Medicaid is a federal/state program based on financial and medical need. The Medicaid program will pay for most medically-necessary services for individuals who qualify. Medicaid pays for 70% of all nursing home care and serves approximately 48,000 individuals in home and community based waiver programs.

The Ohio Department of Medicaid operates the Medicaid program in Ohio. The County Departments of Job and Family Services process Medicaid applications and make initial eligibility decisions. There are many different categories of individuals who can be eligible for Medicaid. This presentation only addresses the category of individuals who need Medicaid to pay for nursing facility level of care services.

Applications: The Medicaid Application is filed with the County Department of Job and Family Services in the county in which the individual lives, or in the county in which the individual is placed in the nursing facility. The Department of Job and Family Services must determine eligibility within 45 days of application, absent extenuating circumstances. An authorized representative may apply for the individual and his or her acts bind the applicant in most situations.

An individual must meet three basic rules to be eligible for Medicaid:

1. the individual must be categorically eligible
2. the individual’s countable income must be at or below a certain level
3. the individuals countable, available resources must be at or below $1,500

Each of the categories set forth above will be discussed during this presentation.