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Medicaid Expansion vs. Long-Term Care Medicaid

Ohio expanded Medicaid under the ACA in 2014 -- a completely different eligibility pathway from the long-term-care Medicaid seniors use.

HomeState RulesMedicaid Expansion vs. Long-Term Care Medicaid
Short answer

Ohio expanded Medicaid under the Affordable Care Act in 2014, extending coverage to lower-income adults generally. That expansion population and eligibility test have nothing to do with the long-term-care Medicaid pathway seniors use to qualify for nursing home or waiver coverage.

Two separate systems, easy to conflate

Medicaid expansion uses a income-based test (MAGI) aimed at working-age adults. Long-term-care Medicaid for seniors uses a different, non-MAGI aged/blind/disabled eligibility pathway, with its own income and asset limits, that has existed since long before the ACA expansion and is administered separately.

What this means for your search

Do not assume that Ohio's Medicaid expansion status tells you anything about whether your parent will qualify for nursing-facility Medicaid or an HCBS waiver. Confirm your parent's specific income and asset picture against Ohio Department of Medicaid's long-term-care eligibility rules, ideally with an elder law attorney if the numbers are close to the limits.

How families actually pay for care

Ohio expanded Medicaid under the Affordable Care Act in 2014. That expansion pathway is for lower-income adults generally and is a completely different eligibility track from the aged/blind/disabled Medicaid pathway seniors use to qualify for long-term care coverage — do not assume expansion status tells you anything about nursing-facility or waiver Medicaid eligibility.

Ohio runs its home- and community-based Medicaid programs through a few specifically named waivers, and mixing them up is the most common source of confusion we see:

  • PASSPORT pays for in-home services — personal care, homemaker help, adult day care, respite, home modifications — for seniors who need a nursing-facility level of care but want to stay at home. It does not pay for assisted living room and board.
  • Ohio's Assisted Living Waiver is the program that actually pays for care services delivered inside a licensed Residential Care Facility. It still does not cover room and board, only the care services themselves, and not every RCF holds a provider agreement.
  • MyCare Ohio (branded in some materials as “Next Generation MyCare”) is Ohio's managed care program for people who qualify for both Medicare and Medicaid, coordinating medical care and long-term services and supports through a single managed care plan.

All three are administered locally, for the Cincinnati region, through the Council on Aging of Southwestern Ohio, the Area Agency on Aging covering Hamilton, Butler, Warren and Clermont counties.

For veterans, the federal VA Aid and Attendance pension enhancement adds a monthly payment on top of an existing VA pension for veterans or surviving spouses who need help with daily activities. Rates and the net worth limit adjust annually -- confirm the current figures directly at va.gov before relying on them, since a same-year figure quoted from memory is exactly the kind of number this site will not guess at.

Questions families ask

How many days can an assisted living community in Ohio provide skilled nursing before a resident must transfer?

Ohio caps the skilled nursing an RCF may provide at 120 days in any 12-month period per resident, under ORC 3721.011, with exceptions for physical/occupational/speech therapy and hospice residents.

Is independent living licensed the same way as assisted living in Ohio?

No. Independent living is generally unlicensed housing in Ohio because it does not include personal care. Assisted living is licensed as a Residential Care Facility specifically because it involves hands-on help with daily activities.

Where can I see a facility's Ohio inspection record before touring?

Ask the community directly for its most recent Ohio Department of Health inspection report, or contact the Ohio Department of Health directly to request survey history for a specific facility.

What is PASSPORT and what does it actually cover?

PASSPORT is Ohio's largest Medicaid home- and community-based waiver for seniors, paying for personal care, homemaker help, adult day care, respite, home modifications and structured family caregiving for those who need a nursing-facility level of care but want to stay home. It does not cover assisted living room and board.

Does Medicaid pay for assisted living room and board in Ohio?

No. Even under Ohio's Assisted Living Waiver, Medicaid pays for the care-services portion of an assisted living stay, not room and board. Families cover room and board out of income, Social Security or other private funds.

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