Phase 1: Applying for Medicaid and Initiating SSDI – The Dual Approach Initial Contact and Eligibility Check for Medicaid: While Elena was still recovering, her sister Maria helped her get started with Medicaid. Maria remembered that the rehabilitation social work had said Medicaid could help. They went to the Ohio Benefits website (benefits.ohio.gov), which is the fastest way to apply. They also wrote down the phone number for the Ohio Medicaid Consumer Hotline (1-800-324-8680) in case they needed help or wanted to apply by phone. Understanding Medicaid Financial Requirements (Pre-SSDI Income): Elena found out that to get Medicaid in Ohio, people with disabilities have to meet certain money and savings limits. In 2025, someone applying alone could only make up to $794 a month for regular Medicaid (called ABD Medicaid) and have no more than $2,000 in assets. For special Medicaid Waivers, the income limit was higher—$2,901 a month—but the asset limit stayed the same. Since Elena had no job and very little savings after her accident, she likely qualified Gathering Documentation for Both: Maria helped Elena gather all the necessary documents for both Medicaid and SSDI. This included: Proof of Ohio residency (driver's license, utility bills). Proof of U.S. citizenship or alien status. Her Social Security Number. Extensive medical records detailing her T10 SCI, including hospital discharge summaries, neurological assessments, rehabilitation progress reports, and doctor's notes confirming her permanent disability and the functional limitations it imposed. These documents were critical for both Medicaid's disability determination and the SSDI application. Statements for any bank accounts or other financial assets. Detailed work history for the SSDI application. Completing the ApplicationsMaria used the Ohio Benefits website to fill out the Medicaid form called “Request for Cash, Food and Medical Assistance” (JFS 07200). She made sure to say Elena was applying because of a disability. At the same time, she started the SSDI application on the Social Security website. She explained Elena’s injury and how she can’t perform “substantial gainful activity” (SGA). In 2025, non-blind applicants can’t earn more than $1,620 a month to qualify for SSDI. Submitting and Following Up: After submitting both applications online, they got confirmation numbers. Maria set reminders to follow up with the Cuyahoga County Department of Job and Family Services (CDJFS) for Medicaid and the Social Security Administration (SSA) for SSDI. Phase 2: The Impact of SSDI Approval on Medicaid – Coordination is Key SSDI Approval and its Income: A few months later, Elena got great news - her SSDI application was approved. She would start getting monthly payments, which was a relief. However, she also learned that this money would count as income and could affect her Medicaid eligibility, since Medicaid has income limits. Medicaid Redetermination and Qualified Income Trust (QIT): At first, Elena got Medicaid because she had low income. However, now she was getting SSDI, which was likely above the basic ABD Medicaid income limit of $794/month (but potentially below the Medicaid Waiver limit of $2,901/month), her case had to be reviewed again. If her SSDI income was above the basic ABD Medicaid limit but below the waiver limit, she could still get Medicaid if she qualified for a waiver program, as the waiver income limit is higher. If her SSDI income was above the Medicaid Waiver income limit of $2,901 per month, she would need to set up a Qualified Income Trust (QIT), also known as a "Miller Trust." A QIT is a special legal instrument where income exceeding the Medicaid limit is deposited into the trust, allowing the individual to still qualify for Medicaid. This "excess" income in the QIT is then used to pay for medical expenses or a portion of her care costs, if applicable. Maintaining Medicaid for Waiver Services: Elena's goal was to maintain her Medicaid coverage because it gave her access to the Home and Community-Based Services (HCBS) waivers. Without Medicaid, she wouldn’t be able to get these crucial services for in-home care. Phase 3: Securing Waiver Resources and Maximizing Benefits Understanding the Need for Waivers and SSDI's Role: Now that Elena is likely able to keep her Medicaid (either directly or by using a QIT because of her SSDI income), she and her sister Maria focused on learning more about waivers. SSDI would help pay for her everyday needs like rent and food, but it wouldn’t cover the special long-term care she needed that waivers provide. Detailed Waiver Research: They went to the Ohio Department of Medicaid website (medicaid.ohio.gov) and looked at the section called “HCBS Waivers”: They focused on the Head and Spinal Cord Injury (HASCI) Waiver and the Ohio Home Care Waiver (OHCW), both designed for individuals with physical disabilities who meet a nursing facility level of care but wish to stay in their homes. Elena, being under 60, was eligible for the OHCW. Contacting Key Agencies for Waiver Enrollment: To get personalized information and begin the waiver application process, Elena (with Maria's help) reached out to: Ohio Benefits Long-Term Services and Supports (OBLTSS) Hotline (844-644-6582): A support navigator helped them understand the specific eligibility for each waiver, the importance of the "level of care" assessment, and how her SSDI income would be considered for waiver eligibility. They confirmed that for waiver eligibility, her income could be higher than for basic Medicaid, but if it exceeded $2,901/month, a QIT would be necessary to "spend down" the income to the eligible level. Cuyahoga County Department of Job and Family Services (CDJFS): They continued to engage with CDJFS for the formal submission of Form ODM 02399, "Request for Medicaid Home and Community-Based Services (HCBS) Waiver," clearly indicating Elena's interest in the HASCI and OHCW waivers. The "Level of Care" Assessment (Essential for Waivers): Even though Elena was getting SSDI, she still had to pass "nursing facility level of care" (LOC) assessment. A case manager (assigned by ODM) would visit and objectively determine if Elena's T10 SCI and functional limitations were severe enough that she would need institutional care unless she got help from home. If she passed this check, she could get waiver services at home instead. Utilizing Both Benefits: Elena's SSDI benefits would provide her with a monthly income to cover her personal living expenses, such as rent, groceries, and utilities. Her Medicaid, combined with the approved waiver (like HASCI or OHCW), would then cover the costs of crucial in-home services like personal care attendants, durable medical equipment (like a specialized wheelchair or shower chair), home modifications for accessibility (e.g., ramp installation, bathroom grab bars), and rehabilitation therapies provided in her home. This plan helped Elena stay in her home, get the care she needed, and manage her finances wisely.