Ohio Medicaid Home Modifications as a Spend-Down Strategy

Two Ways Home Modifications Enter the Picture

Home modifications intersect with Ohio Medicaid in two distinct ways, and families often confuse them.

As a spend-down strategy before applying for Medicaid. While reducing countable assets to the $2,000 limit, families can pay for home improvements from the applicant's funds. Because the primary residence is an exempt asset (up to the $752,000 home equity interest limit), money spent on the home converts countable cash into exempt property value. The CDJFS does not treat home improvements as uncompensated transfers — they are fair-value expenditures on the applicant's own property.

As a covered service under Ohio's HCBS waiver programs. Once enrolled in the PASSPORT waiver or another home and community-based services program, Medicaid may fund accessibility modifications that allow the participant to remain safely at home. These are paid by the waiver program, not out of the participant's assets.

This post focuses on both — using modifications to spend down before application, and understanding what the waiver covers after enrollment.

Spend-Down Home Modifications

During the pre-application spend-down, the goal is to convert countable dollars into exempt home equity. The CDJFS accepts legitimate improvements that maintain or increase the value and livability of the primary residence. Qualifying improvements include:

• Accessibility modifications — wheelchair ramps, grab bars, walk-in showers, widened doorways, stair lifts, first-floor bathroom additions
• Major systems replacement — furnace, air conditioning, water heater, roof, electrical panel, plumbing
• Structural repairs — foundation work, window replacement, siding, gutters
• Safety upgrades — handrails, non-slip flooring, improved lighting, emergency response systems

The key requirement: the work must be performed on the applicant's primary residence, paid at fair market rates, and documented with invoices and receipts. The CDJFS caseworker will review home modification expenditures during the five-year financial audit — contractor invoices and canceled checks provide the paper trail.

Cosmetic upgrades (new countertops, landscaping, luxury bathroom remodels) may attract closer scrutiny, especially when a large project is completed days before a Medicaid application. Do not assume that every upgrade is a safe spend-down; document fair-market payment and have unusual projects reviewed.

What PASSPORT Covers After Enrollment

Ohio's PASSPORT waiver includes home modifications as a covered service for enrolled participants who meet the nursing facility level of care but choose to remain at home. The waiver covers modifications that are directly related to the participant's medical condition and necessary for safe home-based care.

PASSPORT-funded modifications typically include:

• Ramp installation and widened doorways for wheelchair access
• Bathroom modifications (roll-in showers, raised toilets, grab bars)
• Kitchen modifications for wheelchair-height access
• Emergency response system installation

The modifications must be recommended in the participant's person-centered services plan and approved by ODM, the Ohio Department of Aging, or their designee (often the local Area Agency on Aging). They cannot exceed $15,000 per individual in a calendar year, and the program approves the lowest-cost alternative that meets the assessed need.

Structural changes that primarily increase property value rather than address the participant's care needs (finishing a basement, adding a bedroom) are not covered under PASSPORT.

The Community Spouse's Home

For married couples, the primary residence is already an exempt asset as long as the community spouse continues to live there. Spending down by improving the community spouse's home is one of the most straightforward strategies available — it preserves assets in a form the community spouse uses daily, while reducing the countable balance the CDJFS evaluates.

This is especially useful when the couple's countable resources are modestly above the Community Spouse Resource Allowance maximum of $162,660. A $20,000 roof replacement or $15,000 accessibility modification can close the gap between the couple's current countable assets and the target spend-down amount without losing value to care costs.

Documenting the Modifications

For both the spend-down and waiver contexts, documentation is essential:

• Written contractor estimates before work begins (shows fair market value)
• Signed contracts specifying the scope of work
• Invoices and proof of payment (checks, not cash — the CDJFS needs a paper trail)
• Before and after photographs if the modifications are substantial
• For waiver-funded modifications: the care plan amendment approving the modification

The Ohio Medicaid Long-Term Care & Asset Protection Guide covers home modifications alongside the other spend-down strategies — prepaid funerals, debt repayment, vehicle purchase, and medical equipment — with the complete checklist for documenting each expenditure for the CDJFS review.

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