Ohio Medicaid Patient Liability: How Your Parent's Monthly Payment Is Calculated
Medicaid Does Not Make Nursing Home Free
A common misconception: once a parent qualifies for Ohio Medicaid long-term care, the state pays for everything. It does not. Medicaid covers the difference between the nursing facility's Medicaid rate and the patient's monthly contribution — called the patient liability.
The patient liability is the portion of your parent's gross monthly income that goes directly to the nursing home each month. Medicaid pays the rest. Understanding exactly how this number is calculated prevents surprises on the first bill and ensures the community spouse keeps what they are entitled to.
The Basic Formula
Ohio calculates patient liability by subtracting allowed deductions from the parent's total gross monthly income:
Gross Monthly Income – Allowed Deductions = Patient Liability
Gross monthly income includes all sources before any deductions: Social Security benefits, pension payments, Required Minimum Distributions from retirement accounts, rental income, and any other recurring income. If the parent has a Qualified Income Trust (Miller Trust), the income flows through the QIT and is distributed according to the statutory priority order.
What Gets Deducted
The deductions reduce the patient liability — they represent income the parent keeps or diverts to other purposes before paying the facility.
Personal Needs Allowance (PNA): $75.00 per month for nursing facility residents, or $50.00 per month for Assisted Living Waiver participants. This small amount is the parent's discretionary spending money for personal items — toiletries, clothing, subscriptions, phone charges.
Health insurance premiums: Medicare Part B premiums, Medicare Supplement (Medigap) premiums, and any other health insurance premiums the parent pays are deducted from income before calculating patient liability. If your parent pays the 2026 standard Medicare Part B premium of $202.90 per month, that amount comes off the top.
Community Spouse Monthly Income Allowance (CSMIA): If the parent is married and the community spouse's own income falls below the Minimum Monthly Maintenance Needs Allowance (MMMNA), a portion of the parent's income is diverted to bring the spouse's total up to the MMMNA floor. For the period July 1, 2026 through June 30, 2027, the standard MMMNA floor is $2,705.00 per month.
The spousal income allowance is one of the most significant deductions. If the community spouse has $1,500 per month in personal income (their own Social Security, for example), and the MMMNA is $2,705, the parent can divert $1,205 per month to the spouse before any patient liability is calculated.
Excess Shelter Allowance: If the community spouse's actual housing costs (rent or mortgage, property taxes, homeowner's insurance, and a standard utility allowance) exceed $811.50 per month (effective July 1, 2026), the MMMNA can be increased by the excess amount. This means more of the parent's income goes to the spouse and less goes to the facility. The maximum MMMNA with any adjustments is capped at $4,066.50 per month unless increased by a probate court order or state hearing decision.
Incurred medical expenses: Medical costs not covered by Medicare or other insurance — dental work, vision care, hearing aids, prescription copayments — can be deducted from income in the month they are incurred.
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A Worked Example
A parent has the following monthly income:
- Social Security: $1,800
- OPERS pension: $1,400
- Total gross income: $3,200
Because income exceeds $2,982, a QIT is required. All income flows through the trust.
Deductions:
- Personal Needs Allowance: –$75.00
- Medicare Part B premium: –$202.90
- Spousal income allowance (spouse's own income is $1,200; MMMNA is $2,705; difference: $1,505): –$1,505.00
- Total deductions: –$1,782.90
Patient liability: $3,200.00 – $1,782.90 = $1,417.10 per month
The nursing facility receives $1,417.10 from the parent each month. Medicaid pays the balance of the facility's Medicaid rate.
The QIT Distribution Priority
If a QIT is in place, the trustee distributes funds from the trust in this strict order:
- Personal Needs Allowance ($75 nursing home / $50 assisted living)
- Community Spouse Monthly Income Allowance
- Incurred medical expenses not covered by third parties
- Patient liability (the remaining balance, paid to the facility)
The QIT must be funded every month — the parent's gross income (or the portion exceeding the SIL) must be deposited into the QIT bank account, and then distributed according to this priority. Failing to fund the QIT in any month causes immediate loss of eligibility for that month, and the facility charges the full private-pay rate.
When the Numbers Change
Patient liability is recalculated whenever the parent's income changes (a Social Security COLA, a pension adjustment) or when the community spouse's circumstances change (a change in their own income or housing costs). The parent or their representative must report income changes to the CDJFS within 10 calendar days using Form ODM 10203.
The MMMNA, PNA, and shelter allowance thresholds are updated annually by the state. The amounts in this post reflect 2026 standards.
Our Ohio Medicaid Long-Term Care & Asset Protection Guide walks through the patient liability calculation with your parent's specific income sources, including how to maximize spousal deductions and medical expense credits to reduce the monthly payment to the facility.
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Download the Ohio — Medicaid Long-Term Care Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.