Ohio expanded Medicaid under the Affordable Care Act, effective January 1, 2014, covering adults age 19 to 64 up to 138 percent of the federal poverty level for acute and primary medical care. Nursing home and waiver eligibility for seniors runs through a completely separate, non-MAGI aged/blind/disabled Medicaid pathway with its own income and asset tests.
Why this distinction trips families up
Families researching Ohio senior care funding sometimes encounter the fact that Ohio expanded Medicaid and assume that changes what is available for a parent's assisted living or nursing home costs. It does not. The expansion population is adults under 65 qualifying on income alone through the Modified Adjusted Gross Income (MAGI) methodology. Long-term care Medicaid for seniors uses an entirely different, non-MAGI aged/blind/disabled pathway, with asset limits, a five-year lookback on transfers, and a medical necessity requirement the expansion population never faces.
Two Medicaids, side by side
| Medicaid expansion | Long-term care Medicaid | |
|---|---|---|
| Who it serves | Adults 19–64, income-based | Seniors and disabled adults needing nursing-facility level of care |
| Eligibility test | MAGI income only | Non-MAGI income and asset limits, functional need |
| Covers assisted living? | No | Only through the separate Assisted Living Waiver |
| Asset limit | No asset test | $2,000 single applicant |
Ohio expanded Medicaid under the Affordable Care Act (adults age 19 to 64 up to 138 percent of the federal poverty level), commonly cited as effective January 1, 2014. That expansion pathway is entirely separate from the aged/blind/disabled, non-MAGI Medicaid rules that govern nursing home and waiver eligibility for seniors; the two should not be conflated.
How Cleveland-area families actually pay for care
Medicare does not pay for assisted living. Ohio has expanded Medicaid, but that expansion covers acute medical care for adults under 65, not long-term assisted living costs. Long-term services and supports for seniors run through three separate programs: the Assisted Living Waiver, PASSPORT, and MyCare Ohio for dual-eligible residents.
The Assisted Living Waiver
The waiver that pays for services delivered inside a licensed Residential Care Facility, for Medicaid-eligible adults age 21 and older with a hands-on need for help with activities of daily living.
What it covers: Personal care and supportive services provided by the RCF's staff.
PASSPORT
Ohio's flagship home and community-based services (HCBS) Medicaid waiver, designed to keep Medicaid-eligible seniors who need nursing-facility level of care at home instead of in an institution.
What it covers: Personal care, home-delivered meals, adult day care, minor home modifications, personal emergency response systems, medical transportation, and, added in October 2024, Structured Family Caregiving.
MyCare Ohio
A managed care program for Ohioans eligible for both Medicare and Medicaid that coordinates medical care, behavioral health, and long-term services and supports, including nursing facility and waiver services, through a single managed care plan.
MyCare Ohio's Northeast Ohio region covers all of Cuyahoga, Lake, Lorain, Medina, and Geauga counties, plus Summit and Portage counties, matching this site's full 7-county service area.
Eligibility basics
- Ohio resident and U.S. citizen or qualified non-citizen
- Age 21 or older (PASSPORT and the Assisted Living Waiver primarily serve people age 60 and older in practice) and meets Nursing Facility Level of Care
- Financially eligible under Ohio's non-MAGI, aged/blind/disabled Medicaid rules (see nf_medicaid below); this is a different eligibility pathway than the MAGI-based Medicaid expansion population
How to start: Apply through the Ohio Department of Medicaid at benefits.ohio.gov, or contact the Area Agency on Aging serving your county for a waiver assessment and to get on any waiting list.
Does Ohio have a broad state assisted living benefit?
Like Texas, Ohio has no broad state-funded assisted living entitlement that pays a private-pay family's full monthly bill. Unlike Texas, Ohio did expand Medicaid, but that expansion covers acute and primary medical care for adults under 65, not long-term assisted living costs, which run through the separate aged/blind/disabled Medicaid pathway described above. What does exist:
- The Assisted Living Waiver, which pays for care services delivered inside a licensed RCF but not room and board, requires Nursing Facility Level of Care and financial eligibility, and is subject to waiver capacity and waiting lists in many counties.
- PASSPORT and MyCare Ohio, which support people who want to remain at home rather than move into a facility, but do not pay for assisted living room and board either.
- The Residential State Supplement (RSS) program, administered by the Ohio Department of Mental Health and Addiction Services rather than the aging network, which provides a cash supplement toward rent for low-income adults with disabilities living in Class Two Residential Facilities. RSS is a different licensing track (OhioMHAS-licensed residential facilities for adults with mental illness or developmental disabilities) than the ODH-licensed RCFs most seniors use, and the two should not be conflated. As of mid-2023 the allowable facility fee under RSS was $1,600 per month.
Assisted Living Waiver capacity, wait times, and which local RCFs hold a waiver-provider agreement change over time and are not published in one place. Confirm current availability with the Area Agency on Aging serving the family's county.
Nursing home Medicaid in Ohio, 2025
- Income (the "special income level"): $2,901 per month (300 percent of the SSI federal benefit rate, the 'special income level' Ohio uses for nursing facility and waiver eligibility)
- Countable assets, single applicant: $2,000; couple: $3,000 combined
- Personal needs allowance: $75 per month — Ohio raised the nursing facility Personal Needs Allowance from $50 to $75 per month effective October 1, 2025 under OAC 5160:1-6-07. As drafted, that increase applies to residents of medical institutions (nursing facilities) and did not extend to the Assisted Living Waiver, where the PNA remained $50 per month as of this writing. A veteran receiving VA pension while on Medicaid in a nursing facility may also keep a $90 per month VA allowance under 38 U.S.C. 5503(d), which stacks with the state PNA.
- Community Spouse Resource Allowance: $31,267 to $148,620
- Minimum Monthly Maintenance Needs Allowance: $2,465 to $3,715.50 per month in 2025, the range for the Minimum Monthly Maintenance Needs Allowance protecting a community spouse's income.
Nearly all remaining income, after Medicare premiums, any spousal allowance, and allowable medical expenses, is applied to the cost of care as a patient liability.
VA Aid and Attendance
Aid and Attendance is not a flat check. VA pays the difference between countable income and the maximum annual pension rate. Unreimbursed medical expenses, including assisted living and home care costs, reduce countable income, which is why a veteran with substantial care bills can qualify despite moderate income.
| Situation | Maximum annual rate | Approximate monthly |
|---|---|---|
| Veteran, no dependents | $29,093 | about $2,424 per month |
| Veteran with one dependent | $34,488 | about $2,874 per month |
| Two veterans married, both eligible | $46,143 | about $3,845 per month |
| Veteran, no dependents, Housebound | $21,313 | about $1,776 per month |
| Surviving spouse, no dependents | $18,697 | about $1,558 per month |
| Surviving spouse, one dependent child | $22,304 | about $1,859 per month |
Net worth limit: $163,699 for December 1, 2025 through November 30, 2026, with a three-year look-back on asset transfers. Rates effective December 1, 2025. Monthly figures are the annual maximum divided by twelve. VA publishes these rates annually, not monthly. These figures are federal VA pension rates, identical in every state, including Ohio. They are not Cleveland- or Ohio-specific.
Source: VA veterans pension rates
Medicaid estate recovery
Ohio's Medicaid Estate Recovery Program (MERP) is required by federal law and recovers certain Medicaid payments from the estate of a deceased recipient. Ohio is an 'expanded recovery' state, meaning assets that pass outside of probate (such as through a transfer-on-death deed or joint survivorship) can be subject to recovery, not only probate assets. Recovery applies to nursing facility services, home and community-based waiver services such as PASSPORT and the Assisted Living Waiver, and related hospital and prescription drug costs, for recipients age 55 or older or of any age if permanently institutionalized.
The state must present its claim within 90 days of the estate's release-of-assets filing, or within one year of the recipient's death, whichever is later. Recovery is delayed while a surviving spouse, minor child, or blind or disabled child of any age lives in the home. A sibling with an equity interest who lived in the home for at least a year before the recipient's institutionalization may also qualify for an exemption. Hardship waivers exist but are evaluated case by case.
Source: Ohio Medicaid
