When you need one
Ohio determines long-term care Medicaid using a special income level (SIL) of 300% of the SSI benefit rate for one person (OAC 5160:1-6-03.1). If your countable income is at or below the SIL, you don't need a trust. If it's above, OAC 5160:1-6-03 says you may set up a QIT to become eligible. A QIT can be used only by someone whose income is over the SIL, who is eligible for Medicaid long-term care services, and whose income is subject to patient liability.
Ohio's QIT rules
- The trust must be irrevocable and valid under Ohio law or another state's law.
- Only your income can go in; no other assets, except interest the account earns.
- The income sources must be identified, and you can't assign your right to receive the income to the trust.
- The account must be titled as a QIT in your name, and its location, account number and who can access it must be documented.
- When you die, what's left goes to the Ohio Department of Medicaid, up to the amount Medicaid paid for you, before anyone else is repaid.
How the money flows each month
- Deposit income. Ideally your income is deposited directly into the QIT account. You may put in all or part of it; income left out is counted.
- Pay out within 30 days, in order. First a personal needs allowance; then any allowance for a spouse or dependents; then health care costs, including your patient liability.
- Trust costs. The trustee may take a small monthly amount set in the rule for bank and legal fees; a higher amount needs approval from the Ohio Department of Medicaid.
- Keep records. Submit the trust document, proof of the account and deposit records with your application, and show deposits at every annual renewal.
Payments from the trust other than those the rule allows can be treated as a transfer of assets and cause a period when Medicaid won't pay for long-term care (OAC 5160:1-6-06.5).
Apply for Medicaid at benefits.ohio.gov or your county Job and Family Services office. For Medicare questions alongside long-term care, you can request a call from a licensed insurance agent. More in Ohio Medicaid and Medicare.
Related questions
Does Ohio Medicaid pay for nursing home care?
Who qualifies and patient liability.
What is the PASSPORT waiver in Ohio?
Long-term care at home.
Does Ohio Medicaid take your house after death?
Estate recovery.
Sources
- Ohio Administrative Code — Rule 5160:1-6-03.2, use of qualified income trusts (QIT) (eff. Oct. 12, 2026)
- Ohio Administrative Code — Rule 5160:1-6-03.1, special income level
- Ohio Administrative Code — Rule 5160:1-6-03, special income rules for long-term care
- Ohio Administrative Code — Rule 5160:1-6-07, patient liability
More questions in this guide
- Can I have Ohio Medicaid and Medicare at the same time?
- Does Ohio Medicaid pay for nursing home care?
- 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 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
Does a qualified income trust let me keep my income?
No. Money in the trust still goes toward your care. After a personal needs allowance and any allowance for a spouse or dependents, it pays your patient liability and other medical costs.
Do I need a lawyer to set up a QIT in Ohio?
The rule doesn't require one, but the trust must be a valid, irrevocable trust that meets every condition in OAC 5160:1-6-03.2, so many families use an elder law attorney. The trust may pay a small set amount each month for bank and legal fees.
What happens if I miss a monthly deposit?
Income that should have gone into the trust but didn't is counted for that month, which can make you ineligible. Medicaid paid during a month you weren't eligible can be recovered.
Does a QIT work for PASSPORT or other waivers?
Yes. The QIT rule covers Medicaid payment of long-term care services, which include nursing homes and home and community-based waivers.
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