Ohio Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are several different Medicaid eligibility groups, the focus of this page is on Ohio residents who are 65 years of age and over. Specifically, long term care is covered. 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.
Medicaid in Ohio is called Medical Assistance (MA). The Ohio Department of Medicaid administers the state’s Medicaid program.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Ohio seniors may be eligible. These programs have differing eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that OH offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; 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 about waivers here.
3) Regular Medicaid / Aged, Blind, or Disabled (ABD) – This is an entitlement program; 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.
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 does not mean one is ineligible or cannot become eligible for a Medicaid program in Ohio. More.
|2022 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||$2,523 / month*||$2,000||Nursing Home||$5,046 / month*||$3,000||Nursing Home||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month||$2,000||Nursing Home||$5,046 / month||$3,000||Nursing Home||$2,523 / month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs|
What Defines “Income”
Any income that a Medicaid applicant receives is counted. 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. Coronavirus stimulus checks and Holocaust restitution payments are not counted as income and have no impact on Medicaid eligibility.
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. This means the income of the non-applicant spouse is disregarded. However, 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 $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income is under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to $2,288.75.
In Ohio, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435. 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. More on how Medicaid counts income.
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. Medicaid also considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in the home or have intent to return and have a home equity interest no greater than $636,000 (in 2022). Equity interest is the value of the home in which the applicant outright owns. If a non-applicant spouse lives in the home, it is exempt regardless of the applicant spouse’s circumstances.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a nursing home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets falls under $27,480, the non-applicant spouse can retain 100% of the couple’s assets, up to $27,480.
Ohio has a 5-year Medicaid Look-Back Period that immediately precedes one’s date of Medicaid 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. Unfortunately, some persons mistakenly think that the IRS gift tax exemption extends to Medicaid rules and unknowingly violate the look back rule. Persons who violate this rule are penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
Ohio residents, 65 and over, who do not meet the eligibility requirements in the table 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 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 once the trust has been established, it 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. Ways in which this can be done 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” or “over-asset” or both, but 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. Read more or connect with a Medicaid planner.
Specific Ohio Medicaid Programs
In addition to nursing home care, Ohio Medicaid offers several programs that help seniors remain living in their homes or 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, medical equipment, and supplies.
2) Assisted Living Waiver – The 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 Plan (MCOP) – The is a managed care Medicaid program for persons dually eligible for Medicaid and Medicare. Under MCOP, a variety of in-home supports are provided. While this program does not have limited enrollment, it is not currently available statewide.
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.
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.
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. For general information about the long-term care Medicaid application process, click here.