What is ABD Medicaid and Who is Eligible?
ABD Medicaid assists with medical expenses for Ohioans who are Aged 65 years or older, Blind, or Disabled.
To qualify for ABD Medicaid:
applicants must be:
age 65 or over or
considered legally blind or an individual with a disability (as classified by the Social Security Administration for an adult or child) and
Applicants must also:
be a U.S. citizen or meet Medicaid citizenship requirements;
be an Ohio resident;
have or get a social security number;
meet certain financial requirements.
What Services Are Covered Under Medicaid?
ABD health care coverage consists of the primary and acute care benefit package and long-term care if a person has the required level of care need. Covered services include prescription drugs, home care, doctor visits, hospital care, laboratory and x-rays, medical equipment and supplies, dental care, transportation, mental health, vision services, long-term care, alcohol and drug rehabilitation and other services.
The Ohio Medicaid program has a statewide network of 36,000 providers, including, but not limited to: hospitals, family practice doctors, pharmacies and durable medical equipment companies. A Medicaid consumer may go to any Ohio Medicaid provider. However, a provider's participation in the Medicaid program is voluntary. Consumers should ask the provider if they accept the Medicaid card before scheduling an appointment.
For names of providers near you, please contact the Ohio Medicaid Consumer Hotline at:
1-800-324-8680 or TDD 1-800-292-3572.
What Long-Term Care Services Are Available?
ABD Medicaid provides long-term care services in Nursing Facilities (NFs) and Intermediate Care Facilities for the mentally retarded (ICF-MRs). Home and Community Based Services Waivers provide home health care to individuals who wish to stay in their home but otherwise need institutional care. The number of consumers that can be enrolled in a waiver program at any one time is limited.
There are several types of waivers:
Ohio Home Care Waiver meets 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 institution.
PASSPORT Waiver provides in-home services to individuals age 60 and older.
Individual Options Waiver provides support services for persons with mental retardation and/or developmental disabilities.
Residential Facilities Waiver is for persons with mental retardation and/or developmental disabilities who live in a residential facility.
How To Apply
To apply for ABD Medicaid, an application and an interview need to be completed at our office. When applying for ABD Medicaid, proof of income, resources, age or disability, citizenship (if not a U.S. citizen) and other health insurance is required.
Applicants can ask an authorized representative to apply on their behalf.
What if ABD eligibility is met except their income is too high?
What is Medicaid Spenddown?
Ohioans who are aged, blind or have a disability may qualify for Medicaid after they have incurred or paid a specific amount of medical bills. This is called Medicaid “Spenddown.” Spenddown allows individuals to deduct medical expenses from their income so that income will fall within Medicaid income guidelines. The Spenddown amount is the difference between the ABD monthly income standard and an applicant’s countable monthly income (see example below).
If eligible for Spenddown, the consumer is required to submit proof of medical expenses that meet or exceed the Spenddown amount. Once the Spenddown amount has been met, the consumer is then eligible for Medicaid. The date of Medicaid eligibility depends on the date the consumer reaches his or her spenddown amount. Spenddown eligibility is a monthly process.
The Spenddown amount can be met in three ways:
If the consumer has monthly medical expenses (i.e., medical premiums or unpaid past medical bills) that meet or exceed the Spenddown amount consistently each month, they receive a monthly Medicaid card. This situation is referred to as “on-going” Spenddown.
If the consumer does not have monthly medical expenses that meet or exceed the Spenddown amount each month, then the consumer can submit medical expenses until the Spenddown amount is met. Medicaid eligibility begins on the day the Spenddown amount is met and is valid until the end of the month. This situation is commonly referred to as “delayed” Spenddown.
The consumer also has the option to pay the Spenddown amount directly to the county job and family services. This type of Spenddown is referred to as “pay-in” Spenddown.
Medicaid Spenddown Example:
Monthly Income for Individual
$ 800
Subtract $20 Income Disregard*
- 20
Subtract Countable Monthly Income Standard
- 504
Result equals the Spenddown amount**
= $276
* $20 of income is automatically disregarded.
** $276 of medical expenses would need to be paid or incurred by the individual to be eligible for Medicaid.
Related Programs for the Disabled
County Medical Services (CMS): For individuals not meeting the above requirements for disability, the county agency can pursue a CMS determination of disability and provide the individual with a medical card.
Transportation Services
We provide direct transportation services within Athens County to medical appointments and public agencies. For medical appointments outside of Athens County, we can refer you for transportation with a statement from a local physician that medical services are not available in Athens County. We can provide gas vouchers to cover gas expenses to get yourself to medical appointments.
Incidental expense vouchers may be issued for out-of-county medical appointments, which provide a set value reimbursement after the voucher is returned with a signature by the physician and the recipient (within 4-6 weeks).
Please provide 7 - 10 days notice for transportation services. Spend-Down recipients should meet their spend-down prior to requesting transportation services.
CALL: 592-4477 or 800-338-4484 for the Transportation Unit
The Home Health Aide Program provides homemaker and home health aide services to clients 60 years of age and older. Clients are contracted through several programs (eligibility varies by program) funded through the Area Agency on Aging and the Ohio Department of Job and Family Services. The referring programs are outlined as follows:
Passport:
State of Ohio long term care program funded and administered by the Ohio Department of Aging and the Ohio Department of Job and Family Services. The goal of the program is to slow the growth in the state's institutional long term expenditures and to expand the range of community-based care alternatives. The program provides an opportunity to remain at home and receive telephone support and care services. Eligibility is determined by the Area Agency on Aging. Criteria include Medicaid eligible, age 60 years or older and need for a Medicaid funded nursing facility.
Senior Community Services Block Grant:
The program is available for clients over 60 years of age with low income ($797.50 per month). Homemaking services are provided for Athens County residents one day per week for 1-2 hours of service time.
Title XX Program:
Athens County Job and Family Services (ACJFS) receives an annual block grant each year for direct service or to subcontract service for transportation, health related care, homemaker support and socialization activities. Clients must be 18 years of age or older to receive service under this program while those 60 years of age and older automatically qualify for services. Criteria for service can also be income determined as well as health related problems. Redetermination is annually for clients served under this program.
Medicare Premium Assistance Program
Helps those eligible for Medicare who have limited income get help in paying their Medicare expenses;
Applicants must be eligible for Medicare to qualify;
No face-to-face interview is necessary. Applicants may mail in the application.
Adult Protective Services
County departments of job and family services are required to investigate and evaluate all reports of suspected abuse, neglect and exploitation of adults age 60 and older. These adults may be handicapped due to aging or they may have physical or mental impairments which prevent them from providing for their own care and protection. When funding and services are available, adults who experience abuse, neglect and/or exploitation are offered support for protection and self-sufficiency .
Eligibility: Anyone 60 years of age and older. There is no cost for the investigation to the client/family.
Referrals are accepted from anyone. Mandatory reporters, included in the law are: Senior service providers, ambulatory and home health agency providers, community mental health, alcohol & drug treatment facilities. Also, attorney, physician, podiatrist, dentist, psychologist, coroner, clergyman, nurses, social workers, any employee of a nursing home, adult day care, alternative home, hospital or peace officer having reasonable cause to believe an adult is being abused, neglected or exploited.
BY LAW, ALL REFERRALS ARE CONFIDENTIAL.
Contact:
Athens County Job & Family Services
184 North Lancaster Street
740-592-4477 or 1-800-338-4484
Fax: 740-593-6373
Food Stamp Program
The Food Stamp program was designed to promote the general welfare and to safeguard the health and well-being of individuals by raising the levels of nutrition among low-income households by the U.S. Department of Agriculture.
To be eligible, income must meet federal Guidelines. In Ohio, Food Stamps are issued by using the Ohio Direction Card, an electronic debit card - also called a smart card.
The Food Stamp program requires completing an "Application for Cash, Medical and Food Stamp Assistance" and a face-to-face interview with an caseworker. All income, including earned and unearned, must be verified prior to certification.
The following deductions can be used in the calculation of the Food Stamp allotment: rent/mortgage payment, utility costs, medical expenses, dependent care expenses, and legally obligated child support paid to a non-household member. In order to allow these deductions, however, they must be verified prior to certification. Other mandatory verifications prior to certification include: social security for each member of the assistance group, residency, and identity of the person making the application.
Emergency Food Stamps:
Those persons with little or no income at the time of the application can receive benefits on an expedited (emergency) basis. If income is zero prior to or after completing a budget, the case shall be certified for benefits within 24 hours after application. The screening unit of ACDJFS reviews applications at the point of entry for this expedited service.
