Ohio Pay-In Spend-Down (2026): ABD Eligibility, $994 Limit, and Three Options

If you are an Ohio resident who is over 65 or who meets the disability standard, your gross monthly income exceeds the ABD income limit (2026: $994 for a single applicant), and you need Medicaid for medical coverage but not for nursing facility care or HCBS waiver services, the Ohio ABD Spend-Down is the pathway that gets you in. Many people call it the "pay-in" because the most common option for satisfying the monthly spend-down is paying the excess income directly to the County Department of Job and Family Services as a premium-style payment. The ABD Spend-Down is not the same thing as a Miller Trust; the Miller Trust is for Long-Term Care Medicaid only and the ABD Spend-Down is for non-LTC categorical Medicaid only. The two pathways exist for different populations and different coverage needs. This guide walks through the federal and Ohio authority for the ABD Spend-Down, why Ohio is technically not a medically-needy state under federal law, the three monthly options (ongoing, delayed, and pay-in), the math for calculating the monthly spend-down amount, what services are covered when you qualify, what is not covered, how each county runs the pay-in process, common operational mistakes that cause spend-down enrollees to lose coverage, and how the ABD Spend-Down relates to other Ohio Medicaid pathways including LTC, Medicare Savings Programs, and dual-eligible MyCare enrollment.

By Brevy Care Team · Last verified May 11, 2026

The federal framework: medically-needy versus categorical Spend-Down

Federal Medicaid law gives states multiple options for handling adults who would qualify for categorical Medicaid (aged, blind, or disabled) except that their income or resources exceed the categorical limit. Two of these options are commonly confused, and Ohio's actual structure is sometimes mislabeled.

The medically-needy option at 42 USC 1396a(a)(10)(C) lets a state create a separate Medicaid eligibility group with its own state-set income standard called the Medically Needy Income Limit (MNIL). Applicants with income above the categorical limit but below the medically-needy state-set ceiling, or who can spend their excess income down on medical expenses to the MNIL, get medically-needy Medicaid. The medically-needy option requires CMS approval of a specific state plan amendment.

The categorical spend-down that Ohio uses operates under a different framework. It is not a separate medically-needy group; it is an enrollment mechanism that keeps people in the ABD categorical group when their countable income (after monthly spend-down) drops below the categorical limit. The authority comes from broader federal categorical Medicaid rules combined with state-specific implementation, and in Ohio it is operationalized at OAC 5160:1-3-04.1 and ORC 5163.31.

The differences matter in practice:

• Medically-needy states typically use longer accumulation periods (six months in New York, one month in some others) for satisfying the spend-down. Ohio uses a monthly determination, meaning each calendar month must independently satisfy the spend-down for coverage to apply in that month.
• Medically-needy states typically allow medically-needy Medicaid to cover institutional and HCBS waiver services. Ohio's ABD Spend-Down does not; LTC requires the Miller Trust pathway.
• Medically-needy states typically establish a separate income standard independent of the categorical ABD limit. Ohio's ABD Spend-Down uses the standard ABD limit (2026: $994 = SSI Federal Benefit Rate) as the post-spend-down target.

The practical effect is that many AI tools, consumer guides, and even some health-system patient navigators describe Ohio as a medically-needy state. They are wrong. When you read material that uses that term about Ohio Medicaid, treat it as a yellow flag and verify against OAC 5160:1-3-04.1.

Who qualifies for the ABD Spend-Down

The ABD Spend-Down is available to Ohio residents who satisfy all of the following:

1. Categorically aged, blind, or disabled. Aged means age 65 or older. Blind means meeting the SSA blindness standard. Disabled means meeting the SSA disability standard for working-age adults (substantial inability to engage in substantial gainful activity due to medically-determinable physical or mental impairments expected to last at least 12 months or result in death), or being a child under 18 with a qualifying disability.

2. Resource limit met. The 2026 ABD resource limit is $2,000 for a single applicant and $3,000 for a couple under OAC 5160:1-3-05. The same exempt-asset categories apply as for other ABD Medicaid: primary residence (with home equity rules), one vehicle, personal property and household effects, term life insurance, certain pre-paid funeral arrangements, and others.

3. Countable income above the standard ABD limit. The 2026 ABD income limit is $994 for a single applicant, $1,491 for a couple. Applicants below this limit get standard categorically-needy ABD Medicaid without spend-down. Applicants above this limit can use the ABD Spend-Down pathway.

4. NOT seeking institutional or HCBS waiver services. This is the critical constraint. ABD Spend-Down enrollees get categorical Medicaid for community-based medical coverage. If the applicant needs nursing facility care, PASSPORT, the Assisted Living Waiver, OHCW, MyCare LTSS, or any other LTC service, the ABD Spend-Down pathway does not work and the applicant must instead use the LTC pathway, which involves the 300 percent SIL ($2,982 in 2026) and potentially a Miller Trust.

5. Citizenship and residency. Ohio residency and U.S. citizenship or qualifying immigration status under standard Medicaid rules.

The most common ABD Spend-Down population in Ohio includes:

• Retirees with Social Security retirement benefits between roughly $1,000 and $2,000 per month who do not have employer retiree health coverage
• Adults receiving Social Security Disability Insurance (SSDI) above the SSI threshold but with no employer coverage and significant medical needs
• Older adults with modest pension income on top of Social Security
• Adults who lost SSI due to cost-of-living increases and do not qualify for one of the SSI continuation protections (Pickle Amendment, Disabled Adult Child, Disabled Widow(er), 1619(b))
• Adults newly disabled who are awaiting SSI or SSDI determination but who already meet the disability standard

Calculating the monthly spend-down

The spend-down calculation under OAC 5160:1-3-04.1 follows a consistent formula:

Step 1: Calculate gross monthly income. Include Social Security retirement and disability benefits (gross, before Medicare Part B premium deduction), pension payments, annuity income to the extent counted, IRA and 401(k) distributions, wages from any employment, rental income net of allowable expenses, and other countable income sources. Exclude income that federal law disregards from Medicaid (food stamps, certain Native American income, tax refunds, certain VA benefits per their specific rules).

Step 2: Apply the standard $20 disregard. Federal SSI methodology subtracts a standard $20 from countable income before testing against the eligibility limit. This applies to ABD income testing in Ohio.

Step 3: Subtract the 2026 ABD limit. Single applicants subtract $994. Couples subtract $1,491.

Step 4: The result is the monthly spend-down amount. Each month this amount must be satisfied through medical expenses or pay-in for Medicaid eligibility to apply that month.

Example 1: Retiree with Social Security only. Mrs. Andrews, age 73, has $1,800 per month in Social Security retirement benefits. No pension, no other income. Calculation:

• $1,800 (gross income) - $20 (disregard) - $994 (ABD limit) = $786 monthly spend-down

Example 2: SSDI recipient with modest pension. Mr. Brown, age 58, has SSDI of $1,500 per month plus a small pension of $400 per month. Total $1,900. Calculation:

• $1,900 - $20 - $994 = $886 monthly spend-down

Example 3: Couple with combined income. The Carters, both age 70, have combined income of $2,100 per month (her Social Security $1,200, his Social Security $900). They want spend-down for both. Calculation:

• $2,100 - $20 - $1,491 = $589 monthly spend-down for the couple

Example 4: Income changes mid-year. Mr. Davis has Social Security of $1,500 per month. His annual COLA raises it to $1,545 on January 1. The new monthly spend-down becomes $1,545 - $20 - $994 = $531, up from $486 before. Income changes are tracked monthly; CDJFS adjusts the spend-down amount as needed and the enrollee must satisfy the new amount each month.

Allowable income reductions and disregards. Beyond the standard $20, certain other deductions can reduce countable income depending on the applicant's situation: earned income disregards for adults still working, work-related expenses for adults with disabilities, certain support payments to dependents, and specific other items at OAC 5160:1-3. These details matter for individual cases and an elder-law attorney or benefits counselor can help identify applicable disregards.

The three monthly options: ongoing, delayed, and pay-in

Once the spend-down amount is calculated, the enrollee has three operational options for satisfying it each month. The choice depends on the applicant's medical-expense pattern and their cash flow preferences.

Option 1: Ongoing (recurring medical expenses meet spend-down)

How it works. The enrollee submits documentation of recurring monthly medical expenses that meet or exceed the spend-down amount. Common recurring expenses include the Medicare Part B premium (2026: $185.00 base, though changes by income), Medicare Part D premium (varies by plan, typically $30 to $80), Medicare Supplement (Medigap) premium (varies, typically $100 to $250), recurring prescription costs not covered or not fully covered by Part D, monthly deductibles for ongoing services, and other documented recurring medical costs.

Coverage timing. Full-month coverage from the first of the month, provided the recurring expenses meet the spend-down for that month. CDJFS verifies the recurring expenses periodically and confirms ongoing eligibility.

Best for. Enrollees with consistent monthly medical expenses, particularly those with Medicare premiums and supplemental insurance plus regular prescription costs. Highly stable enrollment.

Watch-out. If recurring expenses fall below the spend-down for any month (insurance plan change reduces premiums, prescriptions discontinue, supplemental coverage ends), the enrollee may need to switch to delayed or pay-in for that month to maintain coverage.

Option 2: Delayed (accumulated medical bills meet spend-down)

How it works. The enrollee accumulates paid or unpaid medical bills during the month. When the total reaches the spend-down threshold, Medicaid coverage activates from that date forward through the end of the month. Bills can include hospital bills, doctor visits, prescriptions, lab and imaging, durable medical equipment, mental health and substance use treatment, and other allowable medical costs.

Coverage timing. Partial-month coverage starting the day the spend-down is met. The first part of the month before the threshold is reached is NOT covered. Charges incurred before the spend-down is met must be paid out of pocket or count toward the spend-down itself.

Best for. Enrollees with infrequent but substantial medical expenses (one major event per month or every few months) who can accept partial-month coverage. Not ideal for those needing consistent month-long coverage.

Watch-out. Charges that count toward the spend-down are the enrollee's own out-of-pocket obligation, not Medicaid's. If the enrollee fails to actually pay (or be billed for) those expenses, they may not count. Documentation matters.

Option 3: Pay-In (pay the excess directly to CDJFS)

How it works. Each month the enrollee pays the spend-down amount directly to the County Department of Job and Family Services as a premium-style payment. Once paid, Medicaid coverage applies full-month from the first.

Coverage timing. Full-month coverage from the first of the month, provided the pay-in is received by CDJFS by the applicable monthly deadline.

Best for. Enrollees with predictable income but inconsistent medical expenses, those who want full-month coverage simplicity, and those who do not want to track and document medical bills monthly.

Operational facts:

• Pay-in is a separate monthly deposit. No annual or quarterly payment alternative exists.
• Pay-in is paid to the County DJFS, not to ODM directly. Each county manages its own pay-in process. Some counties accept ACH or electronic transfer; some only accept mail-in checks or money orders; some allow in-person payment at CDJFS offices.
• The monthly deadline varies by county; typical deadlines fall in the second or third week of the month for that month's coverage.
• The pay-in receipt is the proof of coverage; lose the receipt and you may have difficulty proving Medicaid eligibility for that month.
• If a pay-in payment is missed for one month, Medicaid for that month does not apply (with limited exceptions for reasonable cause). The enrollee may need to use delayed or ongoing for that month, or resume pay-in the following month.

Watch-out. Medicare Savings Program (MSP / MPAP) cost-sharing payments that Medicaid makes on behalf of dual-eligible Medicare beneficiaries CANNOT be applied toward the ABD Spend-Down. The two programs operate separately; MSP pays Medicare premiums, ABD Spend-Down enrolls the person in Medicaid. A dual-eligible person who is QMB or SLMB and also doing ABD Spend-Down has separate processes for each.

What ABD Spend-Down covers (and what it does not)

ABD Spend-Down enrollment provides full Ohio Medicaid categorical coverage for the months in which spend-down is satisfied. Covered services include:

Acute and primary care: physician visits, specialist consultations, outpatient procedures, urgent care, emergency department visits, hospital admissions, ambulatory surgery, lab work, diagnostic imaging.

Prescription medications under Ohio Medicaid pharmacy benefit. Dual-eligible enrollees have Medicare Part D as primary; Medicaid wraparound covers Part D-excluded medications.

Behavioral health: mental health outpatient and inpatient, substance use disorder treatment, community-based behavioral health services, crisis services.

Durable medical equipment within Medicaid coverage limits.

Home health services under Ohio Medicaid home health rules at OAC Chapter 5160-12 when ordered by a physician and meeting medical necessity criteria. Important: this is Medicaid home health (acute, skilled, episodic), not HCBS waiver home and community-based services. The two are different benefit categories.

Dental, vision, and hearing within Medicaid scope. Some services have specific coverage limits.

Transportation to medical appointments through the Non-Emergency Medical Transportation (NEMT) benefit.

Family planning services.

What ABD Spend-Down does NOT cover:

Nursing facility (long-stay institutional) Medicaid. The applicant must use the LTC pathway with the SIL/Miller Trust framework for institutional care.

HCBS waivers: PASSPORT, the Assisted Living Waiver, the Ohio Home Care Waiver, and any other §1915(c) waiver. These all require LTC pathway eligibility, which means meeting the 300 percent SIL or using a Miller Trust to drop countable income below the SIL.

MyCare Ohio Waiver LTSS portion. Same constraint applies; MyCare LTSS requires LTC pathway eligibility, not ABD Spend-Down.

Personal care services beyond Medicaid home health scope. ABD Spend-Down does not authorize long-term personal care attendants, homemaker services, adult day programs, or other community-based long-term care.

Room and board in any Medicaid-paid setting. ABD Spend-Down is for community-based medical coverage; it does not pay for residence.

Long-term skilled nursing or rehabilitation beyond Medicare-eligible recovery periods. Once Medicare benefits exhaust, an ABD Spend-Down enrollee in NF custodial care needs to transition to LTC Medicaid.

Comparison to Miller Trust pathway

The most common confusion is between the ABD Spend-Down and the Miller Trust. They are structurally different mechanisms for different populations and different services.

The critical decision point: if the applicant needs nursing facility care or HCBS waiver services, the ABD Spend-Down does not work and a Miller Trust may be required (if income exceeds the SIL). If the applicant needs community-based medical coverage only, the ABD Spend-Down is the correct pathway and a Miller Trust is not appropriate.

Important asset-side note: the ABD Spend-Down still requires meeting the $2,000 resource limit. Asset spend-down is a separate process from income spend-down. The 60-month transfer lookback for LTC does not apply to the ABD Spend-Down (the lookback is specifically for institutional and HCBS waiver applications), but the standard transfer-of-assets and resource-limit rules still apply in modified form.

Coordination with Medicare and Medicare Savings Programs

Many ABD Spend-Down enrollees are dual-eligible (Medicare + Medicaid). The coordination matters:

Medicare as primary payer. When dual-eligible, Medicare is the primary payer for most acute and ambulatory services. Medicaid is secondary and covers the cost-sharing (Medicare premiums via MSP, copays, coinsurance, and Part D wraparound).

MSP / QMB / SLMB / QI-1. These are Medicare Savings Programs operating separately from ABD Spend-Down. The 2026 thresholds:

• QMB (Qualified Medicare Beneficiary): income up to 100 percent of FPL, $1,330 per month single. Medicaid pays Medicare Part A and Part B premiums, deductibles, copays, and coinsurance.
• SLMB (Specified Low-Income Medicare Beneficiary): income up to 120 percent of FPL, $1,596 per month single. Medicaid pays Medicare Part B premium only.
• QI-1 (Qualifying Individual): income up to 135 percent of FPL, $1,796 per month single. Medicaid pays Medicare Part B premium only. QI-1 enrollment is limited annually and operates on a first-come basis.

An ABD Spend-Down enrollee whose income is below the MSP thresholds can be enrolled in both programs simultaneously. The MSP and ABD Spend-Down enrollments are processed separately but coordinated.

Important: MSP cost-sharing payments do NOT count toward the ABD Spend-Down. Even though Medicaid is paying Medicare premiums for QMB enrollees, those payments do not reduce the spend-down obligation. The enrollee must still satisfy the full monthly spend-down through allowable medical expenses or the pay-in.

MyCare Ohio Waiver consideration. Dual-eligible ABD Spend-Down enrollees in MyCare counties may also be enrolled in MyCare for their Medicare and Medicaid wraparound coverage. The MyCare carrier handles the integrated benefit, but the ABD Spend-Down satisfaction (whether ongoing, delayed, or pay-in) operates separately from MyCare enrollment. See /medicaid/ohio/mycare-ohio-waiver.

Special protections: Pickle, DAC, DW, 1619(b)

Several federal protections preserve Medicaid eligibility for specific populations who would otherwise lose it. ABD Spend-Down applicants should always check these first because they may eliminate the need for spend-down entirely.

Pickle Amendment (P.L. 94-566 § 503). Individuals who lost SSI after April 1, 1977 due to Social Security cost-of-living adjustments, 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 Federal Benefit Rate retain Medicaid under Pickle without needing spend-down.

Disabled Adult Child (DAC) protections under 42 USC 1383c(c). Adult children disabled before age 22 who lose SSI when they begin receiving Social Security based on a parent's work record retain Medicaid.

Disabled Widow(er) (DW) protections under 42 USC 1383c(d). Disabled widows and widowers who lose SSI when receiving Social Security widow benefits retain Medicaid.

1619(b) work continuation under 42 USC 1382h(b). Working SSI recipients whose earnings push them above the SSI cash benefit threshold but who continue to need Medicaid for work-related disability support retain Medicaid eligibility.

Medicaid Buy-In for Workers with Disabilities (MBIWD) under ORC 5163.094. Working adults with disabilities can maintain Medicaid eligibility at higher income levels by paying a sliding-scale premium. For many disabled adults who are working, MBIWD is a better option than ABD Spend-Down because it allows higher income retention.

Check these protections before defaulting to ABD Spend-Down. The protections cost less, have simpler ongoing requirements, and may be operationally easier to maintain.

Worked example: full annual cycle of ABD Spend-Down

To make the operational rhythm concrete, here is Mrs. Edwards's full year on ABD Spend-Down.

Mrs. Edwards, age 71, has Social Security retirement of $1,800 per month and no other income. Her resources are $1,800 in checking (below the $2,000 limit). She has Medicare Part A and Part B, a Part D plan with a $40 monthly premium, and a Medigap Plan G policy with a $180 monthly premium.

Spend-down calculation: $1,800 - $20 - $994 = $786 per month

Choosing the option. Mrs. Edwards's recurring monthly medical expenses include:

• Medicare Part B premium: $185.00 (paid via SSA deduction; counts toward spend-down)
• Part D plan premium: $40
• Medigap Plan G premium: $180
• Regular prescriptions Part D doesn't fully cover: ~$30
• Total recurring: $435/month

This recurring amount ($435) is below her spend-down ($786) by $351. She has three choices:

• Ongoing: Submit her $435 in recurring expenses plus accumulate additional medical bills each month to reach $786. Risky if some months have no extra bills.
• Delayed: Accumulate all $786 each month before getting coverage. Likely results in partial-month coverage starting mid-month each month.
• Pay-in $786 to CDJFS each month. Full-month coverage. Simplest. She chooses this.

The annual cycle.

• January through December: She mails a check for $786 to her county CDJFS by the 15th of each month. CDJFS confirms receipt and her Medicaid card is active for that month. Her recurring medical expenses (Medicare premiums, Medigap, prescriptions) are paid by Medicaid as secondary payer where applicable; some get reimbursed; some flow through her Medicare/Medigap normally. She has full Medicaid coverage for any additional medical needs that arise (specialist visits, lab work, hospital outpatient, urgent care).
• COLA adjustment in January raises her SS to $1,850. New spend-down: $1,850 - $20 - $994 = $836 per month. CDJFS updates her file; she pays the new amount starting January.
• One month she has a heart catheterization and other Medicare-covered procedures with significant out-of-pocket cost. The Medicare and Medigap pay most; Medicaid as secondary covers her remaining liability. The pay-in continues normally.
• Annual redetermination: CDJFS reviews her income, resources, and eligibility once per year. Mrs. Edwards submits the redetermination paperwork, confirms her income is unchanged, confirms her resources are still below $2,000, and continues.

Mrs. Edwards's total annual out-of-pocket for Medicaid coverage: $786 × 12 = $9,432 (or the updated COLA-adjusted amount). In exchange, she has full Medicaid as secondary payer to her Medicare and Medigap, picking up anything they do not cover.

Common operational mistakes

CDJFS records show recurring categories of mistakes that cause ABD Spend-Down enrollees to lose coverage or fail to qualify in the first place.

Trying to use ABD Spend-Down for nursing facility or HCBS waiver services. This is the single most common mistake. The pathway does not work for LTC. Families applying for PASSPORT or NF Medicaid and discovering income above the SIL sometimes default to "let's just do spend-down" and find that the CDJFS application is denied because LTC requires a different track entirely. The correct response is to engage an elder-law attorney about Miller Trust.

Missing the pay-in deadline. Each county has its own monthly deadline. Late pay-ins result in no coverage for that month and may need to be replaced with a delayed option using accumulated bills, which provides partial coverage only.

Counting MSP-paid premiums toward spend-down. Medicare premiums paid by Medicaid via MSP are not allowable spend-down deductions. The enrollee must satisfy the spend-down with other allowable expenses or the pay-in.

Failing to track recurring expense changes. When a Medicare Part D plan changes, when a Medigap policy ends, or when prescription costs decrease, the ongoing option may no longer satisfy the spend-down. Switching to delayed or pay-in mid-year is allowed but requires CDJFS coordination.

Failure to report income changes. Annual COLA, pension changes, IRA distribution changes, and any income event can change the spend-down amount. Failure to report can result in retroactive recalculation, owed pay-ins, or even fraud allegations.

Accumulating assets above the $2,000 limit. ABD Spend-Down requires ongoing compliance with the $2,000 resource limit. Inheritance, gifts, accumulated savings, or other resource increases can disqualify the enrollee until resources drop back below the limit.

Confusing ABD Spend-Down with the LTC Miller Trust. Some applicants believe they can use a Miller Trust to qualify for community-only Medicaid; they cannot. The Miller Trust is LTC-pathway only. ABD Spend-Down is the right tool for community-only Medicaid with income above the ABD limit.

Not exploring Pickle, DAC, DW, 1619(b), or MBIWD first. These protections may eliminate the need for spend-down entirely. Default to spend-down without checking is a missed opportunity.

Missing the federal-state distinction. Treating Ohio as a medically-needy state and assuming six-month accumulation periods or other features that apply in other states. Ohio's monthly determination rule is strict.

Appeals when CDJFS denies or terminates spend-down

When CDJFS issues an adverse decision on ABD Spend-Down eligibility, the spend-down calculation, the allowable deductions, or the pay-in process, the applicant has appeal rights under OAC 5101:6-7-01.

Common rejection reasons:

• Resource limit exceeded ($2,000 single, $3,000 couple)
• Income calculation disputes (what counts as countable income)
• Allowable deduction disputes (which medical expenses qualify for spend-down)
• Pay-in payment timing disputes
• Resource transfer issues that affect categorical eligibility

Process:

• Filing deadline: 90 days from the adverse notice
• File by phone at 1-866-635-3748, by mail, through the JFS portal, or in person at CDJFS
• Aid pending hearing: available if filed within 15 days of an adverse notice for terminations or reductions
• The State Hearing is conducted by an ODJFS hearing officer not employed by the county
• Decision issued in writing; enrollee can pursue further appeal through court if denied

Free legal help: Pro Seniors Cincinnati at 1-800-488-6070, Ohio Legal Aid, Disability Rights Ohio at 1-800-282-9181 (for disability-related ABD Spend-Down appeals), county legal aid offices.

Practical guidance for ABD Spend-Down applicants

The single most important piece of guidance for Ohio adults considering the ABD Spend-Down is: check whether you qualify for a categorical Medicaid pathway first, particularly Pickle, DAC, DW, 1619(b), or MBIWD. If you qualify under one of these protections, you may not need spend-down at all and you can avoid the monthly tracking burden.

Other practical guidance:

Engage a benefits counselor or elder-law attorney early. The 30-minute consultation with someone who knows Ohio Medicaid rules can save significant frustration. Pro Seniors at 1-800-488-6070 offers free counseling for older adults.

Understand the community-only constraint. If your care needs may require nursing facility, PASSPORT, or other HCBS waiver services in the next year or two, plan ahead for the Miller Trust pathway rather than relying on ABD Spend-Down for short-term coverage.

Choose the pay-in option for stability if you can afford it. Pay-in gives full-month coverage and avoids the bookkeeping complexity of ongoing or delayed. The monthly out-of-pocket is predictable.

Coordinate with Medicare and supplemental insurance. Most ABD Spend-Down enrollees are dual-eligible. The interaction between Medicare, Medigap, Part D, and Medicaid as secondary payer needs to be set up correctly to avoid claims denials and unexpected bills.

Track resources carefully. The $2,000 resource limit applies continuously. Inheritance, settlements, accumulated savings, and other resource changes can disqualify you. Consult an elder-law attorney before accepting any windfall.

Track income changes. Annual COLA changes the spend-down amount. Report income changes promptly so CDJFS can adjust the calculation.

Key statutes, rules, and authorities

• 42 USC 1396a(a)(10)(C) (federal medically-needy option, which Ohio did NOT elect)
• 42 USC 1396p(c)(1) (60-month lookback, which does NOT apply to ABD Spend-Down)
• 42 USC 1382h(b) (1619(b) work continuation for SSI)
• 42 USC 1383c(c) (Disabled Adult Child protections)
• 42 USC 1383c(d) (Disabled Widow(er) protections)
• P.L. 94-566 § 503 (Pickle Amendment)
• OAC 5160:1-3-04.1 (Ohio ABD Spend-Down rule)
• OAC 5160:1-3-02.6 (deemed eligibility, including Pickle)
• OAC 5160:1-3-05 (ABD resources)
• OAC Chapter 5160-12 (Medicaid home health, distinct from HCBS waivers)
• OAC 5101:6-7-01 (State Hearings)
• Ohio Revised Code 5163.31 (spend-down and pay-in)
• Ohio Revised Code 5163.094 (Medicaid Buy-In for Workers with Disabilities)
• ODM MEPL 194 (2026 FPL Income Guidelines)
• ODM MEPL 191 (2026 COLA / resource limits)
• ODM 2026 Standards Help Sheet

This guide reflects Ohio Medicaid policy and federal categorical Medicaid framework in effect as of May 2026. Income limits, resource limits, and rule citations may change with annual SSI COLA adjustments and ODM rule revisions. Verify current figures with the Ohio Department of Medicaid and engage a qualified Ohio benefits counselor or elder-law attorney before structuring your spend-down approach or making decisions that depend on this information.

Find personalized help navigating Ohio's ABD Spend-Down at brevy.com.