Nursing Home/Waiver

Medicaid provides long-term care services for individuals in Nursing Facilities (NFs) and Intermediate Care Facilities for the mentally retarded (ICF-MRs)
Medicaid can also provide Home and Community-Based Services Waivers to individuals who wish to stay in their home, but otherwise need institutional care. The number of consumers that can be enrolled in a waiver program at any one time is limited
Income/resources for Facility and Waiver Medicaid eligibility will be evaluated once an application is received

To apply for Medicaid for an individual going into or currently in a Nursing Facility, or for Passport/Waiver services, please complete and submit the following application:click here or apply online
If you do not have an open Medicaid case, you must complete and submit BOTH of the following applications to apply for Passport/Waiver services (click here -7200 form) (click here -2399 form) If you want someone to apply for you or on your behalf, please complete and submit the Designation of Authorized Representative form (click here)
In person at our agency during regular business hours (M – F 8:00 am-4:00 pm)
By dropping a completed application in the agency drop box located in the front of our building, open 24 hours
By mailing a completed application 239 W Main Street Lancaster, Ohio 43130
By faxing a completed application to 740-689-4848.

Proof of citizenship, or alien registration card/I-9
Social Security Card
Birth Certificate
Driver’s License, State ID
Proof of all income (employment, child support, disability, unemployment, etc)
All resources (bank statements, all life insurance policies, stocks, bonds, annuities, IRA, trusts, and etc )
Proof of disability (doctor statement, doctor/hospital records)
Social Security award letter (if applicable)

We offer face to face appointments or phone appointments for you or your Authorized Representative Monday – Friday from 8:00 am – 4:00 pm
If you cannot come to an appointment during regular business hours, you can file an application at any time and we will contact you to make other arrangements