Ohio Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, this page is strictly focused on Medicaid eligibility, specifically for Ohio residents who are 65 years of age and over, and specifically for long term care, whether that be at home, in a nursing home or in assisted living. Make note, Medicaid in Ohio is called Medical Assistance (MA).
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Ohio seniors may be eligible. These programs have slightly different eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Ohio offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – Limited number of participants. Provided at home, adult day care or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement and is provided at home or adult day care.
Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Ohio offers multiple pathways towards eligibility. The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from a Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 Ohio Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Nursing Home||$3,375 / month||$3,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Help w 2/ADLs||$3,375 / month||$3,000||Help w 2/ADLs||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Help w 2/ADLs|
|Regular Medicaid / Aged Blind and Disabled||$759 / month||$2,000||None||$1,029/ month||$3,000||None||$759 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. (As of July 2018, this figure falls between $2,057.50 / month and $3,090 / month). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $123,600 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
It’s important to be aware that Ohio has a 5-year Medicaid Look-Back Period. This is a period of 5 years in which Medicaid checks to ensure no assets were sold or given away under fair market value in order to meet Medicaid’s asset limit. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For Ohio residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also commonly referred to as Miller Trusts, offer a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one deposits their excess income over the Medicaid limit into a trust, and a trustee is named, giving that individual legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled. In addition, the money in the account can only be used for very specific purposes, such as paying medical expenses accrued by the Medicaid enrollee.
Unfortunately, Qualified Income Trusts do not assist one with extra assets in qualifying for Medicaid. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing their extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Ohio Medicaid Programs
Nursing home care is an entitlement program in Ohio, but the state Medicaid program also offers several programs that help seniors remain living outside of nursing homes.
1) PASSPORT Waiver – the formal name is Pre-Admission Screening System Providing Options & Resources Today. Fortunately, everyone simply refers to this program as PASSPORT. Under PASSPORT, Ohioans can receive adult day care, home care, home modifications, medical equipment and supplies; all provided in an effort to help persons avoid unnecessary nursing home placement.
2) Assisted Living Waiver – for persons who would otherwise require nursing home level care, the Assisted Living Waiver provides an alternative. Enrollment is limited and not all assisted living residences in the state will accept the waiver.
3) MyCare Plan – is the name of the state managed care, Medicaid program. Under MyCare Plan, a variety of in-home supports are provided, like PASSPORT, though MyCare does not have limited enrollment.