Medicare covers short stays; Medicaid covers long-term care
| Medicare (Part A) | Ohio Medicaid | |
|---|---|---|
| Type of care | Skilled nursing or rehab after a qualifying inpatient hospital stay | Long-term nursing facility care, including custodial care |
| How long | Up to 100 days per benefit period | As long as you stay eligible and need that level of care |
| Your share | Days 1–20: nothing; days 21–100: $217 a day in 2026 | Your patient liability: most of your income after allowances |
How to qualify in Ohio
- Level of care: you must need an intermediate or skilled level of care under OAC 5160-3-08.
- Resources: countable resources must be within Ohio's aged, blind and disabled limit (OAC 5160:1-3-05.1). Your home is generally excluded while you intend to return or a spouse or dependent relative lives there.
- Income: Ohio uses a special income level of 300% of the SSI benefit rate (OAC 5160:1-6-03.1). Above it, a qualified income trust can make you eligible.
- Transfers: Ohio looks back 60 months for gifts or transfers for less than fair market value; improper transfers cause a restricted coverage period (OAC 5160:1-6-06 and 5160:1-6-06.5).
What you pay: patient liability
Under OAC 5160:1-6-07, Medicaid reduces its payment to the nursing home by your patient liability. It is your income minus a personal needs allowance, an allowance for a spouse or dependents at home when one applies, and certain health insurance costs, such as Medicare premiums. You pay that amount to the nursing home each month.
How to apply
- Apply for Medicaid. At benefits.ohio.gov or your county Job and Family Services office, and say you need long-term care.
- Gather records. The county asks for income, bank and asset records, including the past 60 months of transfers.
- Choose a Medicaid-certified nursing home. Ask the facility whether it accepts Medicaid before you move in. For complaints, call the State Long-Term Care Ombudsman at 1-800-282-1206.
Medicaid paid for nursing home care can be recovered from your estate after death: see Does Ohio Medicaid take your house after death? If you'd rather stay home, see PASSPORT and other waivers. For Medicare plan questions, you can request a call from a licensed insurance agent.
Related questions
What is a qualified income trust in Ohio?
When income is above the limit.
Does Ohio Medicaid take your house after death?
Estate recovery rules.
What is the PASSPORT waiver in Ohio?
Medicaid care at home instead.
Sources
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Long-term care
- Ohio Administrative Code — Rule 5160:1-6-03.1, special income level
- Ohio Administrative Code — Rule 5160:1-6-07, post-eligibility treatment of income (patient liability)
- Ohio Administrative Code — Rule 5160:1-6-06, transfer of assets
- Ohio Administrative Code — Rule 5160:1-3-05.13, treatment of the home
More questions in this guide
- Can I have Ohio Medicaid and Medicare at the same time?
- Does Ohio Medicaid take your house after you die?
- Is MyCare Ohio available in my county?
- What is the difference between Medicare and Medicaid in Ohio?
- What is a dual eligible special needs plan in Ohio?
- What is a qualified income trust (Miller trust) in Ohio?
- What is MyCare Ohio?
- What is Next Generation MyCare Ohio?
- What is the PASSPORT waiver in Ohio?
Part of the guide: Ohio Medicaid and Medicare together · All questions
Frequently asked questions
What if my income is too high for nursing home Medicaid in Ohio?
If your income is above Ohio's special income level of 300% of the SSI benefit rate, you can set up a qualified income trust (Miller trust) under OAC 5160:1-6-03.2 and deposit income into it each month to qualify.
Can I keep my house if I go into a nursing home on Ohio Medicaid?
Your home isn't counted while you intend to return to it, or while your spouse or a dependent relative lives there (OAC 5160:1-3-05.13). After death, Ohio may seek repayment from your estate.
Does MyCare Ohio cover nursing home care?
Yes. If you are in a MyCare Ohio plan, the plan covers Medicaid nursing facility care, and if you also chose it for Medicare, it covers Medicare skilled nursing stays too.
Medicare in your Ohio county
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