Your mom fell at home in Dayton, went to rehab, and now the team says she needs a nursing home for good. The social worker says to apply for Medicaid at the county JFS office and mentions patient liability and maybe a Miller trust. You want to understand what that means before you sign anything.
This guide uses Ohio Department of Medicaid (ODM) rules in Ohio Administrative Code Chapters 5160:1-3 and 5160:1-6, plus a county JFS page on applying. We don't list dollar figures, because many change each year. We explain how each rule works and point to the official rules. For decisions about trusts, property or gifts, talk with your county JFS office or an Ohio elder law attorney.
First, the level-of-care test
To get Medicaid payment for long-term care, your parent must be an Ohio resident, have or get a Social Security number, meet citizenship rules and need an institutional level of care, meaning care in a nursing home or similar setting for at least 30 days6. They must also meet financial and transfer-of-resource rules6.
If your parent is coming from a hospital, Medicare may cover a short rehab stay first after a qualifying hospital stay7. That is often the best time to start the Medicaid paperwork, while there is still time to gather records. See when Medicare stops paying for a nursing home.
The resource limit
Ohio sets the resource limit in rule. For one person, it's the standard SSI-level amount, and for a married couple living together it's a slightly higher amount1. Countable resources are what remain after all exclusions, measured at equity value, meaning fair market value minus any debts against the property1. Bank accounts, investments and property other than the home generally count.
Because the limit is low, many families spend savings on care first. Paying for your parent's own care, debts, and excluded items is generally fine, but keep receipts. See Medicaid spend-down.
Income: the special income level and Miller trusts
If your parent doesn't qualify under the basic categories because of income, Ohio checks income against the special income level, which is 300 percent of the current SSI benefit rate for one person8. Only someone in a continuous period of institutionalization can be evaluated this way, and they must also meet the resource rules8.
If countable income is above the special income level, your parent can set up a qualified income trust, also called a Miller trust, to become income eligible29. Income placed in the trust isn't counted for eligibility, but the trust must follow strict rules in the Administrative Code9. An elder law attorney usually drafts it. Ask the county caseworker what they need to see.
Patient liability: what your parent pays each month
Approval doesn't mean your parent keeps their income. Ohio calculates patient liability, also called share of cost, and reduces its payment to the nursing home by that amount. Your parent must pay patient liability to the facility3. The calculation starts with income, then subtracts a small personal needs allowance set in rule, a monthly income allowance for a spouse at home if there is one, and certain other allowed deductions such as health insurance premiums3.
Patient liability must be recalculated when circumstances change3. If a pension rises or an insurance premium ends, tell the county so the amount stays correct.
The home
The home your parent owns and lives in as their principal residence is excluded regardless of value4. A temporary absence, like a nursing home stay, doesn't end the exclusion as long as your parent provides a signed statement of intent to return and hasn't established a permanent residence elsewhere4. If your parent leaves with no intent to return, the home can stay excluded while a spouse or dependent relative continues to live there4. Otherwise, it becomes a countable resource4.
Federal law also sets a home equity limit for long-term care payment, with exceptions when a spouse or certain children live there10. Ask the county for the current figure. See can a nursing home take your house and Medicaid estate recovery.
When one spouse stays at home
When one spouse needs nursing home care and the other stays at home, the spouse at home keeps a community spouse resource allowance (CSRA). It's based on everything the couple owned on a snapshot date, usually the first day of the month of a continuous stay11. The CSRA is generally half of the couple's combined countable resources, but no less than a yearly minimum and no more than a yearly maximum1112. The nursing home spouse can then keep only the standard resource limit11.
While the nursing home spouse is eligible, none of the at-home spouse's income counts toward them11. The at-home spouse may also receive a monthly income allowance from the nursing home spouse's income, figured partly from housing costs3.
The 60-month look-back
Ohio looks back 60 months, or five years, from your parent's baseline date. Any transfer for less than fair market value during that time is presumed improper5. The result is a restricted Medicaid coverage period, during which Medicaid won't pay for long-term care. It's figured by dividing the value transferred by the state's average private pay rate for nursing facility care13.
Annuities get special attention. Your parent and spouse must disclose any annuity, and buying one is treated as an improper transfer unless it meets specific conditions14. Federal law allows some exempt transfers, such as to a spouse10. See the Medicaid look-back period and caregiver agreements with family.
How to apply in Ohio
- Apply online, by phone or at the county. Use benefits.ohio.gov, call the Medicaid Consumer Hotline, or submit an application to your county JFS office156.
- Name an authorized representative if needed. Anyone 18 or older, including a family member, can be one6.
- Submit even if incomplete. An application with a name, contact information, date and signature is accepted, and the county will ask for the rest6.
- Expect a caseworker call. The county may contact you within days to ask about resources6.
- Ask about prior months. Eligibility can be explored for three months before the application date6.
- Read the approval notice. It shows patient liability.
Columbiana County says the process is usually complete within 30 to 45 days6. For general steps, see how to apply for Medicaid for an elderly parent.
Documents to collect
- Identity, age and residence. Proof of age if 65 or older, and citizenship or immigration documents if requested6.
- Income records. Social Security and pension letters.
- Five years of financial statements. Bank, investment and retirement accounts for the full look-back5.
- Property records. Deeds, mortgage statements and vehicle titles.
- Insurance information. Medicare cards, supplemental policies and life insurance6.
- Annuity and trust papers. Any annuity must be disclosed14.
An example of how it fits together
Frank, 88, a retired machinist in Toledo, enters a nursing home permanently. His pension and Social Security together are above the special income level, so his daughter works with an elder law attorney to set up a Miller trust9. He signs a statement that he intends to return home, so his house remains excluded4. After spending savings on care down to the resource limit1, he applies.
The county approves him and sets his patient liability: his income minus the personal needs allowance and his supplemental insurance premium3. He pays that amount to the nursing home each month, and Medicaid pays the rest. This is an illustration, not advice.
When both spouses need care
Sometimes both parents need long-term care. Ohio has a separate rule for this. If both are expected to need care for less than 30 consecutive days, the regular aged, blind and disabled rules apply instead of the long-term care chapter16. If both are likely to need care for more than 30 days and no longer live together, for example one in a nursing home and the other on a home care waiver, each spouse's eligibility is generally determined separately16. Tell the county early if both parents need help, because the order of applications and the snapshot date can matter.
Planning carefully, not quickly
Families often hear about trusts, annuities or deeding the house to a child. Federal law allows a few of these steps in narrow situations, such as transfers to a spouse10. Many others create a restricted coverage period5. Ohio also treats most annuity purchases as improper unless they meet specific conditions14, so be wary of anyone selling a product as a way to qualify.
Before moving money or property, ask your county JFS office or an Ohio elder law attorney how the step would be treated. If your parent pays a relative for care, put it in a written agreement first at a fair rate and keep records of the hours. Keep receipts for every large purchase made during the five years before applying.
Common mistakes Ohio families make
- Assuming high income rules your parent out. A Miller trust may solve it2.
- Gifting money to family. Transfers within 60 months create a restricted coverage period5.
- Buying an annuity on a salesperson's advice. Many annuities count as improper transfers14.
- Skipping the intent-to-return statement. It keeps the home excluded4.
- Not reporting changes. Patient liability must be updated3.
If the county denies coverage or sets an amount you think is wrong, the notice explains how to request a state hearing.
Getting help
Your county JFS office and the nursing home's business office can help with forms. The long-term care ombudsman can help if a facility pressures your parent to leave while an application is pending. See nursing home eviction. For costs in the state, see how to pay for assisted living in Ohio. For other large states, see Illinois, Pennsylvania, New York, California, Florida and Texas.
