How Is "Level of Care" Determined for Ohio Nursing Facility Medicaid?

Before Ohio Medicaid will pay for nursing facility care — or for most home- and community-based waivers meant to avoid nursing facility placement, like PASSPORT — an applicant has to be found to need a "nursing facility level of care" (NFLOC), a specific functional and medical determination distinct from the financial (income and asset) eligibility rules covered in our Medicaid and PASSPORT explainer. This determination is made through a standardized assessment that looks at a person's ability to perform activities of daily living (bathing, dressing, transferring, toileting, eating), cognitive status, and any skilled nursing or rehabilitation needs, generally conducted by a case manager or assessor associated with the local Area Agency on Aging or, for the PASSPORT waiver specifically, through the process described in our PASSPORT assessment explainer. A person can be financially eligible for Medicaid but not meet the NFLOC functional threshold, or vice versa — both pieces have to line up before nursing facility or waiver coverage is approved, which is why the application process typically involves both a financial caseworker and a separate clinical assessor.