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, 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 (HCBS) – Limited number of participants. Provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (meeting the eligibility requirements ensures assistance will be provided) and is available at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they could be immediately eligible for long term care from a Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for a Medicaid program in Ohio. More.
|2020 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||$2,349 / month||$2,000||Nursing Home||$4,698 / month||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Help w/2 Activities of Daily Living||$4,698 / month||$3,000||Help w/2 Activities of Daily Living||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Help w/2 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$783 / month||$2,000||None||$1,175 / month||$3,000||None||$1,175 / month||$3,000||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, in the case when only one spouse of a married couple is applying for nursing home Medicaid or a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. For married couples with one spouse applying for Regular Medicaid, the combined income of the applicant spouse and the non-applicant spouse is counted towards the income limit. (Click here to learn more about how Medicaid counts income for eligibility purposes).
For married couples in which only one spouse is applying for nursing home Medicaid or a HCBS Medicaid Waiver, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of January 2020, this figure is $3,216 / month. Basically, if the non-applicant has income under this amount, the applicant spouse can transfer a portion, or in some cases, all of his or her income to bring the non-applicant’s income up to this amount. While some states use both a minimum and maximum figure, the state of Ohio uses one standard figure. This spousal impoverishment rule is intended to ensure the non-applicant spouse has sufficient funds with which to live. To be clear, this rule does not apply to regular Medicaid.
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 his or her spouse lives in the home and the home is valued under $595,000 (in 2020).
For married couples, as of 2020, the community spouse (the non-applicant spouse) of a spouse applying for nursing home Medicaid or a Medicaid Waiver can retain up to 50% of the couple’s joint assets, up to a maximum of $128,640, as the chart indicates above. That said, if half of the couple’s assets falls below $25,728, the non-applicant spouse can retain 100% of the couple’s joint assets, up to $25,728. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). As with the spousal income allowance, this rule does not extend to regular Medicaid.
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. Unfortunately, some persons mistakenly think that the IRS gift tax exemption extends to Medicaid rules and unknowingly violate the look back rule. 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 his or her 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 ones that are non-countable, 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. For this program, the number of program participants is limited.
2) Assisted Living Waiver – for persons who would otherwise require nursing home level care, the Assisted Living Waiver provides an alternative. To be clear, this program does not cover the cost or room and board. Rather, it assists in covering the cost of care services in assisted living residences. Enrollment is limited and not all assisted living residences in the state will accept the waiver.
3) MyCare Ohio Plan (MCOP) – the name of the state managed care Medicaid program for persons dually eligible for Medicaid and Medicare. Under MCOP, a variety of in-home supports are provided, like PASSPORT, though MyCare does not have limited enrollment. At the time of this writing, this program is not available statewide.
How to Apply for Ohio Medicaid
In order to apply for long-term care Medicaid in Ohio, seniors can apply online at Ohio Benefits, call the Consumer Hotline at 1-800-324-8680, or go to their county Job and Family Services office. Persons might find their local Area Agency on Aging office helpful, as they should be able to answer Medicaid program questions and offer application assistance.
Prior to submitting an application, Ohio Medicaid applicants should be certain that they meet all eligibility requirements, which are covered in detail above. For those seniors who have income and / or assets(s) greater than the limit(s), Medicaid planning is strongly encouraged. In addition, the application process can be quite complicated, as documentation must be included with the application. For general information about the application process for long-term care Medicaid, click here.