One of the most common and effective ways for Ohio seniors and their families to pay for long-term or nursing home care is through the state’s Medicaid program. There are a variety of Ohio Medicaid programs that each have their own eligibility requirements and each cover their own specific long-term care and senior care services. These programs cover a wide range of services for Ohio seniors including both medical services in a community setting (such as in a nursing home or assisted living facility), as well as non-medical services to support seniors who require care either in their homes or in an adult day care setting. To learn more about Ohio Medicaid eligibility requirements for seniors, read our guide below or reach out to the Sunbound team to request more information. 

Ohio Medicaid Overview

Medicaid is a program that is jointly funded and administered by the federal and Ohio state governments that can help pay for some or all of the costs of long-term care for Ohio seniors (meaning Ohio residents age 65 and above). The program is administered by the Ohio Department of Medicaid (also known as ODM) under guidelines set by the federal government. Ohio Medicaid is designed to provide long-term and senior care for seniors either at home or in a community setting (such as a nursing home or assisted living facility). There are three main categories of Medicaid programs for Ohio seniors.

Ohio Medicaid for nursing homes

For Ohio seniors who require a Nursing Home Level of Care Ohio Medicaid will provide long-term care benefits for individuals in nursing homes. In Ohio this is an entitlement program meaning that all Ohio seniors who reside in nursing homes and meet the eligibility requirements will receive coverage from Ohio Medicaid. 

Ohio Medicaid HCBS waivers

HCBS waivers, which stands for Home and Community Based Services, are designed to provide care to Ohio seniors so that they do not have to move into a nursing home setting. These services can be provided in a variety of settings such as at an adult day care center or assisted living facility, or at the Ohio senior’s home. Unlike Ohio Medicaid for nursing homes, HCBS waivers in Ohio are not an entitlement program meaning that there are limits on how many participants can receive coverage in Ohio at a given time (and that wait lists for new applicants may exist when this limit is reached).

Aged, Blind and Disabled Medicaid

Commonly referred to as “regular state Medicaid,” Aged, Blind and Disabled Medicaid provides long-term care benefits outside of an institutional or nursing home setting. These services include assistance with the Activities of Daily Living like homemaking tasks and personal care assistance, and time in adult day care. This category of Medicaid benefits is generally designed to assist seniors who require a slightly lower degree of care than either nursing home Medicaid or HCBS waivers. 

Ohio Medicaid asset and income eligibility limits

As is the case in other states, in order to be eligible for Ohio Medicaid a senior applicant must have both income and assets below certain thresholds. These thresholds change depending on certain criteria such as whether the applicant is single or married as well as the nature of the senior applicant’s financial resources. 

Ohio Medicaid income limits

In Ohio nearly all of a Medicaid applicant’s income is counted towards the income threshold, including not only wages but things like pension payments, Social Security income, and withdrawals from IRA or other retirement accounts. Like with most other states, Ohio Medicaid income eligibility limits are different for single or married applicants. For single applicants the income limit is $2,742 per month, and for married applicants who are applying together the limit is a combined $5,484 per month. 

One important thing for married couples to remember is that when only one spouse is applying, only the applicant spouse’s income is counted. Further, the non-applicant spouse can receive what is known as a Minimum Monthly Maintenance Needs Allowance whereby the applicant spouse transfers some of their income to the non-applicant spouse. The benefit of the Minimum Monthly Maintenance Needs Allowance is twofold: it prevents the non-applicant spouse from being impoverished so that the applicant spouse can apply for Medicaid, and also allows the applicant spouse to reduce their own income so that they may be eligible for Ohio Medicaid coverage.

Ohio Medicaid asset limits

Just like with income eligibility, asset limits are different depending on whether the Ohio Medicaid applicant is single or married. For single individuals the asset limit is $2,000 and for married individuals where both spouses are applying the limit is $3,000. Where only one spouse is applying, the asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse. 

While these limits may seem low, it is important to remember that many assets are not counted towards this asset threshold. Countable assets in Ohio include cash, investments like stocks and bonds, and real estate that is not the applicant’s primary residence. Non-countable assets include things like personal belongings and household furnishings, an automobile, and the first $688,000 in equity value in the senior applicant’s home.

Finally, it is important to remember Ohio Medicaid’s 5-year look back period. Under this rule, Ohio Medicaid will go through all of an applicant’s asset transfers in the five years preceding their application for Ohio Medicaid coverage to ensure that the applicant did not give away or sell any assets below fair market value in order to qualify for Ohio Medicaid. Because violation of this rule can result in being barred from applying for Medicaid for a set period of time, it’s important to consult a local Ohio elder law attorney or financial advisor before applying for Medicaid to ensure that you have not run afoul of the 5-year look back period.

Ohio Medicaid medical eligibility requirements

Along with meeting the above asset and income eligibility requirements, Ohio seniors must also meet specific medical and functional criteria. For both institutional nursing home Medicaid and various Ohio Medicaid waiver programs, including HCBS waivers, a senior applicant must require a Nursing Home Level of Care as defined by the Ohio state government. 

In Ohio the requirements for Nursing Home Level of Care can be met by showing that a senior applicant requires either “intermediate” or “skilled” level of care. For intermediate care, a senior must either: require assistance with 2 Activities of Daily Living (or assistance with 1 ADL as well as medication administration), require skilled nursing or rehabilitation services, or require 24-hour support due to a cognitive impairment. To require a skilled level of care, a senior must require skilled nursing 7 days a week, skilled rehabilitation 5 days a week, or have an “unstable medical condition.” 

Applying for Ohio Medicaid

Before applying for Ohio Medicaid it’s important for Ohio seniors to first confirm that they are eligible. While it’s of course important to confirm that you are eligible both on financial and medical grounds, generally the more complicated questions will come from an Ohio senior’s financial eligibility. To make sure that you or your senior loved one is eligible for Ohio Medicaid,  be sure to consult a local Ohio elder law attorney or financial advisor who has experience in applying for Medicaid. 

One reason that this is so important is because there are several strategies that can help an Ohio senior qualify for Medicaid even if they appear to exceed Ohio Medicaid’s income or asset eligibility thresholds. These Medicaid planning strategies, including ways to spend down assets in line with Medicaid’s rules or moving money into an instrument like a Medicaid Asset Protection Trust, can be very effective. But because they can also be very complex, it’s incredibly important to consult a local Ohio Medicaid expert before going through with any of these Medicaid planning strategies. 

Once you’ve made sure that you or your senior loved one is eligible for Ohio Medicaid, the first step is generally to reach out to the Ohio Department of Medicaid. You can do this online at the Ohio Benefits Program website, by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680, or in person by visiting your local Ohio Department of Job and Family Services office.    

To learn more about how Sunbound can help make senior living more affordable for you or your loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and is on a mission to make senior living affordable for everyone.