individualized service plan developed by the person with the disability, their family or caretakers, and the Ohio state agency.

Option for Self-Direction: This plan allows the person with the disability to work with loved ones and professionals to form a care plan.

  • Community Community: adult day services, interpretation services, non-medical transportation, social services
  • Health Health: nutrition services, specialized adaptive or assistive equipment and supplies
  • Home Home: home delivered meals, environmental accessibility modifications, homemaker services, personal care services, respite care
  • Work Work: supported employment in the community or in an enclave (integrated or sheltered workshop), vocational habilitation

Level One (LO) waiver:

This waiver is for people with developmental disabilities, and is run by the Ohio MR/DD agency. This waiver is intended to help people get the services they need in the community without having to move into an intermediate care facility. This waiver covers people who have the natural supports necessary to live successfully and safely in the community.

Level of Care: intermediate

  • Community Community: transportation, adult day services
  • Health Health: personal emergency response systems, specialized medical equipment and supplies, environmental accessibility modifications, emergency assistance, day habilitation
  • Home Home: personal care, homemaker services, institutional or informal respite
  • Work Work: supported employment

Passport waiver:

This waiver is intended to support older adults. Under this waiver, people whose disabilities are significant enough to require nursing home care can get many of these services provided to them at home instead.

Ages: 60 and older

Level of Care: nursing

  • Community Community: adult day care, medical transportation
  • Health Health: emergency response, medical equipment and supplies, nutritional services
  • Home Home: personal care, home delivered meals, homemaker services, chore services, independent living assistance
  • Social Services Social Services: social services
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