2020 Pacesetter Prize Winner

Effective Transitions

Why a Pacesetter Prize for Ohio?

Ohio is a national leader in transitioning people who need LTSS and are moving out of institutions and back into the community. The Ohio Department of Medicaid works with its six managed care plans to integrate LTSS services, which has brought relief to thousands of residents. The state also provides supplemental services, including personal budget training and transitional support to individuals transitioning back into the community. Ohio improved its rank in the Effective Transitions category from No. 31 in 2017 to No. 18 in 2020. Its overall State Scorecard rank rose from No. 34 to No. 19 during the same time period.

Success Highlights

  • The HOME Choice program, which has transitioned more than 14,000 people from institutional to home and community-based settings since 2008, was recently revised to integrate transition efforts into facets of the state LTSS programs.
  • Ohio incorporated transitional services into its Medicaid dual demonstration waiver and fee-for-service waiver programs to make HOME Choice permanent and sustainable. For example, all of the Medicaid-funded waivers, including the Ohio Home Care Waiver, added community integration services, which can provide household budgeting training. MyCARE Ohio, which offers health insurance coverage for people eligible for Medicare and Medicaid and other Medicaid-funded waivers, are now required to provide community transition services.
  • The state’s Recovery Requires a Community Program also can provide transitional supports to people with behavioral health challenges transitioning out of a nursing facility.
  • Ohio’s Long-Term Care Ombudsman Program maintains a plan to address skilled nursing facility closure, facilitating transitions to community-based LTSS programs. This is especially important during the COVID-19 pandemic.

What’s next for Ohio?

Ohio continues to monitor the HOME Choice program to ensure changes will deliver long-term sustainability for the program and for individuals. The state also is responding to current and near-term challenges. In response to COVID-19, Ohio set up intermediary Health Care Isolation Centers, or temporary safe places for people to get specialized care that could be difficult to obtain given current public health emergencies.