Most US long-term care is paid for by Medicaid — not Medicare. Medicare covers short rehab stays after a hospital admission, then stops. The bill for ongoing nursing-home care, memory care, or significant in-home support has to be paid by someone, and for the majority of Ohio seniors that source is Ohio Medicaid.1

Ohio runs its Medicaid program through the Ohio Department of Medicaid (ODM). Long-term-care benefits are accessed through multiple programs: nursing-facility Medicaid (the institutional track), the PASSPORT waiver for in-home services, and (for dual-eligibles in 29 counties) MyCare Ohio — one of the largest integrated Medicare-Medicaid managed care programs in the country.

Three eligibility tests, in order

1. Medical eligibility

Before the financial math starts, your parent has to be medically eligible — meeting nursing-facility level of care through the PASSPORT assessment or, for institutional Medicaid, a Level of Care determination. The assessment measures ability to perform activities of daily living (bathing, dressing, toileting, transferring, eating) and instrumental activities of daily living (medication management, meal preparation).2

Schedule the assessment through your local PASSPORT Administrative Agency (operated by the regional Area Agency on Aging) or through ODA at the Ohio Senior Helpline. Wait times vary by region; urban Ohio typically faster than rural.

2. Income

For Ohio Medicaid long-term care, the gross income cap is approximately $2,901/monthin 2026 — 300% of the federal SSI benefit rate, changes annually. If your parent’s gross income from all sources (Social Security, pension, IRA payouts, annuity income) exceeds the cap, they are not automatically disqualified. They’ll need a Qualified Income Trust(Miller Trust) to divert above-cap income so it doesn’t count toward eligibility.

3. Assets

The applicant’s countable assetsmust be at or below $2,000 on the date of application. “Countable” is doing the work in that sentence.

Not counted (in most cases):

Counted:

The 60-month look-back, in plain English

Ohio (like every state) reviews any transfer of assets for less than fair market value made in the 60 months before the Medicaid application. If the caseworker finds one, Medicaid assesses a penalty period— a window during which the applicant is otherwise eligible but Medicaid won’t pay.

The penalty math is straightforward: the value of the transfer divided by Ohio’s penalty divisor. The divisor approximates the statewide average monthly cost of nursing-facility care (recent figures around $7,500-$8,500 ). A $50,000 gift becomes roughly a 6-month penalty. The clock does not start until your parent is otherwise eligible— spent down and in care — so the penalty hits at exactly the moment families need Medicaid most.

MyCare Ohio: integrated dual-eligible managed care

MyCare Ohio is one of the largest dual-eligible managed care demonstrations in the United States, operating since 2014 in 29 Ohio counties.3 The program integrates Medicare and Medicaid benefits for individuals who qualify for both (dual-eligibles) through five managed-care plans:

MyCare Ohio plans coordinate medical, behavioral health, and long-term-care services through a single plan with a single care coordinator. If your parent qualifies as dual-eligible and lives in a MyCare county (which includes Cleveland, Columbus, Cincinnati, Akron, Toledo, and Dayton metros), they are generally enrolled in MyCare unless they opt out.

Practical implication: the MyCare care coordinator becomes the single point of contact for almost every benefit decision. Get to know who your parent’s coordinator is, what their contact info is, and what services the plan authorizes.

The PASSPORT waiver: getting Medicaid to pay for in-home care

PASSPORT (Pre-Admission Screening System Providing Options and Resources Today) is Ohio’s primary Medicaid HCBS waiver for older adults, administered by ODA through the 12 Area Agencies on Aging. Operating since 1984, PASSPORT serves thousands of Ohioans annually with in-home long-term-care services.4

Services include personal care, adult day services, home modifications, respite, and (importantly) consumer-directed care under the Self Determination option — the ability to hire and pay a caregiver, including an adult child (but typically not a spouse).

PASSPORT has a financial-eligibility process aligned with institutional Medicaid (same income cap, same asset limits, same look-back). The functional-eligibility test is the PASSPORT assessment.

The community-spouse situation

If one spouse needs care and the other doesn’t, Ohio follows the federal spousal-impoverishment rules. The well spouse (the community spouse) keeps:

Most one-spouse-needs-care situations can be planned to a non-catastrophic outcome with 12-24 months of lead time. Talk to an Ohio elder-law attorney before doing anything — the spousal rules involve a snapshot-date determination that produces meaningful variance based on careful timing.

Ohio Medicaid estate recovery

Ohio, like every state, has a Medicaid Estate Recovery Program (MERP). After the death of a Medicaid recipient who received LTC benefits at age 55 or older, Ohio files a claim against the probate estate for the value of LTC services paid. Ohio historically has been one of the more active estate-recovery states. As in Florida, Ohio pursues recovery through probate; non-probate transfers (joint tenancy, beneficiary designations, properly funded revocable trusts) are generally outside the reach of recovery.5

Practical implication: probate-avoidance planning (TOD designation affidavits for real property under R.C. 5302.22, beneficiary designations on financial accounts, trusts) reduces estate-recovery exposure significantly. This is one area where Ohio’s well-developed TOD-deed statute is particularly useful.

What to do this month

For the broader picture on Medicaid eligibility nationally, see our Medicaid pillar overview. For Ohio-specific legal and estate-planning content, see Legal & Financial in Ohio.