Care in an institution
The Medicaid program offers a broad set of services for those who have special health care needs. Sometimes, the best solution for a person with a severe disability or medically unstable condition is care in an institution such as a nursing home or an intermediate care facility for people with mental retardation and/or developmental disabilities (ICF-MR).
Nursing homes and ICF-MRs provide care for people who are unable to care for themselves in their home and who need help with activities of daily living such as dressing, bathing, eating, grooming, and taking medicine. Currently, Ohio Medicaid pays for approximately 70 percent of the nursing home costs in the state of Ohio. The Ohio Long-Term Care Consumer Guide is available to help families find an appropriate care settings based upon their specific needs.
There are also alternatives to institutional care. Medicaid has several programs for people who have extensive care needs and would prefer to receive services in their home and community.
Thinking about purchasing long-term care insurance? A new type of long-term care policy offering Medicaid asset protection is now available in Ohio. For more information on qualified policies, please visit: http://www.ltc4me.ohio.gov/
When applying for institutional care through Medicaid, applicants will need to show proof of income, resources, disability, U.S. citizenship or qualified alien status and other health insurance. Individuals must also meet Transfer of Resources provisions. Once it is determined that financial requirements are met, a level of care assessment will be conducted to identify the appropriate type of long-term care Medicaid will provide.
Once the care needs of the individual are determined, an additional computation is completed to establish how much of their income will be applied to the cost of care in the institution. This is called the Patient Liability.
How will this affect family members?
If an individual is in need of institutional care and has a spouse or dependent family members, it is possible that some of that individual's income and assets can be kept to support those who remain at home. This is called Spousal Impoverishment and was established as a provision in the Medicare Catastrophic Coverage Act (MCCA) of 1988. Its purpose is to protect the community spouse from becoming "impoverished".
How it works
A resource assessment is conducted to determine the amount that will be given to the spouse and dependents at home. In 2008 in Ohio, the maximum amount a spouse or dependent family member can keep is $104,400 and the minimum is $20,880 (these figures change annually). In addition, the spousal impoverishment law also allows one year for the institutionalized spouse to transfer assets to the community spouse. From here, the patient liability is determined.
More information about long-term care can be found in our long-term care publications: