Ohio Assisted Living Waiver and PASSPORT Waiver: Eligibility, Costs, and the 120-Day Rule

Ohio offers two primary Medicaid waivers for long-term care outside of nursing facilities: the PASSPORT waiver (for home-based care) and the Assisted Living Waiver (for residential care facilities). Both can fund dementia care services, but they work very differently — and the 2026 MyCare Ohio transition has changed how you access them.

The PASSPORT Waiver: Home-Based Care

PASSPORT is Ohio's classic home care waiver, designed to keep older adults in their own homes instead of nursing facilities. It's administered through regional Area Agencies on Aging and covers personal care aides, adult day services, home-delivered meals, emergency response systems, and home modifications.

Eligibility: Your parent must be age 60 or older, meet the nursing facility level of care standard (determined through a clinical assessment), and meet the same financial thresholds as institutional Medicaid — $2,000 in countable assets and gross monthly income at or below $2,982 (or a Miller Trust in place if income exceeds that).

The cost cap: Ohio caps PASSPORT spending at 60% of what the same care would cost in a nursing facility, with a statutory monthly ceiling of $14,700. This means there's a hard limit on how many hours of home care your parent can receive — if their needs exceed that cap, the care plan must be restructured or they'll need to transition to a facility.

The 2026 MyCare change: If your parent is dual-eligible for both Medicare and Medicaid, they can no longer enroll in legacy PASSPORT. Instead, they're automatically transitioned to the Next Generation MyCare Ohio waiver, managed by Anthem, CareSource, or Molina. The services are substantially similar, but the case management shifts from the Area Agency on Aging to the commercial carrier.

The Assisted Living Waiver: Residential Care

If your parent moves to a licensed Residential Care Facility (what most people call "assisted living"), the Assisted Living Waiver covers the personal care and clinical service components of their stay. The critical detail most families miss: Medicaid does not pay room and board.

Your parent is responsible for monthly room and board payments to the facility, capped at $944 per month (calculated as the 2026 SSI benefit rate of $994 minus the $50 personal needs allowance). Any additional income your parent has — after subtracting that $944 and the $50 personal needs allowance — goes to the facility as "Patient Liability" for care services.

In practice, this means a parent on the Assisted Living Waiver still pays nearly $1,000/month out of their own income even with Medicaid covering care costs.

The 120-Day Rule: Why It Matters for Dementia

This is the most important regulatory boundary for families using assisted living memory care. Under Ohio Revised Code Section 3721.011, a Residential Care Facility may only provide skilled nursing care on a part-time, intermittent basis — defined as less than eight hours per day or forty hours per week.

A resident cannot receive skilled nursing services within an RCF for more than 120 days within any rolling 12-month period. Skilled nursing services include advanced wound care, continuous tube feeding, daily clinical injections, and other medical interventions requiring a licensed nurse.

If your parent's dementia progresses to the point where they need daily, continuous skilled nursing care beyond this 120-day threshold, the facility is legally required to issue an involuntary discharge notice. Your parent must then transfer to a licensed skilled nursing facility, where there's no limit on skilled care scope.

This creates an urgent planning scenario: families settle into a memory care assisted living unit assuming it's a permanent placement, then face a forced transfer when the parent's condition deteriorates past what the facility can legally provide.

How to Choose Between the Two

Stay home (PASSPORT or MyCare waiver) if your parent's home can be made safe, a reliable caregiver (family or paid) is available, and your parent's care needs stay within the monthly cost cap. Home-based waivers also allow the Structured Family Caregiving option, where a live-in family member can be certified and paid as a personal care assistant.

Assisted living (ALW) if your parent needs 24/7 supervision that can't be safely provided at home, particularly for wandering risk. Look for facilities with the Ohio Department of Health Memory Care Endorsement (OAC 3701-16-21), which requires secured units, a minimum of three daily structured therapeutic activities, and staffing ratios at least 20% above the facility's basic assisted living baseline.

The Ohio Dementia & Memory Care Guide includes a care-path comparison worksheet, a facility tour checklist for evaluating memory care units, and a 120-day skilled nursing tracker to monitor whether your parent is approaching the discharge threshold.

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