Medicaid 101: Part 2 – Medicaid Assisted Living Waiver ProgramFebruary 8, 2018
Medicaid 101: Part 4 – Income eligibility and Patient LiabilityFebruary 22, 2018
Part 1 of this Medicaid blog series generally discussed the Medicaid program and its eligibility requirements. Those requirements apply to individuals seeking Medicaid benefits in the nursing home. Those same requirements also apply to individuals seeking coverage of in-home services under the PASSPORT program, but the Medicaid PASSPORT program has some additional requirements.
What is the PASSPORT program?
The PASSPORT program provides in-home services to individuals who need a nursing-home level of care but who can safely remain in the community. This alternative to nursing home care is administered by both the Ohio Department of Aging and the Ohio Department of Medicaid. The Ohio Department of Aging agency conducts the healthcare assessments and eligibility for the program, while the Ohio Department of Medicaid examines the individual’s financial eligibility for the program.
PASSPORT gets its name from the two phases of the enrollment process: “PASS” is the Preadmission Screen System. This process determines whether the individual qualifies for enrollment in the program based on the individual’s needs. “PORT” is the Providing Options and Resources Today phase of the process. During this phase, a caseworker will work with the individual to design a personalized care plan to meet the individual’s needs at home.
PASSPORT – universal requirements
As with the nursing home program, an individual must meet the following criteria to be eligible for the PASSPORT program:
- At least an intermediate level of care (assistance with at least two of the following: bathing, grooming, toileting, dressing, eating, mobility)
- Countable assets of $2,000 or less for a single individual, or meet the asset requirement for a married couple (See Part 6)
- Gross income of $2,250 or less (or have a Qualified Income Trust – See Part 4)
PASSPORT – additional requirements
First, for an individual to qualify for the PASSPORT program, he or she must be able to safely reside at home. A physician must give approval, both verbally and in writing, that at-home services will meet the individual’s needs. Similarly, the individual’s needs and level of care must be more than can be met by other community services or resources.
Second, the individual must agree to participate in PASSPORT and participate in the development of his or her service plan. This plan must provide for at least one service on a monthly basis.
Finally, the individual cannot be enrolled in PASSPORT while living in a nursing home or hospital, and PASSPORT must have a slot available. In our experience, there has not been a waiting list for the program over the last several years.
PASSPORT – What’s covered?
If an individual can qualify for the PASSPORT program, the PASSPORT agency will provide services as agreed in the individual’s service plan. These services can include nursing care, nutrition consultation and home-delivered meals, medical equipment and supplies, emergency response systems, personal care and homemaker services, and adult day care and respite services. In any month, however, the services provided to the individual cannot exceed a cost of $14,700 per month. This cost cap may limit the number of hours or types of services PASSPORT can provide.
Depending on the individual’s income, he or she may owe a patient liability to cover part of the cost of services provided. See next week’s blog post, Part 4, for further discussion regarding patient liability.
PASSPORT offers the option for an individual to direct his or her care. This option allows an individual to choose his or her own caregivers, or potentially keep a caregiver who has already been providing services and is familiar with the individual’s needs.
PASSPORT is a great option for individuals who wish to live at home as long as possible. While PASSPORT may not provide all of the services necessary to keep an individual at home, the PASSPORT services can often supplement the help provided by a spouse, children, and other loved ones.
You can visit the Ohio Department of Aging’s website for further information about the PASSPORT program. There are 11 service regions throughout Ohio, and each region has a specific PASSPORT agency. In Central Ohio, you can contact the Central Ohio Area Agency on Aging for more information.