Ohio Medicaid Spousal Protections for Nursing Home Care

James Schroeder
Jun 6
5 min read

It's never too late to make smart decisions about money. I wish I had started saving in my teen years but unfortunately it was years later before I started. In order to protect as much of your hard earned assets it would have been better if you had made a plan five or more years ago. Still there are steps you can take to protect a good portion of your assets even if one spouse has or is about to enter a nursing home.

When one spouse enters a nursing home and applies for Ohio Medicaid to cover long-term care costs, federal Spousal Impoverishment Protections (established in 1988 and expanded by the Affordable Care Act in 2014) ensure the non-institutionalized spouse, or community spouse, maintains financial stability. These rules apply to Medicaid-funded nursing home care and, in Ohio, certain Home and Community-Based Services (HCBS) Waivers. Below is an overview of these protections specific to Ohio as of 2025, based on federal guidelines and Ohio Department of Medicaid (ODM) rules.

1. Income Protections: Minimum Monthly Maintenance Needs Allowance (MMMNA)

Purpose: Ensures the community spouse has sufficient income to live independently.
How It Works:
- The community spouse retains all their own income (e.g., Social Security, pensions) without it affecting the institutionalized spouse’s Medicaid eligibility.
- If the community spouse’s income is below the MMMNA, they may receive a portion of the institutionalized spouse’s income to meet the allowance.
- 2025 Ohio MMMNA Limits:
  - Minimum: $2,465/month (aligned with federal standards for 48 states).
  - Maximum: $3,715.50/month, adjustable for high living expenses (e.g., housing costs, subject to a fair hearing).
- If the community spouse’s income exceeds the MMMNA, the institutionalized spouse’s income typically goes toward nursing home costs, minus a personal needs allowance ($50/month in Ohio for 2025).
Example: If the community spouse earns $2,000/month, they can receive $465/month from the institutionalized spouse to reach the $2,465 MMMNA. If they earn $2,800, no transfer is needed, and their excess income doesn’t impact eligibility.

2. Asset Protections: Community Spouse Resource Allowance (CSRA)

Purpose: Allows the community spouse to retain a portion of the couple’s assets without affecting Medicaid eligibility.
How It Works:
- Ohio conducts a resource assessment when the institutionalized spouse begins a continuous 30-day nursing home stay, tallying joint, non-exempt assets (e.g., savings, investments, but not the home, one car, or personal belongings).
- The community spouse keeps the CSRA, calculated as:
  - Up to half of the couple’s countable assets, within federal minimum and maximum limits.
  - 2025 Ohio CSRA Limits:
    - Minimum: $31,584.
    - Maximum: $157,920 (Ohio uses the federal maximum).
  - The institutionalized spouse must reduce their assets to $2,000 to qualify for Ohio Medicaid.
- Example: If a couple has $200,000 in countable assets, the community spouse keeps $100,000 (half). If assets total $400,000, the CSRA is capped at $157,920. If assets are $45,000, the community spouse keeps $31,584.
Exempt Assets:
- The primary home (up to $742,000 equity in Ohio for 2025, if the community spouse or dependent lives there).
- One vehicle, household goods, personal effects, prepaid funeral plans, and life insurance (up to $1,500 face value).

3. Home Protection

General Rule: The primary home is exempt from Ohio Medicaid asset calculations if the community spouse (or a dependent relative) resides in it, regardless of value (up to the $742,000 equity limit).
Post-Death Risks:
- After the institutionalized spouse’s death, Ohio’s Medicaid Estate Recovery Program may seek to recoup costs, potentially placing a lien on the home. Recovery is prohibited while the community spouse lives in the home.
- Protection Strategies:
  - Transfer ownership to the community spouse or an irrevocable trust before or during the Medicaid application.
  - Use tenants by the entirety ownership (recognized in Ohio) to potentially shield the home from recovery after the institutionalized spouse’s death.
  - Transfer the home to a child who lived there for 2+ years and provided care that delayed nursing home placement.
Caveat: If the community spouse sells the home during the institutionalized spouse’s lifetime, the proceeds become a countable asset, potentially disqualifying the institutionalized spouse from Medicaid.

4. Additional Strategies

Spousal Refusal: Ohio does not formally recognize spousal refusal (unlike New York), so the community spouse’s resources are typically considered in eligibility calculations. Consult an attorney for alternative strategies.
Medicaid-Compliant Annuities: Excess assets can be converted into an income stream via a Medicaid-compliant annuity for the community spouse, which doesn’t count as an asset. Ohio requires these to be actuarially sound and name the state as a remainder beneficiary.
Spend-Down Strategies: Spend excess assets on exempt items (e.g., home repairs, prepaid funeral expenses, medical equipment) to meet the $2,000 asset limit.
Irrevocable Trusts: Transferring assets (e.g., the home) to an irrevocable trust 5+ years before applying avoids Ohio’s 60-month look-back period, which penalizes recent transfers.
Long-Term Care Insurance: Ohio’s Long-Term Care Partnership Program allows policyholders to protect additional assets from Medicaid spend-down, based on the insurance payout.

5. Ohio-Specific Rules and Planning

Look-Back Period: Ohio enforces a 60-month look-back period for asset transfers. Gifts or transfers within 5 years may delay eligibility, with penalties based on the transferred amount divided by the average daily nursing home cost ($269/day in Ohio for 2025).
Application Process: Ohio requires a resource assessment through the local County Department of Job and Family Services (CDJFS). Retroactive coverage may apply up to 3 months before the application if eligible.
Home Equity Limit: Ohio’s $742,000 home equity cap (2025) may affect eligibility if the community spouse lives in a high-value home. Exceptions apply for undue hardship.
HCBS Waivers: Ohio’s PASSPORT and Assisted Living Waivers extend spousal protections to home-based care, with similar income and asset rules.

Key Considerations

Timing: Protections apply after a 30-day nursing home stay and Medicaid application. Request a resource assessment early to plan the CSRA.
Appeals: If the CSRA or MMMNA is insufficient (e.g., high housing costs), request a fair hearing through ODM to increase allowances.
Emotional Impact: The community spouse may face loneliness or stress. Ohio’s Area Agencies on Aging offer support programs.

Action Steps

Contact Ohio Medicaid: Reach out to your local CDJFS or call the Ohio Medicaid Consumer Hotline (1-800-324-8680) for a resource assessment.
Consult an Elder Law Attorney.
Review Finances: Gather asset and income documentation for the resource assessment.
Plan Early: Implement trusts or insurance 5+ years before nursing home care to avoid look-back penalties.

For more information, visit Ohio Medicaid or contact a local elder law attorney.