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You are here: Home > Benefit Services > Aged, Blind & Disabled (ABD) Medicaid

Aged, Blind & Disabled (ABD) Medicaid

Specialized Medicaid Benefit Center

SMBC is a service center within the Cuyahoga County Department of Employment and Family Services. SMBC provides Medicaid and other benefits to individuals throughout Cuyahoga County. 

SMBC Office locations
  • Virgil Brown Building - 4th Floor, 1641 Payne Avenue, Cleveland, 44114
  • Metro Health Medical Center
  • Cuyahoga County Board of Developmental Disabilities (CCBDD) sites 

You can apply for Medicaid benefits online now! Click here.
Ohio Medicaid offers a span of programs for older adults and people with disabilities to assist with medical expenses. These programs provide health care coverage consisting of primary and acute-care benefit packages along with long-term care. Working Ohioans with disabilities may be interested in the Medicaid Buy-In for Workers with Disabilities program.
Medicaid for the Aged, Blind & People with Disabilities (ABD)To qualify for ABD Medicaid, applicants must be:

  • age 65 or older, or
  • considered legally blind, or
  • an individual with a disability (as classified by the Social Security Administration), and
  • must meet basic requirements. 

When applying for this type of Medicaid, proof of income, resources, age or disability, citizenship (if not a U.S. citizen) and other health insurance is required. A face-to-face interview with the local county department of job and family services is also necessary. Applicants can ask an authorized representative to apply on their behalf.

For additional information, click on http://jfs.ohio.gov/ohp/consumers/abd.stm

Helpful links  Related programs
 Getting Care  Medicaid Buy-In for Workers with Disabilities
 Healthchek  Medicare Premium Assistance Program
 Income Guidelines  Breast & Cervical Cancer
 Medicare Part D  Limited Income Newly Eligible Transition Program

United Health Care ABD:
http://www.uhccommunityplan.com/plan/details/OH/321/MEDICAID/plan-details 

Molina ABD:
http://www.molinahealthcare.com/medicaid/members/oh/pdf/30305oh-abd-coveredservices.pdf?E=true

Paramount ABD:
www.paramountadvantage.org/about/

CareSource ABD:
https://www.caresource.com/documents/abd-memberhandbook-pdf/

Buckeye ABD:
http://www.bchpohio.com/member-secure/benefits-grid/

General Waiver Information

What is a Medicaid home and community-based services waiver?

It is a program that helps people stay at home instead of going to live in a nursing home, hospital or institution for persons with mental retardation.

How does a waiver program help me stay at home?

If you are enrolled in a waiver program, Medicaid could pay for such services as:

  • Nursing
  • Help with personal care and homemaking
  • Temporary relief for your caregiver of family
  • Adaptations to make your home more accessible for you .

There are four Medicaid waiver programs in Ohio:

Each waiver program serves people who have a particular set of needs. The financial requirements are the same for each waiver. Other requirements and services may be different for each waiver.

Each waiver program serves people who have a particular set of needs. The financial requirements are the same for each waiver. Other requirements and services may be different for each waiver.

Additional information on these waivers can be found at the following web sites: 
http://jfs.ohio.gov/OHP/consumer.stm 
http://www.state.oh.us/age/passport.htm 

Your Rights

You have a right to a state hearing.
You can ask for a state hearing if you do not agree with an action or a decision on your waiver application or Medicaid benefits.

If you want to know more about state hearings, ask you county department of Job and Family Services for a copy of ODHS 4059 – Explanation of State Hearing Procedures. 

Your civil rights
The Ohio Department of Job and Family Services is a public agency which manages federal funds. Laws do not allow discrimination in managing programs that use federal funds. Types of discrimination include age, sex, race, color, national origin, religion, ancestry or handicap. If you feel you have been discriminated against, send your complaint to:

Civil Rights
Office of Internal Administration
Ohio Department of Job and Family Services
30 East Broad Street, 32nd Floor
Columbus, Ohio 43266-0423

Specific Waiver Information

Nursing Home/Institutional Care

This program is for individuals who cannot care for themselves at home and may need care in an institutional such as a nursing home or an intermediate care facility for people with mental retardation and/or developmental disabilities (ICF-IID). 

  • The individual must have a level of care to receive services
  • The individual is allowed to keep a monthly needs allowance
  • In some cases, a monthly needs allowance may be provided to a spouse  and/or minor children from the individual’s income
  • Any remaining income is patient liability, paid directly to the facility to cover cost of care 

When an individual applies for nursing home/institutional care, they must meet the transfer of resources provisions. Resources and the transfer of resources are reviewed from five (5) years prior to the first date of institutionalization to the present. If the individual has transferred resources improperly, then they will be placed on restricted coverage. This means that they have Medicaid coverage, but their room and board at the facility will not be paid by Medicaid until the restricted coverage period ends. 

Assisted Living Waiver (ALW)

Assisted living offers more supervision and services than what may be available in a traditional home setting and allows individuals to have more independence and fewer restrictions than a nursing facility. Recipients of ALW keep a portion of their income to pay for their room and board and personal needs. The remaining income is the patient liability and is paid directly to help cover the cost of care. In order to be eligible for the ALW, individuals must meet ALL of these requirements: 

  • At least age 21
  • Have an intermediate level of care
  • Meet income and resource provisions  

ALW services are administered by the Ohio Department of Aging (ODA) and Western Reserve Area on Aging Agency (WRAAA). 

Other Waivers

Home and community –based service waivers provide home health care to individuals who wish to stay in their home but otherwise need institutional care. There are several types of waivers: 

Ohio Home Care Waivers meet the home care needs of individuals, up to age 60, whose medical condition would otherwise require them to live in a nursing home or other institutions. ODJFS administers the waiver services. 

PASSPORT Waivers provide in-home services to individuals aged 60 or older. Ohio Department of Aging (ODA) and Western Reserve Area on Aging Agency (WRAAA) administer the waiver services.  

Individual Options and Level One Waivers provide support services for individuals with developmental disabilities. 

Eligibility requirements: 

  • Individual must meet the level of care requirements of the specific waiver
  • Applicants must complete both a standard application (JFS 7200) and a waiver application (JFS 2399)  

Waiver recipients keep a portion of their income to pay for their expenses and personal needs. The remaining income is the patient liability and is paid directly to the associated administrative agency to help cover the cost of care. 

Program of All-Inclusive Care for the Elderly (PACE)

PACE emphasizes a holistic approach to medical care based on the philosophy that living with the community is best for the frail elderly and their families. Participants live in a variety of settings in nursing homes and adult group homes, but most reside in their own communities. IN order to receive Medicaid coverage for PACE services, individuals must: 

  • Be a Cuyahoga County resident
  • Qualify for Medicaid coverage under the institutional financial eligibility standards
  • Require an intermediate or skilled level of care
  • Be at least aged 55
  • Be willing to accept all of their care from PACE providers 

Residential State Supplement (RSS) Program

RSS provides cash assistance to Medicaid eligible aged; blind or disabled adults who have increased needs due to a medical condition which not severe enough to require institutionalization. The RSS cash payment is used together with the individual’s personal income to help prevent premature or unnecessary institutionalization. To be eligible the individual must: 

  • Meet the financial and resource criteria
  • Have at least a protective level of care
  • Agree to live in the designated RSS living arrangement.