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Medicaid Waiver vs. Nursing Home Medicaid

Both use the same non-MAGI financial test. They pay for completely different settings.

HomeComparisonsMedicaid Waiver vs. Nursing Home Medicaid
Short answer

Ohio's home and community-based Medicaid waivers (the Assisted Living Waiver, PASSPORT and MyCare Ohio) and traditional nursing home Medicaid use the same non-MAGI, aged/blind/disabled financial eligibility pathway, with the same income and asset limits. The difference is where the care happens: waivers keep someone in an RCF or at home; nursing home Medicaid pays for care inside a licensed nursing facility.

The eligibility test is the same

Both pathways require meeting Ohio's $2,901 per month (300 percent of the SSI federal benefit rate, the 'special income level' Ohio uses for nursing facility and waiver eligibility) income limit and the $2,000 asset limit for a single applicant, along with a Nursing Facility Level of Care determination. Clearing this test qualifies someone for the financial side of either pathway; which one they actually use depends on where they live and what waiver capacity is available.

Where they diverge

  • Nursing home Medicaid pays the facility directly for room, board and care once the resident has spent down to the asset limit and is admitted to a Medicaid-certified nursing facility bed.
  • The Assisted Living Waiver pays only for care services inside an RCF; the resident pays room and board directly, capped at the SSI federal benefit rate minus a $50 personal needs allowance.
  • PASSPORT and MyCare Ohio support staying at home and do not pay for room and board anywhere.
Waiver capacity is limited. Unlike nursing home Medicaid, which is an entitlement once eligible, the Assisted Living Waiver and PASSPORT can have waiting lists. Ask the Area Agency on Aging serving your county about current wait times.
How Cleveland families pay for care. Medicare does not cover assisted living. Ohio's long-term supports run through the Assisted Living Waiver, PASSPORT, and MyCare Ohio for dual-eligibles, none of which cover room and board in assisted living. Read the full explanation →

Questions Cleveland families ask

Does Ohio's Medicaid expansion pay for a parent's assisted living or nursing home care?

No. Ohio's Medicaid expansion under the Affordable Care Act, effective January 1, 2014, covers adults age 19 to 64 up to 138 percent of the federal poverty level for acute and primary medical care. It's a completely separate pathway from the aged/blind/disabled Medicaid rules that govern nursing home and waiver eligibility for seniors. Long-term care coverage for seniors runs through Ohio's non-MAGI Medicaid rules, not the expansion population.

How does Ohio's Assisted Living Waiver work, and does it cover the full monthly bill?

The Assisted Living Waiver, administered by the Ohio Department of Aging through PASSPORT Administrative Agencies, pays for personal care and supportive services delivered inside a licensed Residential Care Facility for Medicaid-eligible adults 21 and older with a hands-on ADL need. It does not cover room and board; the resident pays that directly to the facility, capped at the SSI federal benefit rate minus a $50 personal needs allowance.

What is PASSPORT and how is it different from the Assisted Living Waiver?

PASSPORT is Ohio's flagship home and community-based Medicaid waiver, delivered through Area Agencies on Aging, designed to keep Medicaid-eligible seniors who need nursing-facility level of care living at home rather than in an institution. It covers personal care, home-delivered meals, adult day care, minor home modifications, medical transportation, and, as of October 2024, Structured Family Caregiving. Like the Assisted Living Waiver, it never pays for room and board, since it's strictly an in-home program.

What is MyCare Ohio and which Cleveland-area counties does it cover?

MyCare Ohio is a managed care demonstration for Ohioans eligible for both Medicare and Medicaid, coordinating medical care, behavioral health, and long-term services and supports through a single plan. Its Northeast Ohio region covers all of Cuyahoga, Lake, Lorain, Medina, and Geauga counties, plus Summit and Portage counties. As of mid-2026 Ohio was mid-transition on a restructuring called Next Generation MyCare, so families should confirm current plan and county status directly with the Ohio Department of Medicaid.

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