Ohio Medicaid Spend-Down: How Much Can You Actually Keep in 2026?

Countable assets: checking, savings, CDs, brokerage accounts, second vehicles, second properties, life insurance with significant cash value, and retirement accounts in payout status (rules vary).

Exempt assets typically include: the primary residence (up to Ohio's home-equity cap), one vehicle, household goods and personal belongings, an irrevocable funeral trust within state limits, and term life insurance.

The 'spend-down' is the legal process of converting countable assets into exempt ones, or paying down debt and care costs, until the applicant is at or below the asset limit.

If one spouse needs long-term care Medicaid and the other still lives in the community, federal law lets the 'community spouse' keep half of the couple's countable assets up to a federal maximum that adjusts every year.

The community spouse also keeps the house, one car, and a Minimum Monthly Maintenance Needs Allowance from the institutionalized spouse's income.

The community spouse resource allowance and home equity cap shift slightly each year, so confirm the current Ohio figures with an elder-law attorney before relying on them.

Ohio Medicaid reviews five years of financial history when you apply for long-term care benefits. Gifts and below-market transfers during that window trigger a penalty period (months of ineligibility) calculated on the value transferred.

Common landmines: paying a child to be a caregiver without a written care contract, signing the house over to a child to 'protect' it, large birthday or holiday checks to grandchildren, and CD interest that disappeared into a child's account.

Working with a Medicaid planning attorney before any transfers is almost always cheaper than fixing a penalty period later.

If long-term care Medicaid is more than five years away, you have planning room. If it is six months away, you have spend-down room (paying down a mortgage, prepaying funeral, buying a more reliable car for the community spouse) but you do not have gifting room.

PASSPORT and the DODD waiver follow the same eligibility math as nursing-home Medicaid, so this matters whether you want care at home or in a facility.

Countable: checking, savings, CDs, stocks, bonds, second cars, vacation property, cash-value life insurance over $1,500 face, retirement accounts in payout status (rules vary).

Not countable: primary residence (subject to equity cap and intent to return), one vehicle, household goods, irrevocable burial trust, prepaid burial up to state limit, term life insurance.

The Ohio Department of Medicaid spend-down page has the official guidance.

Ohio Medicaid reviews asset transfers in the 60 months before application. Gifts and transfers below market value can create a penalty period (no Medicaid coverage for X months based on transfer amount divided by state average nursing-home cost).

Annual gifting under $18,000 to children does NOT exempt the gift from Medicaid lookback. Federal gift tax rules and Medicaid rules are different. This catches a lot of families.

Spousal transfers, transfers to a disabled child of any age, and a few other categories are exempt from the penalty. Talk to an elder law attorney before you move money.