There are many factors that go into the decision to move to a senior living community. One of the biggest factors you may face, for yourself or your loved one, is the price. Once you know what a community costs, you probably start thinking about how you’re going to pay for it. Depending on your situation, Medicaid Waiver may help reduce your financial burden and stress.

Medicaid Waiver Eligibility and Coverage

Medicaid Waiver isn’t an easy program to understand. Its many ins and outs, and requirements, are often confusing. Before understanding the waiver process, you should understand who is eligible and what it can cover.

Who is Eligible for Medicaid Waiver

The requirements for Medicaid Waiver eligibility are determined by the state where you live. In Ohio, you generally must meet these requirements to qualify.

• Be at least 21 years old
• Need assistance with your daily activities, known as activities of daily living (ADLs)
• Be able to cover the state’s predefined monthly price
• Meet the financial criteria, including income and assets, set by your county’s Department of Job and Family Services

What Medicaid Waiver covers

In Ohio, Medicaid Waiver applies only to assisted living. This also includes specialized memory care communities that provide assisted living in a secure environment for those with Alzheimer’s and dementia. Through the program, all senior living community expenses are covered for you or your loved one. Once you are eligible, enrolled, and living at an approved community, all your expenses will be covered, including these.

• Assistance with activities of daily living (ADLs)
• Room, suite, or apartment accommodations
• 24-hour staff availability
• Housekeeping and laundry
• Nursing care
• All meals
• Daily activities and events

Top 6 Things to Know about Medicaid Waiver

You may have planned and saved for retirement your whole life. But, you may still be concerned about paying for senior living. As you look at senior living communities, you will likely see a wide range of prices. No matter what the cost is, financial concerns are common. If you or your loved one meets the financial eligibility, and needs assisted living, waiver may reduce your financial stress and make senior living affordable. These are the top six things you should know about Medicaid Waiver.

Don’t let the name confuse you

When you hear “Medicaid Waiver,” you probably think about Medicaid. But, the two are very different. Traditional Medicaid is income-based health insurance. Medicaid works like typical health insurance and covers your medical expenses.

Medicaid Waiver is different. It doesn’t work like traditional health insurance or Medicaid and does not cover your medical expenses. Instead, it covers much of the cost of assisted living and reduces the amount you are responsible for paying. The program is still based on income and care need. In Ohio, it’s managed by the Department of Medicaid.

Reduce monthly rent expense

While waiver makes senior living more affordable, it does not cover 100% of the cost. Once you or your loved one is approved, your financial responsibility is reduced to an amount you can afford to pay. That amount is based on your income and your state’s program requirements. In Ohio, you would be expected to pay the current social security income (SSI) federal rate, minus $50. With all of your expenses taken care of, the extra $50 can cover anything else you may want or need.

Spend Down Period

Often, an assisted living community requires you to live at the community for awhile before you are eligible. In these cases, you must pay for assisted living on your own for a set amount of time. During the spend down period, you reduce your financial assets. Typically, they must be under $2,000. It’s important to know what a community’s spend down period is so you can be prepared. It may mean moving to a community while you can afford to pay on your own during the spend down window. It’s not uncommon for a community to require a two year spend down.

5 Year Look Back

Once you’ve met the requirements, and completed the spend down period, there is one other requirement to be aware of. After you apply, the state does something known as a five-year lookback. During this part of your approval process, they go through your finances over the last five years. They’re looking to see where your money went. Especially for large transactions, they want to ensure that you spent down your assets in an appropriate way. For instance, you cannot gift a family member a large sum of money in order to reduce your assets.

Medicaid Waiver Certified Communities

If you think you or your loved one may need to rely on Medicaid Waiver in the future, it’s important that you choose the right community from the beginning. Not every senior living community is able to offer or accept waiver. As you look at assisted living communities, make sure to find out if they have Medicaid Waiver certification. Their certification could cover assisted living and/or memory care.

Even when you find a certified community, there is other information you likely need to know. Each approved community can work a little differently. In general, you may want to ask them:

• What is their application and approval process
• What types of Medicaid Waiver units do they offer (i.e. private or semi-private)
• How many Medicaid Waiver units does the community have
• Is there typically a waiting list for Medicaid Waiver approved units

Enjoy life to the fullest

Assisted living is all about providing the care you or your loved one needs, balanced with promoting independence. It’s also a chance to have a more robust social life and better relaxation. In general, calling a senior living community home is a great way to enjoy living life to the fullest. Plus, once you’re approved, you can have peace of mind about your finances now and in the future.

Getting Answers to your Medicaid Waiver Questions

These are just the basics of Medicaid Waiver. There’s a lot more to understand. And, you may feel like you have more questions than answers. If you’re looking for more information about Medicaid Waiver, or have questions you want answered, there are resources that can help. In Ohio, you can contact your PASSPORT administrative agency. They can answer your questions and help you find a Medicaid Waiver certified community near you. If you already know what approved community you are interested in, they can also help answer your questions about the program.

Medicaid Waiver at The Ohio Masonic Communities

The Ohio Masonic Communities is proud to offer Medicaid Waiver for assisted living at Browning Masonic Community. If you are interested in learning more about our Medicaid Waiver process or requirements, please reach out to us here. We also hope to be approved to offer Medicaid Waiver in memory care at Browning Masonic Community in early 2026. To learn more about our memory care Medicaid Waiver, and find out if we are currently approved, contact us here.

The Ohio Masonic Communities offers assisted living at three senior living communities across the state of Ohio – Browning Masonic Community in Waterville, Ohio, Springfield Masonic Community in Springfield, Ohio, and Western Reserve Masonic Community in Medina, Ohio. If you are interested in learning more about assisted living, give us a call at 1 (877) 881-1623 or contact us here.