Ohio Medicaid’s PASSPORT Waiver Program & Consumer-Directed Service Options

Overview of the PASSPORT Waiver

Ohio’s PASSPORT Waiver provides Home and Community-Based Services (HCBS) for elderly state residents in order to delay and / or prevent nursing home admissions. While a variety of long-term care benefits are available, a program participant’s needs and circumstances determines which ones are provided. As an example, home modifications to allow wheelchair access, a personal emergency response system, homemaker services, and personal care assistance might allow one to continue to live at home independently. For a senior with a live-in, unpaid family caregiver, adult day care and respite care might supplement the care already being provided. Furthermore, a new benefit, Structured Family Caregiving, allows a live-in family caregiver, including a spouse, to be paid for providing care.

In addition to providing long-term services and supports, there is an informational component to this program. Via a pre-admission screening, an individual’s care needs and options for long-term care, as well as potential for Medicaid eligibility, are discussed.

While services offered under the PASSPORT Waiver may be provided by licensed care workers, program participants also have the option to self-direct their own care. There are two participant-directed options, allowing one to select and hire their own home care worker (caregiver): Choices Home Care Attendant Service (C-HCAS) and Consumer-Directed Personal Care Service (CD-PCS). Both options allow program participants to hire family members, including spouses, sons, daughters, adult grandchildren, nieces, and nephews, as the caregiver. With C-HCAS, there is a little bit more flexibility, as program participants can choose the hourly pay rate (within an allotted budget), while for CD-PCS, the hourly pay rate is set by the state. For both options, a financial management services agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.

Program participants can live at home or the home of a loved one. They cannot live in an adult foster care home or an assisted living residence. Persons interested in assisted living services should consider Ohio’s Assisted Living Medicaid Waiver Program.

The PASSPORT Waiver is a 1915(c) Medicaid Waiver. PASSPORT stands for Preadmission Screening System Providing Options and Resources Today. It is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, there are a limited number of participant enrollment slots, and when they are full, a waitlist for program participation forms.

Benefits of the PASSPORT Waiver

Follows is a list of benefits available via the PASSPORT Medicaid Waiver. An individual care plan determines which services and supports a program participant receives. Some care services may be participant-directed, meaning the beneficiary is able to choose their care provider.

– Adult Day Health Care
– Alternative Meals Service – i.e., meals from restaurants and senior centers
– Chore Services
– Community Transition Services – assistance with security deposit and utility set-up fees for persons moving from a nursing home to a private residence
– Emergency Response Systems
– Enhanced Community Living – monitoring of health, personal care assistance, homemaker services
– Home Care Attendant – in addition to personal care assistance, assistance is provided with self-administered medications
– Homemaker Services
– Home Medical Equipment / Supplies
– Home Modifications / Maintenance / Repair
– Independent Living Assistance – i.e., medication reminders, help with banking, wellness checks
– Meal Delivery
– Nursing Services
– Nutritional Consultation / Counseling
– Personal Care Assistance
– Respite Care – out-of-home
– Social Work Counseling
– Structured Family Caregiving – financial and supportive services for live-in family caregivers providing personal care assistance and homemaker services. While family, including a spouse, can be the caregiver, it is not required that the caregiver and care recipient be related.
– Transportation – non-emergency medical / non-medical

Eligibility Requirements for Ohio’s PASSPORT Waiver

The PASSPORT Waiver is for Ohio residents who are elderly (65+ years old) or physically disabled (60-64 years old at the time of enrollment) and at risk of nursing home placement. Additional eligibility criteria are as follows.

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases annually in January. In 2025, an applicant, regardless of marital status, can have a monthly income up to $2,901. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,901 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance.

Ohio has set a minimum Spousal Income Allowance of $2,555 / month (eff. July 2024 – June 2025). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. The state also sets a maximum income allowance, which in 2025, is $3,948 / month. While this potentially allows a non-applicant spouse a higher income allowance, any additional amount above the minimum income allowance is dependent on one’s shelter and utility costs. A Spousal Income Allowance, however, can never push a non-applicant’s total monthly income over $3,948.

Assets
In 2025, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA).

The CSRA, in 2025, allows the non-applicant spouse to keep 50% of the couple’s assets, up to $157,920. If the non-applicant’s share of assets falls under $31,584, they can keep 100% of the assets, up to $31,584.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Ohio Medicaid will take it. For eligibility purposes, Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return, and in 2025, their home equity interest is no greater than $730,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant’s spouse lives in the home.
– The applicant has an adult child (over 21 years of age) who is blind or disabled and living in the home.
– The applicant has a child (under 21 years old) living in the home.

While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home.

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the PASSPORT Waiver, the tool used to determine if this level of care need is met is the Adult Comprehensive Assessment Tool (ACAT). Generally, the necessity of supervision or assistance with completing the Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, bathing, toileting, eating) and assistance with Instrumental Activities of Daily Living (i.e., preparing meals, grocery shopping, accessing transportation, etc.) indicates one requires this level of care. While persons with Alzheimer’s disease or a related dementia might meet the functional need for care, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

When persons have income over the limits, Miller Trusts, also called Qualified Income Trusts, can help. “Excess” income is deposited into the trust, no longer counting as income.

When persons have assets over the limits, there are many options. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts are another option that protects assets from Medicaid’s asset limit. For persons who have a significant amount of “extra” assets, the Modern Half a Loaf Strategy, although complicated, might be a good option. With this planning strategy, approximately half of one’s assets are gifted to family and the other half is used to purchase a Medicaid-Compliant Annuity. An annuity turns assets into a stream of income.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Ohio to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, some planning strategies not only help one meet Medicaid’s financial criteria, but also protect assets from Medicaid’s Estate Recovery Program. Unfortunately, they often violate Medicaid’s 60-month Look-Back Rule. Therefore, they should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Certified Medicaid Planner.

How to Apply for the PASSPORT Waiver

Before You Apply

Prior to applying for the PASSPORT Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

As part of the application process, applicants need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since the PASSPORT Waiver is not an entitlement program, there may be a waitlist for program participation. This waiver is approved for a maximum of approximately 39,807 beneficiaries per year. A portion of these slots are reserved specifically for persons who turn 60 years old and wish to transition to the PASSPORT Waiver from the Ohio Home Care Waiver (OHCW). OHCW provides Home and Community Based Services for persons with physical disabilities who enroll before the age of 60. In the case of a waitlist, it is thought an applicant’s access to a participant slot is based on the date of Medicaid application.

Application Process

To apply for the PASSPORT Waiver, an applicant must apply and be approved for Ohio Medicaid. Persons can apply online at Ohio Benefits, via their local County Department of Job and Family Services (CDJFS) Office, or via the Ohio Benefits Consumer Helpline at 1-844-640-6446 (OHIO). On the application there is a question asking, “Are you requesting waiver/long-term care or nursing home care”. It is important that one responds “yes” to this question.

Persons can also contact their local PASSPORT Administrative Agency to begin the PASSPORT Waiver application process. See contact information, or alternatively, persons can call 1-866-243-5678. A pre-screening assessment will be completed as part of the application process.

They can also call the Ohio Department of Aging at 1-800-266-4346 or contact the PASSPORT Administrative Agency in their area. More about the PASSPORT Waiver.

The Ohio Department of Medicaid (ODM), the Ohio Department of Aging, and thirteen regional PASSPORT Administrative Agencies (PAA) administer the Ohio PASSPORT Medicaid Waiver.

Approval Process & Timing

The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waitlist may exist, approved applicants may spend many months waiting to receive benefits.