Ohio Medicaid Income & Asset Limits for Nursing Homes & In-Home Long Term Care

Ohio Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While there are several different Medicaid coverage groups, the focus of this page is on long-term care for Ohio residents aged 65 and older. In addition to care services in nursing homes and assisted living facilities, OH Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which Ohio seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; there are a limited number of participants and wait lists may exist. Intended to delay and prevent nursing home admissions, services are provided at home, adult day care, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged, Blind, or Disabled (ABD) – An entitlement; meeting the eligibility requirements ensures assistance will be provided. Various long-term care benefits, such as personal care assistance or adult day care, may be available.

While Medicaid is jointly funded by the state and federal government, the state administers the program within federally set parameters. The Ohio Department of Medicaid (ODM) is the administering agency.

Income & Asset Limits for Eligibility

Each of the three Medicaid long-term care categories have varying financial and medical eligibility criteria. Financial requirements change annually, vary depending on marital status, and is further complicated due to Ohio offering alternative pathways towards eligibility.

The table below provides a quick reference to allow seniors to determine if they could be immediately eligible for long-term care from an Ohio Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid. More.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in OH, the Veteran’s Aid & Attendance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is counted; the income of the non-applicant spouse is disregarded. Furthermore, the non-applicant spouse (also called a community spouse) may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is the minimum amount of monthly income a non-applicant spouse is said to require to prevent spousal impoverishment.

In OH, the MMMNA is $2,465 (eff. 7/1/23 – 6/30/24). If the non-applicant spouse’s monthly income is under this amount, income can be transferred to them from their applicant spouse, bringing their income up to $2,465. The non-applicant spouse can further increase their income allowance if their housing and utility costs exceed a “shelter standard” of $739.50 / month (eff. 7/1/23 – 6/30/24). However, in 2024, a Spousal Income Allowance cannot push the non-applicant’s monthly income over $3,853.50. This is the Maximum Monthly Maintenance Needs Allowance. More about calculating a Spousal Income Allowance.

In addition to providing spousal support, the Monthly Maintenance Needs Allowance is effective in lowering the applicant’s countable income for eligibility purposes.

Income is counted differently when only one spouse applies for Regular Medicaid; the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. There is no Monthly Maintenance Needs Allowance for the non-applicant spouse. More on how Medicaid counts income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable assets are calculated towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. Medicaid considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, and irrevocable burial trusts. In Ohio, IRAs / 401Ks in “payout status” are also exempt. This means that one’s Required Minimum Distribution (RMD) is being withdrawn. One’s primary home is also generally exempt.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. However, the non-applicant spouse of a Medicaid Nursing Home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2024, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $154,140. If the non-applicant’s half of the assets falls under $30,828, the non-applicant spouse can retain 100% of the couple’s assets, up to $30,828. There is no CSRA for Regular Medicaid.

Medicaid’s Look-Back Rule
Ohio has a 5-year Medicaid Look-Back Period that immediately precedes one’s date of Nursing Home Medicaid or Medicaid Waiver application. During the “look back”, Medicaid scrutinizes all asset transfers to ensure no assets were gifted or sold under fair market value. If this has been done, the Medicaid agency assumes it was to meet Medicaid’s asset limit. Persons who violate the “look back” are penalized with a period of Medicaid ineligibility. The Look-Back Period does not apply to Regular Medicaid.

The IRS Gift Tax Exemption does not extend to Medicaid eligibility. In 2024, this exemption allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this exemption violates Medicaid’s Look-Back Period.

Ohio Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in the home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live in it, the applicant must have Intent to Return. There is no home equity interest limit for Regular Medicaid. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Ohio’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Medical / Functional Need Requirements

An applicant must have a medical need for long-term care Medicaid. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, some program benefits may require additional criteria be met. For instance, for home modifications, the inability to safely live at home without modifying the home might be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.

Qualifying When Over the Limits

Ohio residents, aged 65 and over, who do not meet the financial eligibility requirements above, can still qualify for Medicaid.

1) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, QITs offer a way for individuals over the Medicaid income limit to still become income-eligible and qualify for Nursing Home Medicaid or a Medicaid Waiver. For Medicaid eligibility purposes, money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one deposits their “excess” income into the irrevocable trust, which is managed by a trustee who has legal control of the funds. Irrevocable means that the terms of the trust cannot be changed or canceled. Money in the trust can only be used for very specific purposes, such as paying medical expenses accrued by the Medicaid enrollee.

2) Asset Spend Down – Persons who have countable assets over OH Medicaid’s asset limit can “spend down” assets and become asset-eligible. Examples include making home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s Look-Back Rule. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their primary home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

Specific Ohio Medicaid Programs

In addition to nursing home care, Ohio Medicaid offers several programs that help seniors live in their homes and community.

1) PASSPORT Waiver – The formal name is Pre-Admission Screening System Providing Options & Resources Today. Under PASSPORT, Ohioans can receive adult day care, home care, home modifications, and medical equipment / supplies.

2) Assisted Living Waiver – Assists program participants in living in residential care facilities and assisted living residences. While this program does not cover the cost of room and board, it covers the cost of care services. Not all assisted living residences in the state will accept Waiver participants.

3) MyCare Ohio  – The is a managed care Medicaid program for persons dually eligible for Medicaid and Medicare. Benefits may include adult day care, assisted living services, memory care services, home modifications, meal delivery, personal emergency response systems, and more. While this program does not have limited enrollment, it is only available in 29 counties.

4) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental care and eye care, may be available.

5) Money Follows the Person (MFP) – Also called HOME Choice in Ohio. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

How to Apply for Ohio Medicaid

Seniors can apply for long-term care Medicaid in Ohio online at Ohio Benefits, via the Consumer Hotline at 1-800-324-8680, or in person at one’s county Job and Family Services office. One’s local Area Agency on Aging office might be helpful in answering Medicaid program questions and offering application assistance. The application process may vary based on the program for which one is applying.

Prior to applying, Ohio Medicaid applicants should be certain that all eligibility requirements are met. For seniors who have income and / or assets greater than the limit(s), Medicaid planning is strongly encouraged. The application process can be complicated, particularly since documentation must be included with the application. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.