Ohio Admin. Code 5160:1-6-02.3 - Medicaid: continuing care communities, life care communities, and philanthropic long-term care facilities
The purpose of
this rule is to describe the eligibility requirements for individuals residing
in a continuing care retirement community (CCRC), life care community, or a
philanthropic long-term care facility (LTCF).
"Continuing care retirement communities" and "life care
communities" mean housing communities that provide different types of care
based on each resident's need over time. CCRCs and life care communities may
range from independent living in an apartment to assisted living to full-time
care in a nursing facility. Residents may move from one setting to another,
based on their needs, but continue to live as part of the community. Generally,
CCRCs require a written contract and an entrance fee, in addition to monthly
fees. CCRCs and life care communities may also be philanthropic
"Entrance fee" means a payment generally required for
admission to a CCRC or life care community and may vary in amount based on the
type of housing accommodations and/or type of care.
long-term care facility" means a not-for-profit long-term care
Eligibility for medical assistance for individuals
residing in a philanthropic long-term care facility.
An aged, blind or
disabled person, living in a philanthropic long-term care facility, who has
entered into a life care contract with the LTCF, is eligible for medical
assistance, if all other eligibility requirements for medical assistance are
fulfilled, when the following conditions are met:
LTCF must provide evidence that it is financially unable to operate. The LTCF
must show that the total financial situation of the LTCF indicates the LTCF is
financially unable to fulfill its responsibilities under the life care contract
(rather than showing the individual has exhausted the amount of money turned
over to the long-term care facility); and
The entrance fee
would be depleted had the individual paid the facility at the medicaid
long-term care rate for a comparable facility.
residing in a philanthropic long-term care facility who has not entered into a
life care contract must have eligibility for medical assistance determined in
accordance with Chapter 5160:1-6 of the Administrative Code.
purposes of determining or redetermining eligibility for medical assistance on
or after February 8, 2006, an individual's entrance fee for admission to a CCRC
or life care community shall be considered an available resource to the
individual, in accordance with
U.S.C. 1396p (as in effect October 1, 2016),
when all of the following conditions are met:
The entrance fee
can be used to pay for care, under the terms of the entrance contract, when
other resources or income of the individual are insufficient;
The individual is eligible for a refund of any
remaining entrance fee when the individual dies or terminates the contract and
leaves the CCRC or life care community; and
The entrance fee
does not confer an ownership interest in the CCRC or life care community.
Replaces: 5160:1-6- 01.8
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 9/3/77, 10/26/78, 5/1/79, 9/21/79, 2/21/80, 6/18/89, 10/1/02, 10/1/06, 1/1/16, 12/12/16
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