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

Last updated: May 14, 2021

 

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 will determine 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.

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

The services offered under the PASSPORT Waiver may be provided by licensed care workers or program participants have the option to self-direct their personal care services. This consumer directed option is formally called PASSPORT Consumer-Directed Service Options. A financial management services agency handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments. Family member who are qualified to be hired as caregivers include sons, daughters, adult grandchildren, nieces, and nephews, but not spouses or legal guardians.

Program participants can live at home or the home of a loved one. Unfortunately, they cannot live in an adult foster care home or an assisted living residence. For those interested in assisted living services, Ohio has another waiver called the Assisted Living Medicaid Waiver Program.

The PASSPORT Waiver is not an entitlement program, which means meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms. 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. The Home Care Waiver provides home and community based services for physically disabled persons who enroll before the age of 60.

The PASSPORT Waiver is a 1915(c) Medicaid waiver. PASSPORT stands for Preadmission Screening System Providing Options and Resources Today.

 What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for “Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a nursing home level of care and are at risk of institutionalization such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

 

Benefits of the PASSPORT Waiver

Follows is a list of the benefits available via the PASSPORT Medicaid Waiver. An individual care plan will determine which services and supports a program participant will receive. 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
– 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
– Homemaker Services
– Home Modifications / Maintenance / Repair
– Meal Delivery
– Medical Equipment / Supplies
– Nursing Services
– Nutritional Counseling
– Personal Care Assistance
– Respite Care – out-of-home
– Social Work Counseling
– 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.

 The American Council on Aging provides a quick and easy Medicaid eligibility test for Ohio seniors that require long term care. Start here

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. In 2021, an applicant, regardless of marital status, can have a monthly income up to $2,382. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,382 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her 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. The maximum amount that can be transferred in 2021 is $3,259.50 and is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a spousal income allowance.

 ”Dual eligible” persons who live in an area in which the MyCare Ohio Program is available are ineligible for the PASSPORT Waiver. Dual eligible is a term used for someone who is eligible for both Medicaid and Medicare. Instead, they must enroll in MyCare Ohio.

Assets
In 2021, 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 limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, 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 can keep up to $130,380. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.

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. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Ohio Medicaid spend down calculator.  

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Ohio Medicaid will take their home. Fortunately, 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 to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– 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.

To learn more about the potential of Medicaid taking the home, click here.

 

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, eating, 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 a qualified income trust 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 an 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 the state of 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 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 free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, 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. The waiver is approved for a maximum of approximately 35,919 beneficiaries per year. 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 here at Ohio Benefits. Persons can also apply via their local County Department of Job and Family Services (CDJFS) Office. Contact information can be found here. Alternatively, persons can call the 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 Area Agency on Aging (AAA) office to begin the PASSPORT Waiver application process. Contact information can be found here, or alternatively, persons can call 1-866-243-5678. A pre-screening assessment will be completed as part of the application process.

For additional information about the PASSPORT Waiver, click here. Persons can also all the Department of Aging at 1-800-266-4346.  The Ohio Department of Medicaid and the Ohio Department of Aging 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 even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, 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.

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