When Medicaid in Ohio Will Pay for Long-Term Care in a Nursing Home

In Ohio, Medicaid will pay for a nursing home if it is medically necessary and you don't have enough assets or income to pay for it.

Unless you're covered by Medicaid, paying for a nursing home in Ohio is unaffordable for most people. In 2011, the average daily cost of a private room in a nursing home in Ohio was $223. Medicaid is a very common source of funding for long-term care in Ohio, particularly for those who have already used up their own assets to pay for care. Medicaid is the only option for many people, since private health insurance policies don't cover long term care and few people buy long-term care (LTC) insurance policies. Medicare generally pays for nursing home care only for a short time following a hospitalization.

There are different ways to become eligible for Medicaid, and there are specific eligibility rules for long-term care services like nursing homes. To apply for Medicaid, contact your local Ohio Department of Job and Family Services(ODJFS). You can also fill out an application for services before going to the office.

Ohio's Medicaid Income Limit

If you are 65 or older, blind, or disabled, and you need long-term care in a nursing home, then you must have income at or below 300% of the SSI Federal Benefit Rate, or $2,163 per month in 2014, to qualify for Medicaid. (Ohioans who receive SSI already qualify to receive Medicaid.)

If your income is above the limit, you still might be able to qualify for Medicaid if the income you have over the limit doesn't cover your medical expenses. In Ohio, unlike some other states, people who are sixty-five and older, blind, or disabled can use unpaid medical bills, premiums, or nursing facility bills to “spend down” their income and qualify for Medicaid. A worker from the Ohio Department of Job and Family Services (ODJFS) will determine how much your monthly spend down amount is. You have to satisfy the spend down to be eligible for Medicaid each month. You can satisfy your spend down by showing proof that your medical expenses equal the spend down amount or by paying the amount directly to ODJFS.

Ohio's Medicaid Resource Limit

In addition, to qualify for Medicaid in Ohio, you must have no more than $1,500 in resources. Resources are assets like money and property. Some property does not count toward the resource limit. In Ohio, if you are single, one car is exempt up to a value of $4,500, and your home is exempt for the first thirteen months you are in a nursing facility, up to an equity value of $543,000. If you have more equity in your house, it will be counted toward the resource limit. Personal belongings are also exempt. Retirement accounts are counted as assets only to the extent you can withdraw money from them.

If you have a spouse who will continue to live "in the community" (at home), then one car is exempt with no restrictions on its value. In addition, your home is exempt so long as your spouse still lives there.

How Much a Spouse Can Keep in Ohio

If you have a spouse who is going to continue to live independently, then Ohio will allow you and your spouse to keep more income and assets to support that spouse.

Your spouse will be allowed to keep some income each month. The amount will depend on how many dependents and expenses he or she has. In 2014, the minimum Community Spouse Income Allowance is $1,966.25, and the maximum is $2,931.

Ohio assumes that half of the assets that you had at the time of your first admission to a nursing home (called the "Community Spouse Resources Allowance" (CSRA)) should belong to your spouse, subject to a limit that changes annually. The minimum CSRA in 2014 is $23,448, and the maximum is $117,240. When you apply for Medicaid, ODJFS will tell you how much your community spouse is entitled to keep.

When you apply for Medicaid, your CSRA is subtracted from your countable assets at the time of your application. For example, say Mr. and Mrs. Johnson have $80,000 in countable assets when he moves into a nursing home on February 1st. Mrs. Johnson continues to live in the couple’s home. On that date, Mrs. Johnson's CSRA is calculated to be $40,000. The Johnsons use their savings to pay for Mr. Johnson's nursing home care until December 1st, when he applies for Medicaid. On December 1st, Mr. and Mrs. Johnson have $40,000 left in countable assets. Because Mrs. Johnson's CSRA is $40,000, she is entitled to keep the $40,000. Mr. Johnson then has no countable assets, and he meets the resource eligibility criteria for Medicaid.

Ohio's Personal Needs Allowance

If you receive Medicaid and live in a nursing home, you will be expected to spend almost all of your income on your care. Ohio allows nursing home residents receiving Medicaid to keep only $45 per month as a personal needs allowance.

When a Nursing Home Is Medically Necessary

Medicaid will pay for a nursing home only when it is medically necessary. In other words, you must show that you require a “nursing facility level of care,” meaning that you need the kind of care that can only be provided in a nursing home. In Ohio, there are two nursing facility levels of care, intermediate and skilled. To receive Medicaid-paid nursing facility services in Ohio, you must need at least an intermediate nursing facility level of care. This means you must show that you need hands-on assistance with at least two of the following activities: bathing, dressing, eating, grooming, moving around, using the bathroom, and taking your medication.

You can meet the skilled nursing facility level of care by showing that you need daily skilled nursing or therapy services for an unstable medical condition. For a skilled nursing facility, you have to require the kind of services that can only be provided by a licensed therapist or nurse. Your condition is considered unstable if you require extensive monitoring and adjustments to your treatment, and if your condition is unpredictable and might require immediate interventions.

Medicaid will decide which type of facility is appropriate for you and will only pay for a facility that is adequate for your level of care needs.

Read on to find out whether Ohio's Medicaid program pays for assisted living facilities or home health care.

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