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

Unless you're covered by Medicaid, paying for a nursing home in Ohio is likely to be unaffordable. In 2023, the average cost of a private room in a nursing home in Ohio was almost $10,000 per month.

Medicaid is a very common source of funding for long-term care in Ohio, particularly for older people who have already used up their own assets to pay for home health care or nursing home care. Ohio's Department of Medicaid administers Medicaid benefits and Medicaid's coverage of long-term care.

Medicaid is the only option for many people, since private health insurance policies generally don't cover long-term care (LTC) and few people buy LTC insurance policies. (And Medicare generally pays for nursing home care only for a short time following a hospitalization.)

How to Qualify for Medicaid in Ohio for a Nursing Home

Ohio provides different ways to become eligible for Medicaid, and there are specific eligibility rules for long-term care services like nursing homes, home health care, and assisted living services. In this article, we discuss eligibility for Medicaid nursing homes in Ohio (in another article, we discuss when Medicaid pays for assisted living and home health care in Ohio). Eligibility depends on your monthly income, your assets, and your medical needs.

Ohio's Medicaid Income Limits

If you're 65 or older, blind, or disabled and you need long-term care in a nursing home, your income must be below $2,829 per month (as of 2024) to qualify for Medicaid. The 2024 monthly income limit for a married couple with both spouses applying is $5,658. (Ohioans who receive Supplemental Security Income, or SSI, already qualify to receive Medicaid.)

If you're married, but your spouse isn't applying for Medicaid, only your income is counted toward the income limit.

If your income is above the limit, you still might be able to qualify for Medicaid if your income doesn't cover your medical expenses. This is called "spending down" your income on medical expenses.

Medicaid Spend Down Rules in Ohio

In Ohio, unlike some other states, people who are 65 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 Department of Medicaid can 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 the Department of Medicaid.

Ohio's Personal Needs Allowance

If you receive Medicaid and live in a nursing home, you'll be expected to spend almost all of your income on your care. Ohio allows nursing home residents receiving Medicaid to keep only $50 per month as a personal needs allowance.

Ohio's Medicaid Resource Limits

In addition to having low income, to qualify for Medicaid in Ohio, you must have no more than $2,000 in resources (or up to $3,000 for a married couple, with both spouses applying). Resources are assets like money and property. Both spouses' assets count toward the limit, even if only one spouse is applying for Medicaid.

Some property doesn't count toward the Medicaid asset limit. In Ohio, for example, your car is exempt, and your home is exempt up to an equity value of $713,000 (in 2024). If you have more home equity than $713,000, it will be counted toward the resource limit.

Your personal belongings and household goods are also exempt. In Ohio, retirement accounts aren't counted as assets if you or your spouse are receiving income from them. But the income the Medicaid applicant receives from retirement accounts is counted toward the income limit.

If you have a spouse who will continue to live "in the community" (at home), your home is exempt as long as your spouse still lives there or as long as you intend to return to the house at some point.

How Much Income and Assets Can a Spouse Keep in Ohio?

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

Income. First, your spouse can keep all of the income that's in their name. If they don't have at least $2,555 per month of their own income, they're allowed to keep some of your income to reach that amount. If your spouse has housing costs that are higher than a certain amount, they're entitled to keep more income, up to $3,853.50 per month.

Assets. Ohio assumes that half of the assets that you had at the time of your first admission to a nursing home belong to your spouse, subject to a limit that changes annually. Your spouse's maximum amount is called the "Community Spouse Resources Allowance," or CSRA. The CSRA maximum is $154,140 (in 2024).
When you apply for Medicaid, your CSRA is subtracted from your countable assets at the time of your application.

If half of a couple's assets is less than $30,282, the spouse living at home will be able to keep more than half of the Medicaid applicant's assets to reach that amount. When you apply for Medicaid, the Department of Medicaid will tell you how much your community spouse is entitled to keep.

When a Nursing Home Is Medically Necessary

Medicaid will pay for a nursing home only when it's "medically necessary." That means you must show you need a "nursing facility level of care," meaning that you require 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 generally 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. 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. For a skilled nursing facility, you must need the kind of services that can only be provided by a licensed nurse or therapist.

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

Applying for Medicaid in Ohio

When you apply, you may need to provide documents showing your income, including Social Security or SSI income, your assets, including bank account and retirement account statements, and other benefits, like VA benefits or workers' compensation.

To apply for Medicaid, you can contact your local Job and Family Services office. To save time, you can fill out an application for services before going to the Medicaid office.

You can also apply for Medicaid online at Ohio Benefits or by calling the Ohio Medicaid Consumer Hotline at 800-324-8680.