Ohio Medicaid Eligibility & Income Limits: The Complete Guide

Ohio Medicaid is not one program. It is fourteen distinct eligibility pathways, governed by federal statute (42 USC § 1396a et seq.), federal regulation (42 CFR Part 435), Ohio statute (ORC Chapter 5163), Ohio rules (OAC Chapter 5160:1), and operational guidance issued through ODM Medicaid Eligibility Procedure Letters (MEPLs). Most families need only two or three of those pathways. This guide walks through every income limit, every asset limit, and every test that decides whether an individual qualifies, using the 2026 figures from MEPL 194 (effective 3/1/2026) and the 2026 Ohio Medicaid Standards Help Sheet (effective 1/1/2026).

We use the policy-translator voice: name the statute, give the dollar figure, walk the family from "I think we might qualify" to "here is exactly what I file with which county office."

In This Guide

• The 60-second version
• The sources we used
• Ohio's federal-state architecture: 1634 state, income-cap state, NOT medically-needy
• The three pathways for adult applicants (MAGI / ABD / LTC)
• The 2026 financial limits master table
• MAGI pathway: Group VIII expansion, parents/caretakers, pregnant women, children
• ABD pathway: SSI categorical, ABD spend-down, Pickle Amendment
• LTC pathway: Special Income Limit, Miller Trust mandatory over $2,982
• Pay-in spend-down for ABD (the medically-needy alternative)
• Spousal impoverishment: CSRA $32,532-$162,660; MMMNA $2,643.75-$4,066.50
• Personal Needs Allowance, $75/month (raised 10/1/2025)
• Exempt assets and how to spend down legally
• Transfer penalty: 60-month lookback, APPR divisor $7,787
• Home equity exclusion: $752,000 in 2026; flat $1M cap effective 1/1/2028 under Pub. L. 119-21
• Retroactive coverage: 3 months now, shrinking to 1-2 months on 1/1/2027
• Application process: CDJFS, ODM 07400, ODM 07408, Ohio Benefits portal
• Recertification: 12 months for most pathways, dropping to 6 months for Group VIII on 1/1/2027
• Group VIII Work-Engagement 1115 demonstration
• SUD 1115 demonstration status
• Dual-eligible Medicare Savings Programs: QMB / SLMB / QI / QDWI
• Four worked examples (the four cases families actually face)
• 12 Ohio-specific pitfalls
• Pending Ohio policy watch
• Where to get help, 12 AAAs, Pro Seniors, 4 legal aids, ODM Consumer Hotline, OBLTSS, OSHIIP
• Related reading

The 60-Second Version

• Ohio is a Section 1634 state. SSI receipt = automatic Medicaid; no separate Medicaid application required. Authority: OAC 5160:1-3-02.3.
• Ohio is an income-cap state for Long-Term Care Medicaid. The 2026 Special Income Limit (SIL) is $2,982/month (= 300% of the 2026 SSI Federal Benefit Rate of $994/month). Applicants over $2,982 cannot get LTC Medicaid without a Qualified Income Trust (Miller Trust). Authority: OAC 5160:1-6-03.1; 5160:1-6-03.2.
• Ohio is NOT a federal "medically-needy" state. Many sources mislabel it. Ohio operates an analogous ABD Spend-Down under OAC 5160:1-3-04.1 with three monthly-determination options (ongoing, delayed, pay-in), but this pathway does NOT cover institutional or HCBS waiver services. For LTC, applicants over the SIL must use a Miller Trust.
• 2026 ABD income limit: $994/month single, $1,491/month couple (= 2026 SSI FBR; 2.8% COLA from 2025).
• 2026 ABD/LTC asset limit: $2,000 single, $3,000 couple.
• 2026 spousal impoverishment: CSRA min $32,532 / max $162,660; MMMNA min $2,643.75 (through 6/30/2026) / max $4,066.50; CSMIA = MMMNA minus community spouse's own income.
• Personal Needs Allowance: $75/month for institutional residents (raised from $50 effective 10/1/2025 by Ohio FY26-27 budget).
• Transfer penalty divisor (APPR): $7,787, set 9/1/2024 and not yet updated for 2026 despite the 2026 Help Sheet listing it. Authority: OAC 5160:1-6-06.5.
• Home equity exclusion: $752,000 in 2026 (Ohio uses the federal floor). Pub. L. 119-21 (One Big Beautiful Bill Act, signed 7/4/2025) replaces the band with a flat $1,000,000 cap effective 1/1/2028.
• Lookback: 60 months, applies ONLY to LTC (institutional and 1915(c) waivers); does NOT apply to MAGI or ABD spend-down.
• Group VIII expansion (ACA): 138% FPL (133% + 5% disregard). Approximately 770,000 Ohioans enrolled in CY2026.
• Pub. L. 119-21 (OBBBA) effects: Group VIII work requirement (80 hrs/month, 6-month reporting) by 12/31/2026; retroactive coverage shrinks to 1 month (Group VIII) / 2 months (ABD) on 1/1/2027; Group VIII redetermination drops to 6 months on 1/1/2027; home equity flat $1M cap 1/1/2028.
• MSP / dual-eligible income limits (2026, single, including the $20 income disregard): QMB (100% FPL + $20) $1,350; SLMB (120% FPL + $20) $1,616; QI-1 (135% FPL + $20) $1,816; QDWI (200% FPL + $20) $2,680. MSP resource limits: $9,950 single / $14,910 couple. Per SSA POMS HI 00815.023.
• ODM Director: Scott R. Partika (appointed October 2025 by Gov. DeWine). HQ: 50 W. Town Street, Suite 400, Columbus, OH 43215.
• Application path: County Department of Job and Family Services (88 county offices) via paper ODM 07400 (Healthcare Application) or online at benefits.ohio.gov; LTC supplement ODM 07408. LTC intake hotline: OBLTSS at 1-844-644-6582. General Medicaid hotline: 1-800-324-8680.

If your situation is straightforward, a Group VIII adult under 138% FPL, a child, a pregnant woman, or an SSI recipient, you can often complete the application yourself. If you are over age 65, applying for nursing-home or HCBS waiver Medicaid, married with a community spouse, or carrying assets above $2,000, engage an Ohio elder-law attorney. The 60-month lookback, the Miller Trust mechanics, the CSRA/MMMNA structuring, and Ohio's expanded estate recovery (covered separately at Ohio Estate Recovery) are not areas to navigate alone.

Sources Used

This guide is built on primary sources only.

Federal statute: 42 USC § 1396a (state plan); § 1396a(a)(10)(A)(ii)(V) (special income limit categorical option); § 1396p (transfers, lookback, estate recovery, home equity); § 1396p(c)(1) (60-month lookback); § 1396p(d)(4)(B) (Miller Trust); § 1396p(f) (home equity exclusion); § 1396r-5 (spousal impoverishment).

Federal regulations: 42 CFR Part 435 (eligibility); 42 CFR § 435.601 (ABD financial methodologies); 42 CFR § 435.726 (post-eligibility income / patient liability); 42 CFR § 435.831 (medically needy spenddown methodology); 42 CFR § 435.915 (retroactive coverage).

Federal public laws: Pub. L. 119-21 (One Big Beautiful Bill Act / OBBBA, signed 7/4/2025), Sections 71105 (work requirements), 71106 (retroactive coverage), 71107 (6-month redetermination), 71109 (home equity $1M cap 2028); Pub. L. 118-42 (CAA 2024); Pub. L. 117-328 (CAA 2023, postpartum + continuous eligibility).

Ohio Revised Code: ORC Chapter 5162 (Medicaid administration); ORC Chapter 5163 (Medicaid eligibility); ORC 5163.094 (MBIWD); ORC 5163.21 (eligibility determinations); ORC 5163.31 (spend-down and pay-in); ORC 5163.33 (PNA floor).

Ohio Administrative Code: OAC 5160:1-1 (definitions); OAC 5160:1-2 (application procedures, including 5160:1-2-01 timeliness); OAC 5160:1-3 (ABD eligibility, including 5160:1-3-02.3 SSI, 5160:1-3-02.4 categorically needy, 5160:1-3-02.6 deemed eligibility, 5160:1-3-04.1 spend-down, 5160:1-3-05 resources); OAC 5160:1-4 (MAGI eligibility); OAC 5160:1-5 (MAGI special groups, including 5160:1-5-04 family planning); OAC 5160:1-6 (LTC eligibility, including 5160:1-6-03.1 SIL, 5160:1-6-03.2 QIT, 5160:1-6-06 resources, 5160:1-6-06.1 annuities, 5160:1-6-06.5 transfers, 5160:1-6-07 PNA).

ODM operational guidance: MEPL 194 (2026 FPL Income Guidelines, effective 3/1/2026, supersedes MEPL 186); MEPL 191 (2026 COLA / resource limits); ODM Eligibility Policy Manual; ODM Forms 07400 (Healthcare Application), 07408 (LTC supplement), 10193 (QIT Verification).

Ohio external sources: Pro Seniors Cincinnati QIT Pamphlet; Lucas County ODJFS Spend-Down Pamphlet; Health Policy Ohio "Ohio Medicaid Basics 2025"; LeadingAge Ohio policy bulletins; Ohio Health Care Association communications; Disability Rights Ohio guidance.

Ohio's Federal-State Architecture

Three structural facts shape every Ohio Medicaid eligibility analysis. Get these wrong and the entire pathway analysis falls apart.

Fact 1: Ohio is a Section 1634 state

Under SSA Section 1634 agreements, the state Medicaid agency accepts SSA's SSI eligibility determination as a Medicaid eligibility determination. SSI receipt = automatic Medicaid in Ohio. No separate Medicaid application is required (though some counties still ask for an ODM 07400 to formally enroll the SSI recipient in a managed-care plan). Authority: POMS SI 01715.020; OAC 5160:1-3-02.3.

The eight 209(b) states, CT, HI, IL, MN, MO, NH, ND, VA, operate differently. Those states use more restrictive Medicaid eligibility criteria than SSI itself, requiring SSI recipients to file separate Medicaid applications and meet potentially tighter resource or income tests. Ohio was historically a 209(b) state but converted to 1634 status in 2014. Older guidance documents may still reference Ohio as 209(b); that is incorrect for 2026.

The practical implication for families: if your loved one is on SSI in Ohio, they already have Medicaid. Verify the Ohio Medicaid card and the managed-care plan assignment by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680, there is no separate enrollment to complete.

Fact 2: Ohio is an income-cap state for Long-Term Care

Federal law gives states three options for LTC Medicaid eligibility under 42 USC § 1396a(a)(10)(A)(ii)(V):

1. Income-cap (Special Income Limit) state: Set a hard income ceiling at 300% of the SSI Federal Benefit Rate. Applicants over the ceiling must use a Qualified Income Trust (Miller Trust). Examples: Ohio, Texas, Florida, Nevada.
2. Medically-needy state: Allow spend-down on medical expenses to bring countable income below a state-set "medically needy income limit." Examples: New York, California, Massachusetts.
3. Hybrid: Some combination. Examples: Pennsylvania, Wisconsin.

Ohio chose option 1 in 1995 and has not changed. The 2026 Special Income Limit is $2,982/month for a single applicant ($994 SSI FBR × 3). For a married couple where both spouses are applying for LTC, the SIL is $5,964/month. Applicants whose monthly gross income exceeds $2,982, including Social Security retirement benefits, SSDI, pension payments, IRA required-minimum-distributions, and net rental income, cannot get LTC Medicaid in Ohio without funneling income through a Miller Trust.

The Miller Trust is not a workaround invented by lawyers. It is federally authorized under 42 USC § 1396p(d)(4)(B) and operationalized in Ohio at OAC 5160:1-6-03.2.

Fact 3: Ohio is NOT a "medically-needy" state, but it operates an ABD Spend-Down

This is the most frequently confused fact in Ohio Medicaid. Many lay-audience guides describe Ohio's spend-down as "medically needy", and the shorthand is wrong.

A formal CMS "medically needy" state-plan election (under 42 USC § 1396a(a)(10)(C)) creates a separate Medicaid eligibility group with its own income standard. Ohio does NOT have this election in its state plan for ABD/LTC. What Ohio operates instead is an ABD Spend-Down under OAC 5160:1-3-04.1, a categorical-Medicaid-with-spend-down mechanism for aged/blind/disabled adults whose income exceeds the SSI FBR but who do not qualify for LTC Medicaid through the SIL pathway.

Three operational consequences of the distinction:

• Ohio's ABD spend-down is a monthly determination. Each month the individual must satisfy that month's spend-down amount. New York, for example, uses a 6-month accumulation period. In Ohio, missing one month's spend-down means losing Medicaid for that month.
• Ohio's ABD spend-down does NOT cover institutional or HCBS waiver services. Spend-down enrollees get categorical Medicaid (acute care, primary care, hospital, prescriptions, behavioral health) but NOT nursing-facility care, NOT PASSPORT/Assisted Living/Ohio Home Care/MyCare Ohio Waiver services. For LTC, applicants over SIL MUST use a Miller Trust.
• Ohio's ABD spend-down provides three monthly options (covered in detail below): ongoing (recurring medical bills meet spend-down), delayed (accumulated past bills), and pay-in (pay the excess as a premium-style monthly payment to CDJFS).

Many AI tools and consumer-facing guides describe Ohio as a "medically needy" state. They are wrong. When you read Ohio Medicaid eligibility material that uses that term, treat it as a yellow flag and verify against OAC 5160:1-3-04.1 directly.

The Three Pathways for Adult Applicants

Adult Ohioans seeking Medicaid coverage flow into one of three primary eligibility tracks. Children, pregnant women, parents, and caretaker relatives have their own MAGI thresholds (covered later) but the adult-Medicaid universe in Ohio organizes into three pathways:

Pathway 1: MAGI (Modified Adjusted Gross Income)

For non-disabled adults under age 65, primarily Group VIII (ACA expansion) adults at 138% FPL. Income test only (no asset test). Authority: OAC 5160:1-4; 5160:1-5.

Pathway 2: ABD (Aged 65+, Blind, or Disabled, non-LTC)

For aged/blind/disabled adults who are NOT in nursing facilities and NOT enrolled in 1915(c) HCBS waivers. Two sub-tracks: (a) categorically needy (income ≤ $994 + $20 disregard = $1,014); (b) spend-down (income above categorical but seeking only acute/community Medicaid). Asset limit $2,000 single / $3,000 couple. Authority: OAC 5160:1-3.

Pathway 3: LTC (Institutional or 1915(c) HCBS Waiver)

For applicants seeking nursing-facility, PASSPORT (60+), Assisted Living Waiver, Ohio Home Care Waiver, MyCare Ohio Waiver, DODD waivers (IO/Level One/SELF), or PACE coverage. Two financial gates: (a) income at or below SIL ($2,982/month in 2026), or above SIL with a Miller Trust; (b) resources at or below $2,000 (institutionalized individual). Spousal impoverishment protections apply for community spouse. Subject to 60-month lookback and transfer penalty. Authority: OAC 5160:1-6.

Routing tip: nursing-facility care = LTC pathway. PASSPORT (in-home care for 60+) = LTC pathway. ACA Group VIII (under 65, no LTC need) = MAGI pathway. Aged 70 with mild diabetes living at home, just needing primary care and prescriptions = ABD pathway. The pathway determines every figure that applies, get the pathway right first.

The 2026 Financial Limits Master Table

Sourced from MEPL 194 (effective 3/1/2026) and the 2026 Ohio Medicaid Standards Help Sheet (effective 1/1/2026). All figures monthly unless noted.

Income Limits (2026)

Resource (Asset) Limits (2026)

(Note: ODM's 2026 Help Sheet lists slightly different MSP resource figures, $9,950/$14,910, which appears to be a Help Sheet labeling artifact. The federally-published QMB/SLMB figure is $9,950/$14,910. When in doubt, cite SSA POMS HI 00815.023 directly.)

Spousal Impoverishment Standards (2026)

Other Critical 2026 Figures

The MMMNA minimum resets each July 1 (federal indexing); the MMMNA maximum and CSRA bounds reset each January 1. The 7/1/2026 MMMNA minimum is not yet published as of May 2026; expect a modest increase. Revisit this guide each July and January for fresh figures.

MAGI Pathway Detail

MAGI Medicaid covers non-disabled adults under 65, parents/caretakers, pregnant women, and children under 19. Income test only, no resource (asset) test. MAGI methodology follows IRS rules with federal Medicaid adjustments under 42 CFR § 435.603.

Group VIII (ACA Expansion Adults 19-64): 138% FPL ($1,837/month single in 2026). No dependent-children requirement; no work requirement (yet, see Group VIII 1115 demonstration below). Approximately 770,000 Ohioans enrolled in CY2026. Authority: ORC 5163.03; OAC 5160:1-4-04. Group VIII enrollees receive the Alternative Benefit Plan (ABP), which mirrors the 10 essential health benefits but excludes long-term care services and some Medicaid-only specialty benefits. If a Group VIII enrollee subsequently develops a need for LTC, they must transition to the LTC pathway (which has resource tests and lookback).

Parents/Caretaker Relatives: 90% FPL ($1,197/month single in 2026). Lower threshold than Group VIII, but Group VIII covers anyone 19-64 regardless of children, so most parents will qualify under Group VIII rather than the parents/caretaker category. This pathway exists as a non-expansion alternative for families in non-expansion-eligible categories. Authority: OAC 5160:1-4-03.

Pregnant Women: 200% FPL ($2,660/month single in 2026). Coverage continues for 12 months postpartum (Ohio adopted the federal 12-month postpartum extension under Pub. L. 117-328 / CAA 2023). Includes prenatal care, delivery, postpartum, and pediatric care for newborns through age 1. Authority: OAC 5160:1-5-03.

Children: Two thresholds. Children with other creditable health insurance qualify up to 156% FPL. Children without other insurance qualify up to 206% FPL under Healthy Start CHIP 2. Federal 12-month continuous eligibility (Pub. L. 117-328 / CAA 2023, effective 1/1/2024) means children who qualify on application date stay covered for 12 months even if family income rises. Authority: OAC 5160:1-4-02.

Family Planning Services Only: 200% FPL ($2,660/month single). Covers contraception, screenings, and family-planning-related services for individuals not otherwise eligible. Authority: OAC 5160:1-5-04.

MBIWD (Medicaid Buy-In for Workers with Disabilities) / Ohio WorkAbility: 250% FPL ($3,325/month single in 2026). Resource limit $15,668 (effective 1/1/2026, note: significantly higher than ABD $2,000 limit). Authority: ORC 5163.094. Designed for working adults with disabilities who would lose Medicaid by working at higher income levels. Premium scales with income.

Children's Buy-In Program (CBIP) / Katie Beckett: DOES NOT EXIST in Ohio. This is one of the most-asked-about gaps in Ohio Medicaid. Many states (NY, MA, MN, GA, IA, MS) operate a Katie Beckett / TEFRA pathway that lets disabled children of higher-income families access Medicaid by waiving parental-income deeming. Ohio does not. Disabled children of higher-income Ohio families must access Medicaid through:

• DODD 1915(c) waivers, Individual Options (IO), Level One, or SELF, administered by the Ohio Department of Developmental Disabilities. Waiting lists are multi-year (often 5-10+ years for IO).
• Ohio Home Care Waiver, for medically fragile children with skilled-care needs.
• SSI Disability, if the child qualifies for SSI (rare for higher-income families due to deeming).

This is a significant Ohio gap. Families with disabled children whose income disqualifies them under SSI deeming should research the DODD waivers immediately upon diagnosis given the waiting lists, and engage Disability Rights Ohio or a special-needs-planning attorney.

ABD Pathway Detail

The Aged/Blind/Disabled pathway covers Ohioans who are:

• Age 65 or older, OR
• Blind (meeting SSA's blindness criteria), OR
• Disabled (meeting SSA's adult disability criteria, and Ohio defers to SSA's determination via 42 USC § 1382c).

Three sub-tracks within ABD:

Track A: SSI Categorical (1634)

If the individual receives SSI from SSA, Ohio Medicaid is automatic. No separate application. Authority: OAC 5160:1-3-02.3. The 2026 SSI FBR is $994/month single, $1,491/month couple. Resource limit $2,000/$3,000.

Track B: ABD Categorically Needy (Non-SSI but Income-Eligible)

If the individual does NOT receive SSI but meets income/resource limits, they qualify as ABD categorically needy. Income limit: $994 + $20 standard disregard = $1,014/month effectively. Resource limit $2,000 single / $3,000 couple. Authority: OAC 5160:1-3-02.4.

This sub-track captures retirees with modest Social Security income, individuals on SSDI just below SSI thresholds, and adults with disabilities who do not receive SSI but meet the disability standard.

Track C: ABD Spend-Down (Pay-In Option)

For ABD individuals whose income exceeds $1,014 but who are NOT seeking institutional/HCBS waiver care. Authority: OAC 5160:1-3-04.1; ORC 5163.31.

The spend-down formula:

Monthly countable income
  − $20 SSI standard disregard
  − $994 Medicaid need standard (2026)
= Monthly spend-down amount

Example: A 70-year-old single woman with $1,800/month Social Security has a monthly spend-down of $1,800 − $20 − $994 = $786/month.

She has three ways to satisfy the spend-down each month:

1. Ongoing: Submit proof of recurring monthly medical expenses, Medicare Part B premium, supplemental insurance premiums, recurring prescriptions, that consistently meet or exceed $786/month. If they do, she has Medicaid the entire month from the first.

2. Delayed: Accumulate paid or unpaid medical bills until they reach $786 in any given month. Medicaid eligibility begins on the day she meets the spend-down and ends the last day of that month. (The "delayed" track creates partial-month coverage gaps.)

3. Pay-In: Pay $786 directly to CDJFS each month as a premium-style payment. Medicaid is then full-month, the card covers the entire month. For predictable income but inconsistent medical expenses, this is the cleanest option.

Three operational facts about pay-in:

• Pay-in is a separate deposit each month, there is no annual or quarterly payment option.
• Pay-in is paid to the County DJFS, not to ODM directly. Each county manages its own pay-in process; some accept ACH, some only mail-in checks.
• Medicare Premium Assistance Program (MPAP / MSP) cost-sharing payments CANNOT be applied toward ABD spend-down. The spend-down must be satisfied with non-MSP medical costs or the pay-in.

Important: The Pickle Amendment, DAC, DW, and 1619(b) Special Rules

Several federal protections preserve Medicaid for individuals who would otherwise lose it due to Social Security cost-of-living adjustments or work earnings:

• Pickle Amendment (P.L. 94-566 § 503): Individuals who lost SSI after 4/1/1977 due to SSA COLA increases, but who would still qualify for SSI if those COLAs were disregarded, retain Medicaid. Operationalized in Ohio at OAC 5160:1-3-02.6. Practical effect: many older Ohioans with Social Security at or just above the SSI FBR retain Medicaid under Pickle even if they would not otherwise qualify.
• Disabled Adult Child (DAC): Adult children disabled before age 22 who lose SSI when receiving Social Security based on a parent's work record retain Medicaid. Authority: 42 USC § 1383c(c).
• Disabled Widow(er) (DW): Disabled widows/widowers who lose SSI when receiving Social Security widow benefits retain Medicaid. Authority: 42 USC § 1383c(d).
• 1619(b) Working Disabled: SSI recipients who work themselves above SSI cash payment thresholds, but below their state's 1619(b) Medicaid threshold, retain Medicaid automatically. Ohio's 2026 1619(b) threshold is per SSA tables (state-by-state).

For an aging Ohioan, the Pickle Amendment is the most commonly missed protection. If a family member lost SSI in the past due to a COLA increase, run the Pickle test: would they still qualify for SSI today if the post-loss COLAs were stripped out? If yes, file for Pickle re-entry. CDJFS workers should know the test, but it is frequently missed in practice.

LTC Pathway Detail, The Special Income Limit

LTC Medicaid in Ohio covers nursing-facility care, ICF/IID services, PACE, and 1915(c) HCBS waivers (PASSPORT, Assisted Living, Ohio Home Care, MyCare Ohio Waiver, DODD IO/Level One/SELF). The financial gate has two components: income ≤ SIL (or above SIL with a Miller Trust), and resources ≤ $2,000 single applicant.

The Special Income Limit

Authority: 42 USC § 1396a(a)(10)(A)(ii)(V); OAC 5160:1-6-03.1. The 2026 SIL is $2,982/month (= $994 SSI FBR × 3). Computed monthly from the gross of all income: Social Security retirement, SSDI, pension payments, IRA RMDs, annuity payments, net rental income, dividends, interest. (Some types of income are excluded, supplemental dividends from VA Aid & Attendance, certain disability-program payments, but the default rule is that income counts.)

If gross monthly income is at or below $2,982, no Miller Trust is needed. If it exceeds $2,982, applicant must establish a Qualified Income Trust (Miller Trust) before LTC Medicaid begins.

For 2026, single applicants in LTC at or below $2,982 income do not need to interact with the Miller Trust mechanism at all. Single applicants above $2,982 must use a Miller Trust regardless of how marginal the overage is. There is no "close enough" threshold.

Asset Limit and Spousal Impoverishment

Institutionalized individual: $2,000 resource limit. Authority: OAC 5160:1-6-06.

If married with a community spouse:

• The couple's countable resources are tallied at the resource snapshot (taken on the first day of the first 30-day continuous institutionalization).
• The community spouse retains 50% of the snapshot total, with a floor of $32,532 (CSRA minimum) and a ceiling of $162,660 (CSRA maximum) for 2026.
• The institutionalized spouse must spend down to $2,000.
• Countable resources include: cash, bank accounts, CDs, brokerage accounts, IRAs in pay status (counted as income, not resources, under federal law in some computations, Ohio practice varies), cash-value life insurance over $1,500 face value, second homes, second vehicles.
• Excluded resources include: principal residence (subject to home equity cap), one vehicle of any value, household goods/personal effects, irrevocable burial contracts, irrevocable burial spaces, life insurance with face value ≤ $1,500.

The spousal-impoverishment math drives a great deal of pre-application planning. Engage an Ohio elder-law attorney before the resource snapshot if married, there are timing and structuring choices (annuitization, half-loaf, court-order CSRA expansion under § 1396r-5(e)(2)(C)) that materially affect outcomes.

MMMNA, Income for the Community Spouse

Once the institutionalized spouse qualifies for LTC Medicaid, the post-eligibility patient liability calculation begins. The community spouse is entitled to:

• The Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,643.75 floor (through 6/30/2026), $4,066.50 ceiling.
• Plus an Excess Shelter Allowance for actual shelter costs above $793.13/month.
• Authority: 42 USC § 1396r-5(d)(3); OAC 5160:1-6-07.

If the community spouse's own monthly income is below the MMMNA, the institutionalized spouse's income is shifted to her (Community Spouse Monthly Income Allowance, CSMIA) up to the MMMNA + excess shelter. The CSMIA = MMMNA − community spouse's gross monthly income.

If the community spouse's income exceeds the MMMNA, no CSMIA, and the institutionalized spouse's income flows entirely to PNA + Medicare premiums + patient liability.

If the MMMNA is insufficient to maintain the community spouse, the community spouse may petition for fair hearing to expand the MMMNA, or may file for court-ordered support that increases CSMIA above the federal cap (under 42 USC § 1396r-5(d)(5)).

Personal Needs Allowance, $75 in 2026

For full mechanics, Resident Trust Fund operation, the patient-liability deduction order, the $65 earned-income deduction, VA pension stacking, and the ALW $50/$75 gap, see the Ohio Personal Needs Allowance deep guide.

Ohio's institutional PNA was raised from $50 to $75 effective 10/1/2025, implemented by Gov. DeWine through ORC 5163.33 amendment in the FY26-27 biennial budget. Authority: OAC 5160:1-6-07.

Range: $75 to $140 with the earned-income deduction (some institutionalized individuals continue to earn income from sheltered work; the deduction allows up to $140 PNA in those cases).

PNA is the residual income the institutionalized individual is permitted to keep monthly for personal use, clothing, toiletries, haircuts, occasional restaurant meals, magazines, modest gifts. Many states keep PNA as low as the federal floor ($30/month under 42 USC § 1396a(q)). Ohio's $75 is moderate by national comparison; New York is $50, Massachusetts $72.80, Texas $75. The 2025 raise was the first in 12 years.

Many older guides still report Ohio's PNA as $50. AI tools frequently miss the 2025 raise. For 2026, the Ohio institutional PNA is $75 unless the earned-income deduction applies.

For HCBS waiver enrollees, the maintenance allowance is different, SIMNA at $1,939/month for most waivers, ALMNA at $994/month for Assisted Living Waiver. These are much higher than NF PNA because the waiver enrollee remains in the community and has actual living expenses.

Home Equity Exclusion

Authority: 42 USC § 1396p(f); CMS inflation indexing notice for CY2026.

For 2026, the federal home-equity-exclusion floor is $752,000 (Ohio uses the federal floor). Maximum is $1,130,000, but Ohio elects the floor, so $752,000 is the operative cap.

Home equity above this cap disqualifies the LTC applicant from Medicaid coverage of LTSS (nursing facility, HCBS waivers). Equity is computed as fair market value minus encumbrances (mortgage, home equity loans, recorded judgments). Equity below $752,000 = home is exempt during applicant's lifetime if intent to return / spouse / minor or disabled child / sibling-with-equity-interest residing 1+ year.

Three exceptions to the cap (the cap does not bar Medicaid LTSS if):

1. Spouse lawfully resides in the home.
2. Child under 21 lawfully resides in the home.
3. Blind or disabled child of any age lawfully resides in the home.

OBBBA / Pub. L. 119-21 effect: Effective 1/1/2028, the federal band ($752K-$1,130K for 2026) is replaced by a flat $1,000,000 cap, frozen, no inflation indexing. Section 71109. Since Ohio currently uses the floor, this means Ohio's effective cap rises from $752K → $1M on 1/1/2028, a relaxation. But for high-cost real estate markets (Cincinnati, Columbus suburbs), the eventual cap will not keep pace with inflation. Plan accordingly.

Miller Trust / Qualified Income Trust Mechanics

Authority: 42 USC § 1396p(d)(4)(B); OAC 5160:1-6-03.2; ODM 10193 (QIT Verification Form); Pro Seniors QIT Pamphlet.

For LTC applicants in Ohio with monthly gross income above $2,982 (2026 SIL), a Qualified Income Trust is mandatory. Without one, no Medicaid LTC coverage. With one properly structured and operated, gross income above $2,982 does not disqualify the applicant.

Required Trust Provisions

1. Irrevocable, once established, cannot be terminated or modified to change beneficiary.
2. Funded only with applicant's income, no other person's income, no other assets.
3. Ohio Department of Medicaid named as remainder beneficiary up to total medical assistance paid (or in second position behind community spouse, minor child, or blind/disabled child).
4. Bank account at a financial institution (bank, S&L, or credit union). Some Ohio banks decline these accounts; small community banks and credit unions are typically more willing.
5. Up to $15/month maintenance fee may be paid from the QIT (if the bank charges).

Monthly Operating Mechanics

Each month, the applicant:

1. Deposits income into the QIT, enough to bring "remaining" gross income (income not deposited) below $2,982. The applicant chooses how much to deposit; some applicants deposit just enough to clear the cap, others deposit all income.
2. Withdraws funds from the QIT during the same month, in the following authorized order:
   • (a) Personal Needs Allowance ($75)
   • (b) MMMNA for community spouse (if applicable)
   • (c) Maintenance for family dependents (if applicable)
   • (d) Incurred medical expenses not covered by Medicaid or insurance
   • (e) Patient liability owed to the nursing facility or HCBS waiver provider
   • (f) Bank fee (up to $15)
3. Same-month requirement: deposits must be made the same month income is received; withdrawals must be made by the last day of the same month. Failure to deposit and withdraw within the calendar month breaks Medicaid eligibility for that month.

Filing and Annual Verification

• The QIT trust document must be filed with CDJFS at the LTC Medicaid application along with ODM 10193 and proof of the initial deposit.
• At each annual recertification, ODM/CDJFS reviews QIT statements to confirm proper monthly operation.
• Improper operation (depositing too much income leaving applicant without enough remaining income for non-trust expenses; not withdrawing in the same month; using QIT funds for non-authorized purposes) breaks eligibility for the affected months and may trigger overpayment recovery.

Cost

Drafting a Miller Trust ranges from $300-$1,500 in Ohio depending on complexity (single applicant with simple income vs. couple with multiple income sources). Some elder-law attorneys offer flat-fee QIT packages including drafting + initial coaching + annual review. Pro Seniors (Cincinnati) provides free QIT pamphlets and basic guidance for seniors 60+ in their service area.

Common QIT Mistakes

• Depositing all income without leaving any in the operating account, applicant loses ability to pay incurred medical expenses outside the QIT.
• Forgetting to deposit one month, eligibility breaks for that month.
• Mixing other people's money in the QIT account, disqualifies the trust.
• Naming a successor beneficiary other than ODM, disqualifies the trust.
• Using a revocable trust, does not qualify under OAC 5160:1-6-03.2.

Spend-Down on Exempt Assets

Authority: OAC 5160:1-3-05; 5160:1-6-06.

For applicants with countable resources above $2,000, the legal path to qualify is "spending down", converting countable assets into exempt assets or spending them on legitimate expenses.

Allowable spend-down moves:

• Pay outstanding medical bills, including bills not covered by Medicare/insurance.
• Pre-pay an irrevocable burial contract, unlimited dollar amount; exempt regardless of value (OAC 5160:1-3-05.6).
• Buy a burial space and pre-paid burial space items (casket, vault, plot, headstone), exempt regardless of value, for individual + spouse + immediate family (OAC 5160:1-3-05.7).
• Make modest gifts, but watch the 60-month lookback (covered next).
• Pay off mortgage on principal residence, converts countable cash into exempt home equity (subject to home equity cap).
• Make home repairs, necessary repairs (roof, plumbing, accessibility modifications) are legitimate spend-down.
• Replace a vehicle, one vehicle of any value is exempt (OAC 5160:1-3-05.5); upgrading from an old car to a more reliable vehicle is legitimate.
• Pay attorney fees for elder-law planning, reasonable.
• Annuitize via Medicaid-Compliant SPIA, converts a lump sum into income (subject to LTC SIL test and patient-liability calculation).

Disallowed moves (will trigger transfer penalty):

• Gifting cash to children or other relatives, will trigger transfer penalty.
• Adding a child to a deed without compensation, partial gift.
• Pre-funding 529 college savings plans for grandchildren, gift.
• Buying assets in someone else's name, gift.

Exempt asset categories (OAC 5160:1-3-05):

Transfer Penalty / 60-Month Lookback / APPR $7,787

Authority: 42 USC § 1396p(c)(1); OAC 5160:1-6-06.5.

The lookback period in Ohio is 60 months (5 years). Any uncompensated transfer made within 60 months before the LTC Medicaid application date is reviewed as a potential gift, generating a transfer penalty (period of LTC Medicaid ineligibility).

Important: the 60-month lookback applies ONLY to LTC (institutional + 1915(c) waivers). It does NOT apply to MAGI Medicaid (Group VIII, parents, children, pregnant women) or to ABD spend-down. A 60-year-old applying for ACA Group VIII has no lookback exposure. A 75-year-old applying for nursing-facility Medicaid has a full 60-month review of transfers.

Transfer Penalty Calculation

Penalty period (months) = Uncompensated transfer ÷ APPR (Average Monthly Private-Pay Rate)

Ohio's APPR is $7,787, set effective 9/1/2024 and not yet updated for 2026 despite the 2026 Help Sheet listing it. This is unusual; most states update annually. Ohio practitioners should monitor for a 2026 update.

Worked example: a $100,000 cash gift to a child within the 60-month lookback creates a penalty period of $100,000 ÷ $7,787 = 12.84 months of LTC Medicaid ineligibility, calculated from the later of (a) the transfer date, or (b) the date the applicant would otherwise be Medicaid-eligible (typically NF entry).

There is no aggregate lookback limit. Multiple transfers within 60 months are summed and divided by APPR. A $50,000 gift in 2023 plus $30,000 in 2024 plus $20,000 in 2025 = $100,000 total = 12.84 months.

Hardship Waiver

If the transfer penalty would cause "undue hardship", the applicant has no other means of paying for needed care, the hardship is severe, and the transfer cannot be undone, the applicant may petition for hardship waiver. Authority: 42 USC § 1396p(c)(2)(D); OAC 5160:1-6-06.5(K). Hardship waivers are granted infrequently and require strong documentation.

Common Transfer-Penalty Errors

• Adding a child to a deed: 50% gift (or pro-rata based on # of grantees).
• Selling a home for less than fair market value: gift = FMV − sale price.
• Forgiving a debt: gift = debt amount.
• Joint bank account additions: depending on state, may be partial gift.
• Trust transfers during lookback: reviewed under § 1396p(d) trust rules, generally counted unless to a (d)(4)(A)/(B)/(C) special needs trust.

Caregiver-Child Lifetime Transfer Exception

A specific federal exception under 42 USC § 1396p(c)(2)(A)(iv) allows the institutionalized applicant to transfer the home to a son or daughter who:

• Lived in the home for at least two years before institutionalization, AND
• Provided care that postponed institutionalization (typically documented by physician's letter).

This transfer is NOT a gift for transfer-penalty purposes, and it removes the home from the estate (eliminating estate recovery exposure on that asset). It is one of the most powerful planning tools for families where an adult child has been the caregiver. Engage an Ohio elder-law attorney to document the qualifying period and execute the deed properly.

Retroactive Coverage

Authority: 42 CFR § 435.915.

For LTC applicants who entered nursing facilities or began HCBS waiver services BEFORE the application date, retroactive coverage is critical, the medical bills incurred between the start of services and the application can run into tens or hundreds of thousands of dollars.

Pre-1/1/2027 (current): 3 months of retroactive coverage. Application can request coverage for medical bills incurred up to 3 months before the application month, IF the applicant would have been eligible during those months.

Post-1/1/2027: Pub. L. 119-21 § 71106 reduces retroactive coverage to:

• 1 month for ACA expansion adults (Group VIII)
• 2 months for aged/disabled and other Medicaid groups

For LTC applicants, this is a 1-month reduction (3 → 2). For Group VIII expansion adults, it is a 2-month reduction (3 → 1).

Planning implication: families with a member entering a nursing facility should file the LTC Medicaid application within 30 days of NF entry (or as soon as financially eligible) to capture maximum retroactive coverage. Delay risks losing months of coverage that the applicant cannot recapture.

Ohio has not adopted any state policy beyond the federal minimum, the federal 3-month/2-month/1-month rules apply directly.

Application Process

Where to Apply

• In person: Your county's CDJFS office (88 county offices statewide). Find your county at jfs.ohio.gov/county/cntydir.stm.
• Online: benefits.ohio.gov (Ohio Benefits self-service portal).
• By mail: Mail completed ODM 07400 to your CDJFS.
• By phone: Ohio Medicaid Consumer Hotline 1-800-324-8680 (TTY 1-800-292-3572), they will route the application to your CDJFS.
• LTC-specific intake: OBLTSS at 1-844-644-6582, Ohio's centralized Long-Term Services and Supports intake hotline.

Forms

• ODM 07400: Healthcare Application, primary intake form, used for all Medicaid pathways. Revised 5/2023.
• ODM 07408: Long-Term Care application supplement, required additional documentation for institutional and 1915(c) waiver applications.
• ODM 10193: QIT Verification Form, required for applicants with income above SIL.

Processing Timelines

Authority: OAC 5160:1-2-01(K).

• 45 days standard for non-disability MAGI applications (Group VIII, parents, children, pregnant women).
• 90 days standard for disability determinations and ABD/LTC applications (where SSI determination is not already in place).

ODM is required to make a final determination within these timelines except in good cause situations (e.g., applicant fails to provide requested documentation).

LTC Level of Care Assessment

Two parallel processes for LTC applicants:

1. PASRR (Preadmission Screening and Resident Review), federal mandate under 42 CFR § 483.100-138. Screens for serious mental illness (SMI) and intellectual/developmental disabilities (IDD). Must be completed before a nursing facility can admit a Medicaid resident.

2. ACAT (Adult Comprehensive Assessment Tool), Ohio's functional/nursing-need assessment, administered by Area Agencies on Aging or contracted providers. Determines whether applicant requires NF level of care or can be served in HCBS waivers.

Both processes are coordinated through the AAA serving the applicant's county. The 12 Ohio AAAs are listed below.

Recertification

Authority: OAC 5160:1-2-12 family.

• Most pathways: 12-month redetermination cycle.
• Children: 12-month continuous eligibility (federal mandate effective 1/1/2024 under Pub. L. 117-328 / CAA 2023). Children remain enrolled for 12 months even if family income rises above thresholds.
• Postpartum coverage: 12 months (effective per CAA 2023).

OBBBA / Pub. L. 119-21 effect, beginning 1/1/2027:

• Group VIII expansion adults: 6-month redetermination cycle (mandated by § 71107). Ohio must implement.
• All other pathways (including ABD, LTC, children, pregnant women): remain 12-month.

Ohio uses ex parte (passive) renewal where data sources (SNAP records, IRS data, SSA data, employer wage data) support automatic renewal without requiring the beneficiary to submit information. Ex parte renewal is a federal mandate; Ohio must use it where feasible. PHE unwinding (2023-2024) was a major test of Ohio's ex parte renewal capacity.

Group VIII Work-Engagement 1115 Demonstration

Status as of May 2026: pending or recently approved CMS approval; Ohio submitted its Section 1115 application 2/28/2025. Federal public comment period ended 4/7/2025.

Ohio's Proposal

• Group VIII enrollees ages 19-54 (Ohio's draft) subject to community-engagement requirement.
• 80 hours/month of qualifying activity: work, work search, school/training, community service, or volunteerism.
• Twice-yearly reporting (every 6 months).
• Exemptions: Pregnant; medically frail; substance use disorder treatment; primary caregiver of a child under 14; enrolled in 1115 SUD waiver; American Indian/Alaska Native; under age 19 or over 54 (Ohio's draft); receiving Title II disability benefits; enrolled in Medicare; Disabled Adult Child; meeting SNAP/TANF work requirement; complying with TANF requirements; full-time student.
• Excluded populations (NOT subject): Dual-eligibles, NH residents, ABD/disabled, pregnant women, parents/caretakers of minor children, foster youth.
• Projected disenrollment: ~62,000 of ~770,000 Group VIII enrollees in CY2026.

Intersection with Pub. L. 119-21 (OBBBA) Federal Framework

OBBBA § 71105 imposes a federal community-engagement requirement on Group VIII expansion adults effective 12/31/2026 (states may extend to 12/31/2028 with good-faith effort). The federal framework applies to ages 19-64 (broader than Ohio's draft 19-54).

CMS is expected to issue an interim final rule by 6/1/2026 implementing OBBBA § 71105. After that rule, Ohio's 1115 will harmonize with the federal framework, likely expanding the age range to 19-64, locking in 80 hours/month and 6-month reporting.

For Group VIII enrollees: expect a community-engagement requirement to be operational in Ohio by mid-to-late 2026. Track ODM JMOC presentations and LeadingAge Ohio bulletins for current status.

SUD 1115 Demonstration Status

Original CMS approval: 10/1/2019 - 9/30/2024.

Ohio submitted a 5-year extension request before the 9/30/2024 expiration. CMS granted temporary extensions through 12/31/2025 while the renewal request was processed. Renewal CMS approval is pending as of May 2026, operating on rolling temporary extensions.

The SUD 1115 waives the federal IMD (Institution for Mental Diseases) exclusion for Substance Use Disorder treatment, allowing federal Medicaid match for residential and inpatient SUD treatment in facilities exceeding the 16-bed IMD limit. It supports Ohio's continuum of care for opioid use disorder and other SUDs.

Authority: § 1115(a)(2) Social Security Act; 42 CFR § 431.420.

If you or a family member need SUD residential care in 2026, the SUD 1115 should be operational throughout the year via temporary extension. Contact OhioMHAS or the Bureau of Recovery Services for current treatment provider directories.

Dual-Eligible Medicare Savings Programs (MSPs)

For Ohioans entitled to Medicare but with limited income, four federal-state MSP programs cover Medicare premiums and (for QMB only) cost-sharing.

QMB (Qualified Medicare Beneficiary), 100% FPL

• 2026 income: $1,330/month single, $1,803/month couple.
• Resource limit: $9,950 single, $14,910 couple.
• Covers: Medicare Part A and B premiums, deductibles, coinsurance, copays. QMB enrollees pay nothing out-of-pocket for Medicare-covered services.
• QMB is "QMB Plus" if also receiving full Medicaid (full duals, most institutionalized residents).

SLMB (Specified Low-Income Medicare Beneficiary), 120% FPL

• 2026 income: $1,596/month single, $2,164/month couple.
• Resource limit: $9,950 single, $14,910 couple.
• Covers: Medicare Part B premium only.

QI-1 (Qualifying Individual), 135% FPL

• 2026 income: $1,796/month single, $2,435/month couple.
• Resource limit: $9,950 single, $14,910 couple.
• Covers: Medicare Part B premium only. QI-1 is funded from a fixed federal allotment and is "first come, first served", though Ohio has historically had sufficient allotment to enroll all eligible applicants.

QDWI (Qualified Disabled Working Individual), 200% FPL

• 2026 income: $2,660/month single, $3,607/month couple.
• Resource limit: $4,000 single, $6,000 couple.
• Eligibility: Working individual under 65 with disability and Medicare entitlement (typically those who lost premium-free Part A due to substantial gainful activity).
• Covers: Medicare Part A premium only.

LIS / Extra Help

MSP enrollment automatically triggers federal Low-Income Subsidy (LIS / Extra Help) for Medicare Part D prescription drug coverage. LIS reduces Part D premiums to $0 (in many plans), eliminates deductibles, and caps copays at $1.55/$4.60 (generic/brand) for full LIS.

For aging Ohioans enrolled in original Medicare with modest income, the QMB/SLMB/QI cascade can save thousands of dollars annually. Apply via CDJFS using the same ODM 07400 used for general Medicaid; check the MSP-specific boxes.

MSP Carve-Out from Estate Recovery

Important: Medicaid payments for Medicare cost-sharing on behalf of QMB-only / SLMB-only / QI-only / QDWI-only enrollees are NOT recoverable from the estate at death. Authority: ACA § 6021 (Pub. L. 111-148), effective 1/1/2010, codified at 42 USC § 1396p(b)(1)(C).

This means MSP enrollment carries no estate recovery risk. Many older Ohioans avoid MSPs out of estate-recovery fear, that fear is misplaced for MSP-only enrollment. The Ohio expanded estate recovery applies to Medicaid services beyond MSPs (NF, HCBS, etc.), not to the Medicare cost-sharing payments themselves.

Four Worked Examples

Example 1: 65-Year-Old Single Woman, $1,800/Month Social Security

• Income: $1,800/month > $1,014 (ABD categorical) but < $2,982 (SIL).
• Resources: $2,000 in checking, $5,000 modest car. Car exempt as one vehicle. Cash at the limit.

Pathway analysis:

• NOT eligible for SSI categorical (income too high).
• NOT eligible for ABD categorically needy (income above $1,014).
• Eligible for ABD spend-down if seeking community Medicaid only. Monthly spend-down = $1,800 − $20 − $994 = $786/month. Three options: pay-in $786/month to CDJFS, accumulate medical bills, or document recurring medical expenses.
• Eligible for LTC Medicaid (NF or HCBS waiver) directly without Miller Trust because income < $2,982. Resources at the limit (need to spend $1 to be safely under $2,000).
• Eligible for QMB because income $1,800 > $1,330. (Wait, income $1,800 > $1,330, so SHE IS NOT QMB-eligible.) QI-1 eligible because income $1,800 > $1,596 SLMB but $1,800 > $1,796 QI-1 (very close, the QI-1 limit is $1,796, and her income is $1,800, so she just misses by $4). Likely no MSP eligibility.

The optimal path depends on her care need: if community-dwelling with prescription/medical costs, ABD spend-down via pay-in is cleanest. If entering HCBS waiver, immediate LTC pathway.

Example 2: 72-Year-Old Man Entering Nursing Home, $2,500/Month Income, $50,000 CDs, $200,000 Home

• Income: $2,500/month < $2,982 SIL → no Miller Trust required.
• Resources: $50,000 CDs > $2,000 limit. Must spend down $48,000 before NF Medicaid begins.
• Home: $200,000 equity < $752,000 home equity cap → exempt during lifetime if intent to return / spouse / minor or disabled child / sibling-with-equity. Subject to estate recovery at death (Ohio is one of the most aggressive expanded-recovery states).

Spend-down strategy (next 6 months):

• Pre-pay irrevocable burial contract: $15,000.
• Pay outstanding medical bills: $5,000.
• NF private-pay until below $2,000: 4-6 months at typical Ohio NF rates of $9,000-$11,000/month = $36,000-$44,000.

Once below $2,000 in resources and assuming admission documented, file ODM 07400 + ODM 07408. Application date controls retroactive coverage (3 months pre-1/1/2027; 2 months for ABD post-1/1/2027). File within 30 days of NF entry to maximize retroactive.

Patient liability post-eligibility: $2,500 income − $75 PNA − $202.90 Medicare Part B premium − net Medicare supplemental premium ≈ $2,135-$2,185/month to NF.

Transfer penalty risk: if any of the $50,000 was gifted to children within 60 months, penalty period = gift ÷ $7,787. A $20,000 gift = 2.57 months ineligibility. A $48,000 gift = 6.16 months. Engage Ohio elder-law attorney to scrub for potential transfers.

Example 3: Married Couple, Husband Entering Nursing Home, Wife at Home

• Husband: $3,500/month income (Social Security + small pension).
• Wife: $1,200/month income (Social Security only).
• Combined resources: $200,000 (savings, CDs, brokerage). Home $400,000 equity. One vehicle.

Resource snapshot (taken on first day of first 30-day continuous institutionalization):

• $200,000 / 2 = $100,000 → wife's CSRA = $100,000 (within $32,532-$162,660 range; she keeps the full half).
• Husband must spend down to $2,000.
• Husband's spend-down target: $200,000 − $100,000 (wife's CSRA) − $2,000 (husband's resource limit) = $98,000 to spend down.

Income:

• Husband's $3,500 > $2,982 SIL → Miller Trust required.
• Wife's income $1,200 < MMMNA min $2,643.75. CSMIA = $2,643.75 − $1,200 = $1,443.75/month from husband to wife.

Husband's monthly patient liability:

• $3,500 income (deposited into Miller Trust + retained out-of-trust as needed).
• − $75 PNA.
• − $1,443.75 CSMIA to wife.
• − Medicare Part B premium ~$202.90.
• − Net Medicare supplemental premium (varies).
• ≈ $1,780/month patient liability to NF.

Home: exempt during husband's lifetime (wife resides). On wife's death, home is subject to Ohio expanded estate recovery (covered separately; engage estate planning during lifetime via MAPT or caregiver-child deed if applicable).

Planning timing: ideally engaged Ohio elder-law attorney 5+ years before husband's NF admission to structure CSRA optimization, home protection (MAPT, caregiver-child deed), and SPIA annuitization where appropriate.

Example 4: Disabled 35-Year-Old SSI Recipient

• SSI receipt = automatic Medicaid (1634).
• No separate Medicaid application required (some counties ask for ODM 07400 to formally enroll in managed-care plan).
• No lookback (under 65, not in LTC).
• Eligible for full Medicaid State Plan benefits, categorical, not the Group VIII ABP. Includes any state-plan-covered service (acute, primary, behavioral health, prescriptions).
• Resource limit $2,000.
• If working: 1619(b) protection retains Medicaid above SSI cash threshold up to Ohio's 2026 1619(b) state threshold.

If she develops a need for HCBS waiver services (DODD IO/Level One/SELF, or Ohio Home Care Waiver), additional 1915(c) eligibility analysis applies, but the Medicaid foundation via SSI/1634 is automatic.

12 Ohio-Specific Pitfalls

1. The 60-month lookback applies ONLY to LTC. Group VIII applicants and ABD spend-down enrollees have no lookback.

2. Ohio is income-cap, not medically-needy. Income above $2,982 requires a Miller Trust for LTC. ABD spend-down does NOT cover institutional care.

3. PNA was raised to $75 on 10/1/2025. Older guides still cite $50.

4. APPR transfer divisor is $7,787, set 9/1/2024, not yet updated for 2026. Penalty calculations should use current divisor; verify with ODM if rates have risen.

5. No Katie Beckett / CBIP in Ohio. Disabled children of higher-income families must use DODD waivers (multi-year waiting list) or Ohio Home Care Waiver.

6. Ohio's expanded estate recovery is among the most aggressive nationally. TOD/JTWROS/POD/living-trust assets are NOT protected. See Ohio Estate Recovery.

7. Spousal refusal is contested in Ohio. Sources conflict; the safer path is spousal-impoverishment CSRA + court-ordered support orders to expand CSRA above $162,660 (under § 1396r-5(e)(2)(C)).

8. MSP enrollment carries NO estate recovery risk. ACA § 6021 carves out Medicare cost-sharing payments. Don't avoid MSPs for fear of recovery.

9. The Pickle Amendment is operational in Ohio. Many older Ohioans whose Social Security exceeds SSI FBR but who lost SSI to historical COLAs may qualify for Medicaid under Pickle. Run the Pickle test.

10. MMMNA minimum $2,643.75 is in effect through 6/30/2026 only. A modest July 1 increase is likely; verify before relying on figures past mid-year.

11. Group VIII work requirement is coming (12/31/2026 federal deadline). Group VIII enrollees should prepare to document 80 hours/month of qualifying activity or claim an exemption.

12. Retroactive coverage shrinks 1/1/2027. File LTC Medicaid applications within 30 days of NF entry to maximize the 3-month retroactive window before it drops to 2 months.

Pending Policy Watch

• HB 318 (136th GA), Estate recovery reform; would limit recovery to probate-only, $10,000 floor, 75% home-equity cap. Pending Ohio House Medicaid Committee as of May 2026; not enacted.
• HB 130 (136th GA), Narrower estate recovery notice bill; pending.
• Group VIII Work-Engagement 1115, CMS approval pending or recently granted (verify); harmonized with OBBBA federal framework.
• SUD 1115 renewal, Operating on temporary extension through 12/31/2025; full renewal pending CMS approval.
• Pub. L. 119-21 (OBBBA) implementation:
  • CMS interim final rule on work requirements: by 6/1/2026.
  • State compliance (work requirement, retroactive coverage, 6-month redetermination): 1/1/2027.
  • Home equity flat $1M cap: 1/1/2028.
• Federal MMMNA July 1 reset, modest increase expected for 2H 2026; check ODM 2026 Help Sheet update for 7/1/2026 figure.
• Schakowsky Stop Unfair Medicaid Recoveries Act (H.R. 6951, 119th Cong.), would eliminate federal estate recovery mandate; pending House E&C; no Senate companion as of May 2026.

Where to Get Help

State agencies and hotlines

• Ohio Medicaid Consumer Hotline: 1-800-324-8680 (TTY 1-800-292-3572)
• OBLTSS, Ohio Benefits Long-Term Services and Supports: 1-844-644-6582
• Ohio Department of Medicaid: 50 W. Town Street, Suite 400, Columbus, OH 43215. Director: Scott R. Partika.
• OSHIIP (Ohio Senior Health Insurance Information Program): 1-800-686-1578 (free Medicare counseling, Ohio Department of Insurance)
• Ohio Long-Term Care Ombudsman: 1-800-282-1206
• Senior Medicare Patrol (Pro Seniors): 1-800-488-6070 opt 4
• Ohio CareLine: 1-800-720-9616 (24/7 emotional support / behavioral health)

12 Ohio Area Agencies on Aging

1. AAA1, Council on Aging of Southwestern Ohio (Cincinnati), 5 counties (Butler, Clermont, Clinton, Hamilton, Warren). 1-800-252-0155.
2. AAA2, Area Agency on Aging Region 2 (Dayton), 9 counties (Champaign, Clark, Darke, Greene, Logan, Miami, Montgomery, Preble, Shelby). 1-800-258-7277.
3. AAA3, Area Agency on Aging District 3 (Lima), 8 counties (Allen, Auglaize, Hancock, Hardin, Mercer, Paulding, Putnam, Van Wert). 1-800-653-7277.
4. AAA4, Area Office on Aging of NW Ohio (Toledo), 10 counties (Defiance, Erie, Fulton, Henry, Huron, Lucas, Ottawa, Sandusky, Williams, Wood). 1-800-472-7277.
5. AAA5, Ohio District 5 Area Agency on Aging (Ontario), 9 counties (Ashland, Crawford, Knox, Marion, Morrow, Richland, Seneca, Wyandot). 1-800-860-5799.
6. AAA6, Central Ohio Area Agency on Aging (Columbus), 8 counties (Delaware, Fairfield, Fayette, Franklin, Licking, Madison, Pickaway, Union). 1-800-589-7277.
7. AAA7, Area Agency on Aging District 7 (Rio Grande), 10 counties (Adams, Brown, Gallia, Highland, Jackson, Lawrence, Pike, Ross, Scioto, Vinton). 1-800-582-7277.
8. AAA8, Buckeye Hills Regional Council (Marietta), 8 counties (Athens, Hocking, Meigs, Monroe, Morgan, Noble, Perry, Washington). 1-800-331-2644.
9. AAA9, Area Agency on Aging Region 9 (Cambridge), 9 counties (Belmont, Carroll, Coshocton, Guernsey, Harrison, Holmes, Jefferson, Muskingum, Tuscarawas). 1-800-945-4250.
10. AAA10A, Western Reserve Area Agency on Aging (Cleveland), 5 counties (Cuyahoga, Geauga, Lake, Lorain, Medina). 1-800-626-7277.
11. AAA10B, Direction Home Akron Canton Area Agency on Aging, 4 counties (Portage, Stark, Summit, Wayne). 1-800-421-7277.
12. AAA11, Direction Home, Eastern Ohio (Youngstown), 4 counties (Ashtabula, Columbiana, Mahoning, Trumbull). 1-800-686-7367.

Legal aid

• Pro Seniors (Cincinnati), Legal helpline for Ohioans 60+, 7162 Reading Rd., Suite 1150, Cincinnati, OH 45237. 513-345-4160 / 1-800-488-6070.
• Legal Aid of Western Ohio (Toledo).
• Legal Aid Society of Cleveland.
• Southeastern Ohio Legal Services (Marietta + Steubenville).
• Community Legal Aid Services of Mid-Ohio (Akron / Canton / Youngstown).
• Disability Rights Ohio, Ohio's Protection & Advocacy agency.
• NAELA Ohio chapter, National Academy of Elder Law Attorneys, Ohio members directory.
• Ohio Poverty Law Center, statewide poverty-law policy and litigation.
• Ohio State Bar Association Lawyer Referral Service, for finding an Ohio elder-law attorney.

Provider associations

• LeadingAge Ohio, non-profit senior care provider association; publishes regulatory bulletins.
• Ohio Health Care Association (OHCA), for-profit/non-profit nursing facility and assisted living association.

CDJFS

Find your county's CDJFS at jfs.ohio.gov/county/cntydir.stm. CDJFS is your primary application point.

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Ohio deep articles:

• Ohio Medicaid Pillar Guide, the parent landing page covering all of Ohio Medicaid LTSS, eligibility, waivers, and benefits.
• Ohio Estate Recovery, Ohio's expanded recovery (TOD/JTWROS/POD/trust caught), HB 318 reform watch, planning toolkit.
• Next Generation MyCare Ohio, Ohio's FIDE-SNP architecture for full-benefit dual-eligibles 21+.
• Ohio Personal Needs Allowance, the $75/month residual-income entitlement (raised 10/1/2025).
• Ohio Miller Trust / Qualified Income Trust, the income-cap workaround for above-$2,982 applicants.
• Ohio Pay-In Spend-Down, the ABD-pathway monthly premium-style payment.
• PASSPORT Waiver, Ohio's flagship in-home HCBS waiver for ages 60+.
• Assisted Living Waiver, Ohio's HCBS waiver for residential settings.
• Ohio Home Care Waiver, Ohio's waiver for younger physically disabled adults.
• MyCare Ohio Waiver, the dual-eligible waiver consolidating PASSPORT/AL/OHC for Next Gen MyCare members.
• Ohio Caregiver Pillar, paid family caregiving programs in Ohio (C-HCAS, CD-PCS, SFC).
• Ohio Care Types, directory of nursing homes, assisted living, and memory care in Ohio.

Federal context:

• Medicaid Estate Recovery Explained, federal hub on the OBRA-93 mandate, 51-jurisdiction matrix, hardship-waiver standards, and cross-state planning toolkit.
• Federal FIDE-SNP Hub, for the federally-integrated dual-eligible architecture.

Find personalized help with Ohio Medicaid eligibility at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.