Ohio offers Medicaid waiver programs designed to help older adults and individuals with disabilities remain in their homes or communities rather than entering nursing facilities. The primary program is the PASSPORT Medicaid Home Care Waiver, which assists seniors in obtaining long-term services and supports they need to live independently. In addition, Ohio’s Home Care Waiver serves younger adults with physical disabilities, and both waivers include consumer-directed options such as Structured Family Caregiving. These waivers can provide services like personal care assistance, adult day services, home-delivered meals, homemaker services, and respite for family caregivers. To qualify, applicants must be Medicaid-eligible and require a nursing facility level of care, determined in part by needing assistance with Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs). In this article, we explain what ADLs and IADLs are, and how needing help with these daily tasks is central to qualifying for Ohio’s Medicaid waivers, including PASSPORT and the Ohio Home Care Waiver.
What Are ADLs (Activities of Daily Living)?
Activities of Daily Living (ADLs) are basic self-care tasks that a person must perform daily to live independently. Difficulty with ADLs is common among seniors or those with disabilities, and needing help with these tasks is a strong indicator that supportive care is necessary. Core ADLs include:
- Mobility (Ambulating/Transferring): The ability to move safely, such as walking, getting up from a chair, or transferring from a bed to a wheelchair.
- Dressing: Putting on and taking off clothing (including managing fasteners) without help.
- Eating: Feeding oneself using utensils to get food from plate to mouth and actually consuming the food.
- Personal Hygiene: Bathing or showering and completing grooming activities like shaving, brushing teeth, and combing hair independently.
- Toileting (Continence): Using the toilet independently, getting to the toilet, transferring on and off, and cleaning oneself afterward.
When someone cannot perform several of these tasks unaided, it signals that ongoing care or support at home may be required.
What Are IADLs (Instrumental Activities of Daily Living)?
Instrumental Activities of Daily Living (IADLs) are more complex skills necessary to live independently in a community. While not necessarily performed every day, they are essential for managing one’s household and life. Key IADLs include:
- Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and other necessities.
- Meal Preparation: Planning and cooking meals safely, including gathering ingredients.
- Housekeeping: Keeping the home clean and livable—tasks like cleaning, laundry, and taking out the trash.
- Money Management: Handling finances, such as paying bills on time, managing bank accounts, and budgeting.
- Transportation: Driving oneself or arranging rides (public transit, taxis) to appointments and errands.
- Medication Management: Managing and taking medications properly—remembering to take the correct medicines and refilling prescriptions.
- Communication: Using the phone or computer to communicate—looking up phone numbers, making calls, sending emails, and keeping in touch with others.
A decline in IADLs is often the first sign that someone is beginning to need help, even if they still manage basic ADLs.
Why ADLs and IADLs Matter for Medicaid Waiver Eligibility
Needing help with ADLs and IADLs is not just a daily challenge—it’s a key eligibility criterion for Ohio’s Medicaid waiver programs. Both the PASSPORT Waiver and the Home Care Waiver target individuals who meet a “nursing facility level of care” but wish to continue living at home. The functional eligibility assessment, often conducted during a pre-admission screening, evaluates whether an individual requires hands-on assistance with ADLs and IADLs frequently enough to meet that level of care.
During the screening, an Ohio Department of Aging (ODA) counselor or a county case manager reviews the person’s ability to transfer from bed to chair, walk safely, eat, use the toilet, cook meals, manage medications, and maintain the household. Cognitive impairments, such as dementia-related memory issues, are also considered since they impact daily functioning. Essentially, if someone cannot perform multiple ADLs without assistance or has significant difficulty with IADLs, they are likely to meet the functional requirement for PASSPORT or the Home Care Waiver.
PASSPORT Medicaid Home Care Waiver
PASSPORT is Ohio’s flagship waiver program for older adults who need a nursing facility level of care but want to remain at home or in a community setting. To qualify for PASSPORT, individuals must:
- Be age 60 or older (or age 60–64 with a physical disability).
- Be eligible for Medicaid.
- Require nursing facility level of care (confirmed by in-home assessment and pre-admission screening).
- Live in a setting that meets home- and community-based program requirements (not in a facility).
The program begins with a pre-admission screening over the phone, where staff determine potential Medicaid eligibility and assess care needs. If someone appears eligible, an in-home assessment follows. Once approved, a case manager works with the individual to develop a customized service plan. Covered services may include personal care assistance, homemaker services, adult day health care, respite care, home-delivered meals, and minor home modifications. PASSPORT also offers a Structured Family Caregiving option, which allows a live-in family caregiver (including a spouse) to be paid for providing approved care—such as assistance with ADLs (bathing, dressing, toileting) and IADLs (meal prep, medication management).
Home Care Waiver
The Home Care Waiver serves Ohioans under age 60 who have physical disabilities and require nursing facility level of care. Eligibility criteria mirror those for PASSPORT, except that applicants must be 0–59 years old with a physical disability. Once enrolled, participants receive services similar to PASSPORT (personal care, homemaker assistance, respite, and adult day services). This waiver also includes a consumer-directed component, allowing participants to hire and manage their own caregivers.
Structured Family Caregiving
Both PASSPORT and the Home Care Waiver offer Structured Family Caregiving, which permits eligible participants to employ a live-in family member (including spouses for PASSPORT) to provide care. Under this model, a family caregiver can be paid for assisting with ADLs (like transferring, bathing, dressing) and IADLs (meal preparation, medication reminders), while also receiving training and supervision. This approach supports continuity of care and helps families avoid institutional placement.
Signs That Your Loved One May Qualify
Below are indicators that someone may be a good candidate for Ohio’s HCBS waiver programs due to challenges with ADLs and IADLs:
- Difficulty with Personal Care: Unwashed hair, unkempt nails, or wearing the same clothes repeatedly can indicate problems with bathing, dressing, or hygiene (ADLs).
- Weight Loss or Malnutrition: An empty fridge or noticeable weight loss may signal difficulty preparing or eating meals (ADLs/IADLs).
- Mobility Issues and Falls: Struggling to walk without assistance, holding onto walls, or frequent falls shows declining mobility (ADL: transferring/ambulating).
- Medication Errors or Memory Lapses: Missing doses, mixing up pills, or forgetting appointments point to challenges with medication management and scheduling (IADLs).
- Household Decline: Piles of mail, unpaid bills, or messy living spaces suggest trouble with housekeeping and money management (IADLs).
A pattern of multiple difficulties—such as needing help bathing and dressing plus housework and meal prep—strongly indicates a nursing facility level of care and may qualify someone for PASSPORT or Home Care Waiver services. Document which tasks require assistance when applying to strengthen your case.
We’re Here to Help: Next Steps and Contact Information
Applying for Ohio’s Medicaid waiver programs can be daunting, but you don’t have to navigate it alone. At Momba Home Care, we specialize in assisting Ohio families with the application process—from the initial pre-admission screening to arranging in-home services. If you notice your loved one struggling with daily tasks or if a professional has recommended nursing facility care, it may be time to explore PASSPORT or the Home Care Waiver. We’ll guide you through every step, ensuring you understand eligibility rules, gather necessary documentation, and complete assessments accurately. Our goal is to help you access the care your loved one needs to stay safely at home. Call us or contact us today to get started with Ohio’s Medicaid waivers for home care.