Ohio

What is Ohio Medicaid Long-Term Care?

Medicaid is a health care program for individuals with low income, regardless of age. This content focuses on long-term care Medicaid eligibility for Ohio residents aged 65 and older. Ohio Medicaid provides coverage for nursing home care, assisted living services, and non-medical support to help frail seniors live at home. Ohio seniors may qualify for three types of Medicaid long-term care programs:

1. What is Institutional / Nursing Home Medicaid?

This is an entitlement program, meaning that anyone who meets the eligibility criteria will receive assistance. The benefits are limited to care provided in nursing homes.

2. What are Medicaid Waivers / Home and Community-Based Services (HCBS)?

This program is not an entitlement, and it has a limited number of participants with possible waiting lists. The services aim to delay or prevent nursing home admissions and are provided in home settings, adult day care, or assisted living.

3. What is Regular Medicaid / Aged, Blind, or Disabled (ABD)?

This entitlement program provides long-term care benefits for those who meet the eligibility requirements. The available services include personal care assistance or adult day care.

The Ohio Department of Medicaid (ODM) administers the program within the federally established guidelines.

How Do Income & Asset Limits Affect Eligibility?

Each of the three Medicaid long-term care programs in Ohio has different financial and medical eligibility criteria. These limits change annually, vary depending on marital status, and may offer alternative pathways to eligibility.

What is the Simplified Eligibility Criteria for a Single Nursing Home Applicant in 2025?

A single Nursing Home Medicaid applicant in 2025 must meet the following criteria:

• Income under $2,901 per month
• Assets under $2,000
• Require a Nursing Home Level of Care

What are the 2025 Eligibility Limits for Different Medicaid Programs?

Here is a quick reference table to see if you qualify for Ohio Medicaid long-term care in 2025:

Note: All monthly income, except for certain allowances, must be paid to the nursing home.

How is Income Defined & What Exceptions Apply?

Income includes wages, alimony, pensions, and Social Security benefits. Some sources of income are not counted, such as Holocaust restitution payments and the VA Aid & Attendance benefit.

What is the Treatment of Income for Couples?

If only one spouse applies for Nursing Home Medicaid or a Medicaid Waiver, only the applicant’s income is counted. The non-applicant spouse (community spouse) may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA), which helps prevent spousal impoverishment.

In 2025, the MMMNA is $2,643.75. If the non-applicant’s income is lower, the applicant can transfer income to meet this threshold. The MMMNA may increase if housing and utility costs exceed the shelter standard of $793.13.

How Are Assets Treated in Ohio Medicaid?

Assets include cash, real estate, and investments. However, there are many exemptions, such as personal belongings, a primary home, and irrevocable burial trusts.

How Are Assets Treated for Couples?

All assets of a married couple are considered jointly owned. However, the community spouse can retain 50% of the couple’s assets, up to a maximum of $157,920 in 2025. If the non-applicant spouse’s assets are below $31,584, they can retain 100% of the assets up to that amount.

What is Ohio’s Medicaid Look-Back Rule?

Ohio enforces a 5-year Look-Back Period, meaning Medicaid will examine asset transfers during the 5 years before applying for Nursing Home Medicaid or a Medicaid Waiver. Any transfer of assets below fair market value may result in a period of Medicaid ineligibility.

What Are Ohio’s Medicaid Home Exemption Rules?

The home is generally exempt from Medicaid’s asset limit if the applicant or their spouse lives in the home. However, if neither party lives there, a home equity limit of $730,000 applies. Medicaid’s Estate Recovery Program may seek reimbursement from the estate after the applicant’s death, including the value of the home.

What Are the Medical and Functional Need Requirements for Medicaid?

Applicants must demonstrate a medical need for long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Some services, like home modifications, require additional criteria, such as an inability to live safely at home without modifications.

How Can One Qualify if They Are Over the Income or Asset Limits?

Residents over the Medicaid income or asset limits can still qualify through the following options:

1. What is a Qualified Income Trust (QIT)?

QITs allow individuals to deposit their excess income into a trust, making it exempt from Medicaid’s income limit.

2. What is Asset Spend-Down?

Those over the asset limit can reduce their countable assets by purchasing non-countable items such as home modifications or paying off debt. Documentation of these expenditures is crucial to avoid violating the Look-Back Rule.

3. What is Medicaid Planning?

Medicaid Planning helps individuals who exceed income or asset limits, and it can assist in protecting a home from Medicaid’s Estate Recovery Program. It’s recommended to work with a Medicaid Planner for best results.

What Specific Ohio Medicaid Programs Are Available?

Ohio offers various programs to assist seniors in their homes and communities, including:

• PASSPORT Waiver: Provides long-term services such as home care and medical equipment.
• Assisted Living Waiver: Supports those in residential care facilities and assisted living residences.
• MyCare Ohio: Combines Medicaid and Medicare benefits for those in 29 counties.
• PACE Program: Combines Medicaid and Medicare benefits with additional services like dental care.
• Money Follows the Person (MFP): Helps individuals transition from institutional care to living at home or in the community.

How Can One Apply for Ohio Medicaid?

Seniors can apply online at Ohio Benefits, via the Consumer Hotline at 1-800-324-8680, or in person at their county Job and Family Services office. Application processes may vary depending on the program.

Before applying, ensure that all eligibility requirements are met. If income or assets exceed the limit, Medicaid planning is encouraged.