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Medicaid Spend Down in Ohio: What Replaced It and 2026 Limits

By Modinul Islam Khan Updated November 12, 2026

Reviewed November 12, 2026. Ohio no longer has a Medicaid spend down. The state ended its spenddown program on August 1, 2016, when it switched from a “209(b)” state to a “1634” state, so you can no longer use medical bills to bring your income down to the Medicaid limit. Instead, Ohio now uses fixed income limits, the Medicare Premium Assistance Programs, and, for nursing home or waiver care, a special income limit with a Qualified Income Trust (Miller trust).

If you have read about spend down in other states, our guide to how Medicaid spend down works explains the general idea. This page covers what Ohio residents need to know instead.

No income spend down: since August 1, 2016, Ohio has not let aged, blind or disabled people “spend down” medical bills to qualify (Ohio Department of Medicaid, MEPL 115).
Aged, blind or disabled Medicaid (2026): the income standard is the SSI benefit rate, $994 a month for one person and $1,491 for a couple.
Medicare premium help (2026): QMB up to $1,330 a month, SLMB up to $1,596 and QI-1 up to $1,796 for one person.
Nursing home and waiver care (2026): the special income limit is $2,982 a month (300% of $994). Above that, you need a Qualified Income Trust.
Resource limit: $2,000 for an individual and $3,000 for a married couple.
2027: SSI-based figures change in January 2027. Medicare premium program limits usually update in the spring.

Why Ohio ended Medicaid spend down

Before August 2016, Ohio was a 209(b) state. It set its own disability and income rules for aged, blind and disabled people, and anyone with income over the limit could qualify by showing medical bills equal to the excess each month. That was the spenddown program.

On August 1, 2016, Ohio became a 1634 state. The Ohio Department of Medicaid’s procedure letter on the change says plainly that after the transition, “individuals will no longer be able to spenddown to become eligible for Medicaid.” People who had met a spenddown in the year before the switch got extra months of coverage during a one-year transition, but that window closed long ago.

Being a 1634 state means Ohio follows the federal SSI rules for aged, blind and disabled Medicaid. In practice, people who get SSI are generally covered by Ohio Medicaid, and everyone else is measured against fixed income and resource limits rather than a spend down.

What replaced spend down in Ohio

There is no single replacement. Which program fits you depends on your income and whether you need long-term care.

Aged, blind or disabled (ABD) Medicaid

Full Ohio Medicaid for people who are 65 or older, blind or disabled uses the SSI benefit rate as its income standard. For 2026 that is $994 a month for an individual and $1,491 for a couple (Ohio Department of Medicaid 2026 eligibility chart). Some income may be disregarded, so your county caseworker will work out your countable income.

Medicare Premium Assistance Programs (QMB, SLMB, QI-1)

If you have Medicare and your income is a little too high for full Medicaid, the Medicare Premium Assistance Programs (Ohio’s name for the Medicare Savings Programs) are often the most useful option. QMB pays Medicare premiums, deductibles and coinsurance. SLMB and QI-1 pay the Part B premium, which is $202.90 a month in 2026 (CMS).

Ohio program (2026)	Income level	1 person / month	2 people / month
QMB	100% FPL	$1,330	$1,804
SLMB	120% FPL	$1,596	$2,164
QI-1	135% FPL	$1,796	$2,435
ABD Medicaid	SSI benefit rate	$994	$1,491

Source: Ohio Department of Medicaid, MEPL 194 (QMB/SLMB/QI-1 limits effective March 1, 2026) and the ODM 2026 aged, blind and disabled eligibility chart.

Ohio updates these limits each year when the new federal poverty guidelines come out, so expect new 2027 figures in spring 2027.

Nursing home and waiver care: the special income limit

For long-term care, Ohio uses a special income level (SIL) equal to 300% of the SSI benefit rate (Ohio Adm.Code 5160:1-6-03.1). With the 2026 SSI rate of $994, the SIL is $2,982 a month for one person. It applies to people in a nursing facility and to people receiving home and community-based (HCBS) waiver services or PACE.

Once you qualify, most of your income still goes toward your care each month as “patient liability,” after allowances such as a personal needs allowance and, if you are married, an allowance for your spouse at home. Our page on Medicaid nursing home care explains how this works in more detail.

Qualified Income Trusts (Miller trusts) in Ohio

If your income is above the special income limit ($2,982 a month in 2026) and you need nursing home or waiver care, Ohio does not let you spend down. Instead, you can set up a Qualified Income Trust, often called a Miller trust. Under Ohio Adm.Code 5160:1-6-03.2:

The trust must be irrevocable and can hold only your income (plus any interest it earns).
You can put all or part of your income into it. Income placed in the trust is not counted against the special income limit.
Money must be paid out within 30 days, in this order: your personal needs allowance, any allowance for a spouse or dependents, health and long-term care costs, and up to $15 a month for bank or administrative fees.
When you die, whatever is left goes to the Ohio Department of Medicaid, up to the amount Medicaid paid for your care.
You must give the county the trust document, proof of the account and proof of monthly deposits. If a deposit is missed, that month’s income counts as available.

A Qualified Income Trust does not lower what you pay toward care. It simply lets you qualify. Because the paperwork must be exact, many families use an elder law attorney to draft the trust.

Asset spend down is still allowed

People often use “spend down” for two different things. Ohio ended the income spend down. It did not end the ability to reduce your assets before you apply.

Ohio’s resource limit for aged, blind and disabled Medicaid is $2,000 for an individual and $3,000 for a married couple (Ohio Adm.Code 5160:1-3-05.1). If your countable savings are above that, you can spend the excess on things you get fair value for, such as:

Paying off debts, including medical bills or a mortgage.
Home repairs or accessibility changes, like a ramp or walk-in shower.
Medical equipment, hearing aids, dental work or eyeglasses.
Prepaying funeral and burial costs within Ohio’s rules.

Keep receipts for everything. Giving money away is different, and that is where the look-back period comes in.

The 5-year look-back

For nursing home and waiver Medicaid, Ohio reviews transfers made during the 60 months (five years) before your “baseline date,” which is generally the first date you are both institutionalized (or requesting waiver services) and have applied (Ohio Adm.Code 5160:1-6-06). Gifts or sales below fair market value in that window are presumed improper and lead to a restricted Medicaid coverage period, during which Medicaid will not pay for long-term care. Some transfers are exempt, such as transfers to a spouse, and you can rebut the presumption by showing the transfer was not made to qualify for Medicaid.

Rules for married couples (2026)

When one spouse needs nursing home or waiver care and the other stays at home, federal spousal impoverishment rules protect the spouse at home. Ohio lets the community spouse keep the greater of half the couple’s combined countable resources (up to the federal maximum) or the federal minimum, unless a hearing or court order sets a higher amount (Ohio Adm.Code 5160:1-6-04).

2026 federal standard	Amount
Community spouse resource allowance, minimum	$32,532
Community spouse resource allowance, maximum	$162,660
Minimum monthly maintenance needs allowance (from July 1, 2026)	$2,705
Maximum monthly maintenance needs allowance	$4,066.50

Source: CMS Informational Bulletin, updated 2026 SSI and spousal impoverishment standards (April 27, 2026).

If the at-home spouse’s own income is below the minimum maintenance allowance, part of the other spouse’s income can be shifted to them before patient liability is figured.

What changes in January 2027

SSA has announced that the SSI federal benefit rate will be $1,029 a month for an individual and $1,544 for a couple in 2027 (SSA). At 300% of that rate, Ohio’s special income level would be $3,087 a month starting January 2027. CMS normally publishes new spousal impoverishment figures around the turn of the year. Confirm 2027 amounts with your county office before relying on them.

How to apply for Medicaid in Ohio

Online: apply at benefits.ohio.gov.
By phone: call the Ohio Medicaid Consumer Hotline at 1-800-324-8680.
In person: visit your county Department of Job and Family Services (find it at jfs.ohio.gov/county).

Have proof of income, bank statements, Medicare and insurance cards, and, for long-term care, any Qualified Income Trust documents ready. Ohio Medicaid members in managed care plans may also want to check extra benefits such as CareSource Medicaid dental coverage. When it is time to renew, see our Medicaid renewal phone numbers.

Frequently asked questions

Does Ohio have a Medicaid spend down program?

No. Ohio ended its spenddown program on August 1, 2016, when it became a 1634 state. You cannot use medical bills to meet an income limit in Ohio.

What if my income is too high for Ohio Medicaid?

If you have Medicare, check the Medicare Premium Assistance Programs, which go up to $1,796 a month for one person in 2026. If you need nursing home or waiver care and your income is over $2,982 a month (2026), a Qualified Income Trust can let you qualify.

Can I still spend down my savings in Ohio?

Yes. You can spend countable assets above the $2,000 individual limit on things you receive fair value for. Gifts and below-value sales in the 60 months before applying for long-term care can trigger a penalty period.

Can I use a spend down calculator for Ohio?

Our Medicaid spend down calculator is built for states that still have medically needy programs. Ohio residents should compare income against the fixed limits above instead.

Who can be the trustee of an Ohio Miller trust?

Ohio’s rule sets requirements for the trust itself, not a specific list of trustees. Family members often serve. An elder law attorney can advise on the best choice for your situation.