Ohio Medicaid Long Term Care Eligibility
Ohio Long Term Care
1. Residency and Citizenship – the applicant must be an Ohio resident and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
3. Income Limitations – If single and living alone, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $2,349 to get full coverage paid by Medicaid. If married, the income limit is raised. Income that is not considered countable includes a personal needs allowance ($50.00/month per individual). For coverage under Ohio’s assisted living waiver program, the applicant’s maximum countable income is $733 per month.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away.
Exempt Assets for an applicant in Ohio include:
i. $2,000 or less in cash/non-exempt assets if single. If married and both spouses require care, the asset limit is $3,000. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
ii. One home is exempt (equity limit $595,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum. The home may also be transferred to a sibling who has lived in the home during the preceding year or who holds equity interest in the home; or to a child who has provided care giving services and lived in the home for at least two years, thus preventing the applicant from entering a nursing home environment.
iii. One car, no equity amount specified.
iv. An irrevocable funeral trust with a value of $1,500 or less. Revocable burial contracts are considered countable assets, but if the applicant does not have an existing irrevocable burial contract he/she may put up to $1,500 towards one.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $128,640. If the community spouse’s assets do not equal the minimum of $25,728, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $2,113.75 per month. The maximum amount of income that can be retained is $3,216.00. Depending on their income, dependents other than a spouse may be eligible to keep a portion of the institutionalized person’s income to retain an allowance of $656/month.
Ohio long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
Ohio Department of Aging, Long Term Care: https://aging.ohio.gov/services/ombudsman/
Ohio guide to long term care services: http://dsas.cuyahogacounty.us/pdf_dsas/en-US/MedicaidBenefitsBookle.pdf
Medicaid fact sheet for older people and people with disabilities (2010): https://www.co.lucas.oh.us/DocumentCenter/View/44484
Ohio Waivers service comparison: http://medicaid.ohio.gov/Portals/0/For%20Ohioans/Programs/Waivers/crosswalk-final-2015-01.pdf
Ohio long term care insurance guide: http://www.insurance.ohio.gov/Consumer/OCS/CompleteGuides/Complete_Guide_LTCare.pdf