Medicaid Waivers
A waiver is a program that can waive, or set aside, some of the strict eligibility requirements, including income guidelines, benefits and health care delivery options required under federal Medicaid program regulations. A Home and Community Based Services Waiver can provide extra services that make living at home possible. This can include personal care, nursing, respite, adult day care, supported employment, home modifications, assistive technology and transportation. While waivers can differ substantially between states in eligibility and services, an important advantage is that they can expand services to cover individuals that may be over income for traditional Medicaid. However, because states have the discretion to choose the number of consumers to support in a waiver program, there are often long waiting lists for services.
The Center for Infants and Children with Special Needs at Cincinnati Children's Hospital Medical Center provides information to help families and health care providers identify sources of financial assistance.
Home and Community Based Waivers in Ohio | Eligibility | Waiver Services | Applying for a Waiver | Ohio Medicaid School Program
Medicaid Home and Community Based Services Waivers are programs of in-home and community care that help eligible Medicaid consumers stay at home instead of in a nursing home, hospital or institution for people with mental retardation and / or developmental disabilities:
Ohio Home Care Waivers, administered through the
Ohio Department of Job and Family Services, can assist individuals with severe disabilities and medically unstable conditions who would require care in a hospital or nursing home. Eligible individuals may receive care and services at home, or they may choose to receive their care in a nursing facility.
- Level One and Individual Options Waivers, administered through the Ohio Department of Mental Retardation and Developmental Disabilities, can assist people with mental retardation and / or developmental disabilities to stay in their homes and get support rather than living in an intermediate care facility (ICFMR).
In addition to the usual Medicaid benefits, like doctor visits and prescriptions, a waiver can provide extra services that make living at home possible. This can include personal care, nursing, respite, adult day care, supported employment, home modifications, assistive technology and transportation, depending on the waiver. However, there are generally long waiting lists for waivers since they support a limited number of individuals.
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Waivers allow Ohio Medicaid to try new programs that can waive, or set aside, some of the traditional requirements. Individuals have to be eligible for Medicaid and meet both financial and medical criteria. However, the financial criteria is based only on the income of the individual. The advantage is that the family's income and resources are not considered. Parents and other family members often want to put money aside to provide lifetime care for their child with special health care needs. Having assets in the name of the child with special health care needs, regardless of their age, often disqualifies them from important government programs including Medicaid. Learn more about special needs trusts and Estate and Future Planning.
To be medically eligible, the individual must require a protective level of care related to daily living skills or skilled medical care. Different home and community based waiver programs have varying level of care requirements. This means that the person applying for a waiver will be evaluated to see if an intermediate, skilled level or intermediate care facility for the mentally retarded (ICFMR) level of care is necessary.
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In addition to the usual Medicaid benefits, like doctor visits and prescriptions, an Ohio Home and Community Based Waiver can provide extra services that make living at home possible. The following table is a brief overview of some helpful Ohio waivers that can pay for services for children and adults with special health care needs. Click on the waiver name to find more detailed information:
| Waiver |
Eligibility |
Services |
Agency |
Ohio Home Care Waiver
|
Skilled or Intermediate Level of Medical Care, Financial Criteria, All Ages.
|
Respite, Nursing, Personal Care Aide / Daily Living Services, Therapy, Home Modifications, Transportation, Adaptive and Assistive Devices, Adult Day Health, Emergency Response, Home Delivered Meal.
|
Ohio Dept. of Job and Family Services
Contact your county office or health care provider.
|
| Level One Waiver |
Mental Retardation / Developmental Disabilities, Skilled Level of Care, Financial Criteria, All Ages.
Has spending limits for services.
|
Homemaker / Personal Care, Informal Respite, Institutional Respite, Transportation, Personal Emergency Response Systems, Home Modifications, or Specialized Medical Equipment and Supplies, Emergency Assistance, Adult Day Support, Vocational Assistance and Supported Employment.
|
Ohio Dept. of Mental Retardation and Developmental Disabilities
Contact your county board or case manager.
|
| Individual Options Waiver |
Mental Retardation / Developmental Disabilities, Skilled Level of Care, Financial Criteria, All Ages. |
Homemaker / Personal Care, Home Modifications and Adaptations, Transportation, Respite Care, Social Work Home-delivered Meals, Nutrition, Interpreter Services, Specialized Adaptive or Assistive Medical Equipment and Supplies, Supported Employment, Day Programs and Adult Day Services.
|
Ohio Dept. of Mental Retardation and Developmental Disabilities
Contact your county board or case manager.
|
Home and Community-Based Waivers Medicaid Fact Sheet provides a comparison of all Ohio waivers.
Find information on specific waiver programs available in Kentucky and Indiana.
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Since waiver programs pay for services for a limited number of people, their openings can fill up quickly and there may be a waiting list. Children who have been hospitalized for more than 30 consecutive days will be given priority on the waiver waiting list, thereby significantly reducing their waiting time.
Ohio Department of Job and Family Services, Bureau of Home and Community Services oversees Medicaid's integrated program of home care services. The Ohio Home Care Waiver is administered through their county agencies. When an individual is approved, services are coordinated through a single case management agency, CareStar. CareStar provides information about services, resources and supports.
Ohio Department of Mental Retardation and Developmental Disabilities oversees the Individual Options Waiver and the Level One Waiver through their county boards.
Centers for Medicare & Medicaid Services provides information on Medicare, Medicaid and Waiver programs throughout the United States.
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The Medicaid School Program is overseen by the Ohio Department of Education and the Ohio Department of Job and Family Services. It can reimburse participating schools for related services provided to medicaid-eligible students. Services must be identified in the IEP and can include nursing, occupational therapy, physical therapy, speech therapy, specialized medical transportation and medical equipment and supplies for use only in school. This also covers students who receive the Ohio Home Care or Transitions MRDD waivers. It is possible for a family's current Ohio Home Care waiver provider to go to school with the child if the waiver team determines that the IEP is not adequate to ensure the child's health and welfare.
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If your questions are not fully answered by our Special Needs Resource Directory and its links, please contact us via email.
Rev. 11/09
