As LeadingAge Ohio previously reported in The Source, the United States Court of Appeals for the Sixth Circuit in Price v. Medicaid Director has determined that the Ohio Department of Medicaid and the Ohio Department of Aging do not have to provide retroactive benefits to Medicaid assisted living waiver applicants. However, the Court also determined that ODM and ODA offer a pre-application assessment to determine eligibility for the waiver and to develop the care plan. The Court stated: "[u]nder Ohio's Medicaid regulations, a senior can seek approval of a service plan before making an application for assisted living benefits ... Thus, so long as an applicant anticipates in advance that she might want Medicaid coverage for assisted-living services, she can get a written plan of care approved in advance of her application, ... and thereby receive benefits retroactive to the time of application .... "
It is not clear that the Area Agencies on Aging are expecting or prepared to conduct a pre application assessment. However, the rule contemplates just such a request. OAC 5160-33-04 states “Individuals initially contacting the PAA will receive an in-person assessment to determine eligibility for the assisted living HCBS waiver program. If the individual has not already initiated an application for medicaid or waiver eligibility as described in paragraph (A)(1) of this rule, the PAA may assist the individual.”
Consequently, it is in your facility's best interest, and in the best interest of the Medicaid waiver applicant, to contact the Area Agency on Aging and request a pre-application assessment and care plan for the waiver applicant, at least one month prior to the month of expected Medicaid financial eligibility. This should eliminate any gap in Medicaid coverage due to a delay in the assessment by the Area Agency on Aging after a Medicaid application has been filed. If, in your experience, one month is not a long enough time period to allow for the Area Agency on Aging in your area to schedule the pre-application assessment and care plan, allow for more time. If an Area Agency refuses to conduct an assessment prior to the filing of the application, please contact Nisha Hammel, Director of Advocacy, at nhammel@leadingageohio.org to report your experience.