Ohio Long-Term Care Medicaid Eligibility Requirements (2026)

Ohio's long-term care Medicaid program — covering both nursing facility care and the PASSPORT home-care waiver — has strict financial and clinical eligibility requirements. For 2026, the numbers have shifted from last year, and understanding the exact thresholds determines whether your parent qualifies or faces months of private-pay costs while spending down.

Clinical Eligibility: Nursing Facility Level of Care

Before financial eligibility matters, your parent must demonstrate clinical need. They must require a Nursing Facility Level of Care (NFLOC), meaning they need hands-on assistance with multiple Activities of Daily Living (ADLs): bathing, dressing, transferring, toileting, eating, or continence.

The clinical assessment is conducted in the home by a registered nurse or licensed social worker from the local Area Agency on Aging using the Adult Comprehensive Assessment Tool (ACAT). The evaluation also considers cognitive impairments and the availability of informal family support.

For the PASSPORT waiver specifically, applicants must also be age 60 or older.

2026 Financial Eligibility Thresholds

The Income Test and Miller Trust Requirement

Your parent's gross monthly income from all sources — Social Security, pensions, annuities, interest, rental income — must not exceed $2,982 (the 2026 Special Income Limit, set at 300% of the Federal Benefit Rate).

If income exceeds $2,982, your parent is categorically ineligible unless they establish a Qualifying Income Trust (QIT), commonly called a Miller Trust. This irrevocable trust receives the excess income each month, with the trust paying down to the Medicaid limit. The trust terminates upon your parent's death, with remaining funds reimbursing the state for Medicaid expenses.

Establishing a QIT requires a valid power of attorney with explicit trust-creation authority under R.C. 1337.42. Without it, you need a court-ordered guardianship and Form 75.0 approval — adding weeks of delay.

The Asset Test

Countable resources must be at or below $2,000 for an individual applicant. Countable assets include:

• Bank accounts (checking, savings, CDs)
• Investment portfolios (stocks, bonds, mutual funds)
• Second vehicles
• Cash-value life insurance (face value above $1,500)
• Real estate other than the primary home

Exempt (non-countable) assets:

• Primary residence (if equity is under $752,000, or if a spouse/minor/disabled child resides there)
• One vehicle
• Household goods and personal effects
• Irrevocable pre-need funeral contracts
• Term life insurance (no cash value)

Spousal Impoverishment Protections

When only one spouse applies for Medicaid, the community spouse (the one staying home) receives protections against financial devastation:

Community Spouse Resource Allowance (CSRA):

• Minimum: $32,532
• Maximum: $162,660
• Calculated as the greater of $32,532 or half the couple's total countable assets on the "snapshot date" (first day of continuous institutionalization), capped at $162,660

Minimum Monthly Maintenance Needs Allowance (MMMNA):

• Base amount: $2,643.75/month
• Maximum (with excess shelter adjustment): $4,066.50/month
• The shelter threshold is $793.13 (30% of base MMMNA)
• Standard Utility Allowance: $593/month

If the community spouse's personal income is below their adjusted MMMNA, the shortfall is diverted from the institutionalized spouse's income — reducing their "patient liability" (the amount they pay toward care costs).

The 60-Month Lookback

Ohio enforces a strict 60-month lookback period. Any asset transferred for less than fair market value during the 60 months before the Medicaid application triggers a penalty period of ineligibility.

Penalty calculation: Total value of uncompensated transfers divided by $7,734 (the 2026 monthly penalty divisor) = months of ineligibility.

Example: Your parent gifted $46,404 to grandchildren over the past five years. Penalty: $46,404 ÷ $7,734 = 6 months of Medicaid ineligibility. During those six months, the nursing facility or care costs must be paid privately.

Estate Recovery

After your parent's death, Ohio's Medicaid Estate Recovery program will seek reimbursement from the probate estate for all long-term care services paid. Recovery is deferred while a surviving spouse, child under 21, or blind/disabled child of any age survives.

Next Steps

If your parent appears to meet both clinical and financial eligibility:

1. Contact your local Area Agency on Aging to request a PASSPORT/ACAT assessment
2. Gather 60 months of complete financial records
3. Calculate income against the $2,982 SIL — if over, you will need a Miller Trust
4. Confirm you have a valid power of attorney with trust-creation and government benefits authority
5. Determine whether your county has transitioned to Next Generation MyCare Ohio (changes the enrollment process)

The Ohio Power of Attorney & Guardianship Kit includes the Medicaid eligibility worksheet, PASSPORT authority navigation map, and the properly formatted POA with trust-creation authority — the critical documents for initiating a successful Medicaid application.

See more Ohio guides →