Ohio Medicaid Spend-Down: What To Do Instead

If someone has told you to "spend down" your income to get onto Ohio Medicaid, that advice is out of date. Ohio ended the aged, blind, and disabled (ABD) income spend-down on August 1, 2016, when it became a Section 1634 state, and Ohio's current income rule for those groups carries no spend-down or monthly pay-in.1 What stands in its place depends on the care you need: a Qualified Income Trust for nursing facility or waiver Medicaid, the Medicaid Buy-In if you work, and several protections for people who lose Supplemental Security Income (SSI) that can settle the income question outright.

See who qualifies at Ohio Medicaid

In This Guide

• Why you are still being told to spend down for Ohio Medicaid
• What Ohio ended, and when
• Nursing facility or waiver care: the Miller Trust
• If you are working: the Medicaid Buy-In
• Protections that may make income irrelevant
• The Ohio Medicaid asset spend-down that still exists
• Medicare Savings Programs
• Appeals
• Key phone numbers and contacts
• Frequently Asked Questions

Why you are still being told to spend down for Ohio Medicaid

Ohio ran an ABD spend-down until 2016, so advice written or learned before then may still assume it exists, whether it comes from an older guide or from a relative who qualified that way.1

None of it has applied for nearly a decade. Ohio ended its ABD Medicaid spend-down when it moved to Section 1634 eligibility in 2016.1 An aged, blind, or disabled applicant in the community whose income is over the applicable limit cannot use a spend-down to qualify.3 If you are told to pay a monthly amount to qualify for aged, blind, or disabled Medicaid, ask which rule requires it: Ohio's current ABD income rule attaches no spend-down or monthly pay-in.1 It is worth asking when the person last checked.

What Ohio ended, and when

Before August 1, 2016, Ohio operated under Section 209(b) of the Social Security Act, and that policy let individuals spend down to become eligible for Medicaid.1

On August 1, 2016, Ohio converted to a Section 1634 state, and Social Security's own list of state Medicaid programs still records Ohio that way, with no medically needy program listed for aged, blind, or disabled people.1 The Ohio Department of Medicaid's Medicaid Eligibility Procedure Letter No. 115 records the consequence plainly: under the prior 209(b) policy individuals could spend down, and when Ohio became a 1634 state on that date, individuals would no longer be able to spend down to become eligible for Medicaid.1

Ohio's current income rule for aged, blind, or disabled Medicaid, Ohio Administrative Code (OAC) 5160:1-3-03.5 (effective June 8, 2025), sets the individual and couple income standards equal to the current SSI benefit rate and attaches no spend-down or monthly pay-in to them. No source we rely on shows any ABD spend-down or pay-in in effect after August 1, 2016. An absence is hard to prove, though, so if someone insists one exists, ask the Ohio Department of Medicaid or your county Department of Job and Family Services to name the rule.1

Nursing facility or waiver care: the Miller Trust

If a parent needs nursing facility or waiver care and their income is over the cap, there is a real answer.

Ohio is an income-cap state for institutional and Home and Community-Based Services waiver Medicaid. If countable income exceeds the special income level (300% of the SSI federal benefit rate, or $2,982 per month for a single applicant in 2026, effective January 1, 2026), the applicant does not spend down. They may establish a Qualified Income Trust, also called a Miller Trust, under 42 U.S.C. § 1396p(d)(4)(B), to bring countable income to or below the special income level. Ohio's rule makes the trust an option, not a requirement, but any income not placed in the trust is counted as available when eligibility is decided.2

It only works for someone who is eligible for Medicaid long-term care, whether in a nursing facility or at home through a waiver or PACE. It is not a general substitute for the spend-down that ended in 2016.1

The trust is not a way to keep the money. Only the applicant's own income goes in, all of it still counts toward the monthly amount they pay toward their care, and when they die whatever remains goes to the Ohio Department of Medicaid, up to what Medicaid paid on their behalf. What the trust does is stop the income cap from disqualifying the applicant outright.2

Two practical points. The signed trust document, proof the trust account is open, and proof of the monthly deposits all go in with the Medicaid application, so it is an early step rather than a response to a denial.2 And it is a genuine legal instrument, which is the point at which an elder-law attorney earns their fee. See Ohio Miller Trust (QIT) for how one is set up and administered.

If you are working: the Medicaid Buy-In

Ohio runs a Medicaid Buy-In for Workers with Disabilities, created at Ohio Revised Code (ORC) sections 5163.09 through 5163.098 as Ohio's coverage of the federal optional eligibility groups for working people with disabilities.4

Under ORC 5163.091, an applicant qualifies by showing all of the following:4

• Age: at least 16 and under 65
• Disability and work: either considered disabled for SSI purposes (whether or not an SSI check actually arrives) with earnings from employment, or an employed individual with a medically improved disability, subject to an exception in ORC 5163.096
• Resources: resources, after disregards, within the limit ORC 5163.092 provides for; the Ohio Department of Medicaid's 2026 standards list the individual resource limit as $15,668, effective January 1, 2026
• Income: income, after the disregards Ohio law allows, at or below 250% of the federal poverty line
• Other requirements: any additional conditions set in the program rules that ORC 5163.098 authorizes4

One detail is worth checking against whatever else you have read, because it changed recently. ORC 5163.094 is still titled "Amount of annual individual premium," and it once set one. Ohio's House Bill 96 (136th General Assembly) replaced the text of ORC 5163.094, and since September 30, 2025 that Ohio statute reads, in full, that an individual "shall not be required to pay a premium as a condition of qualifying for the medicaid buy-in for workers with disabilities program." Guides that describe the Buy-In as premium-based are quoting the old statute.4

Note the age ceiling: this is a route for a working adult with a disability rather than for someone 65 or older.4

Protections that may make income irrelevant

Check these before assuming the income limit is the obstacle. Each preserves Medicaid for a specific group, and any one of them may mean the question never arises.

Pickle Amendment. Under Section 503 of Public Law 94-566 and 42 CFR 435.135, someone who lost SSI only because Social Security cost-of-living increases raised their income keeps Medicaid if they would still qualify for SSI with those increases subtracted back out. A spouse's or parent's cost-of-living increases count too. And because the test freezes the Social Security benefit at its level when SSI stopped, while the SSI rate keeps rising, someone who fails the test this year can pass it in a later year, so it is worth re-checking.5

Disabled Adult Child protections under Section 1634(c) of the Social Security Act, 42 USC 1383c(c). An adult whose blindness or disability began before age 22, and who loses SSI because they become entitled to Social Security child's insurance benefits on a parent's record (or to an increase in them), is still treated as an SSI recipient for Medicaid, for as long as they would qualify for SSI with those benefits set aside. That test is decided by the state Medicaid agency, not by Social Security.6

Disabled Widow(er) protections. The federal group for disabled widows and widowers is 42 CFR 435.137, titled for disabled widows and widowers "who would be eligible for SSI except for the increase in disability benefits resulting from elimination of the reduction factor under Pub. L. 98-21." Ask the county to check this group by name; a caseworker who is thinking about ordinary ABD limits may not.6

Section 1619(b) work continuation under 42 USC 1382h(b). An SSI recipient whose earnings stop the cash payment keeps Medicaid if they still have the disabling impairment, still meet every non-earnings SSI rule, need Medicaid in order to keep working, and have gross earnings at or below their state's threshold amount. Earning above that charted amount does not end it automatically: the Social Security field office then works out an individualized threshold.7

The Ohio Medicaid asset spend-down that still exists

This is the distinction to get right, because the two are easy to confuse.

What Ohio eliminated was an income spend-down. Spending down excess assets, meaning reducing countable resources to the $2,000 limit for a single long-term care applicant before qualifying, was never affected and remains ordinary Medicaid practice.3,1

So when a caseworker or attorney says to spend down before applying, ask which they mean. If they mean assets, they are right. If they mean paying a monthly amount to qualify on income, Ohio's current ABD income rule has no such provision.1

Ohio Medicaid Asset Spend-Down covers the valid version, including which assets are exempt and how the transfer penalty interacts with it.

Medicare Savings Programs

For anyone with Medicare, these run separately from everything above and are worth checking on their own.

Ohio administers the Medicare Savings Programs as its Medicare Premium Assistance Programs, and your county Department of Job and Family Services decides eligibility. Ohio's 2026 monthly income guidelines took effect March 1, 2026, and each is a ceiling on countable income, not on gross pay.8

The FPL percentages and Ohio monthly figures come from Ohio's own 2026 guidelines; what each program pays is the federal rule that applies in every state. What the table cannot show is the second half of the benefit: enrolling in QMB, SLMB, or QI-1 automatically deems you eligible for Part D Extra Help (the Low-Income Subsidy), with no separate application, so the premium only rows are not the whole of what SLMB and QI-1 are worth.8

A note on the $20: Ohio applies its income disregards to your income rather than to the published limit, so each Ohio figure sits exactly $20 below the federal one, which builds the $20 SSI general income exclusion into the limit instead (QMB $1,350, SLMB $1,616, QI-1 $1,816 for one person).8

Appeals

If a county Department of Job and Family Services denies, reduces, or terminates Medicaid, you may request a state hearing from the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings. The rules are OAC 5101:6-3-02 for hearing requests and OAC 5101:6-4-01 for keeping benefits while the appeal is pending.9

• Filing deadline: 90 calendar days, counted from the day after the notice of action is mailed; your request is dated the day the state or county agency receives it
• How to file: call or write your county agency, write to ODJFS Bureau of State Hearings, PO Box 182825, Columbus, Ohio 43218-2825, or fill out the request form that comes with the notice and mail it or fax it to (614) 728-9574. Only you can ask by phone; a request someone else makes for you must be in writing, with a statement you sign naming them as your representative
• Keeping benefits during the appeal: if your assistance will be reduced, stopped, or restricted, request the hearing within 15 days of receiving that notice. Continuation is conditional, not automatic. Missed it? A request received within 10 days after the change takes effect, with good cause such as a death in the family or a sudden illness, restores benefits to the previous level
• The phone line: call the Bureau of State Hearings at 1-866-635-3748 if your benefits changed without written notice, or changed even though you asked for a hearing in time, to ask whether they should continue; the same line arranges taking part by telephone if you cannot get to the hearing9
• The trade-off: if benefits continue and you lose the hearing, you may have to repay what you were not eligible to receive9

If you are in an Ohio managed care plan, the plan's own internal appeal generally comes first, and the state hearing follows once that is exhausted.10

If a denial rests on a caseworker applying spend-down rules, say so in the appeal and point to the 1634 conversion.

Key phone numbers and contacts

Learn More

Find personalized help navigating Ohio Medicaid 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.