If you are planning for the years ahead, one question keeps many Central Ohio families awake at night: how will we pay for long-term care? Nursing home costs can climb past $100,000 a year, and most people are surprised to learn that Medicare does not cover this kind of extended care.

That is where Medicaid comes in. For most Americans, Medicaid is the program that actually pays for long-term nursing home and home-based care once other resources run out. Understanding how it works in Ohio is one of the most important steps you can take to protect your family’s legacy.

In this article, you will learn what Medicaid is, how it differs from Medicare, how Ohio decides who qualifies, what assets are protected, and why planning can make all the difference. For more information on Medicaid and paying for long-term care in Ohio, schedule a consultation with DuPont Law Group.

Medicare vs. Medicaid: The Key Difference

People mix up these two programs all the time. The names sound alike, and both involve the government and healthcare. But they work very differently.

Medicare is an earned benefit. You pay into it through payroll taxes during your working years, and nearly everyone qualifies at age 65, regardless of income or assets. Medicare covers hospital stays, doctor visits, and short-term rehabilitation. It does not cover long-term custodial care, which is the day-to-day help with bathing, dressing, eating, and similar needs.

Medicaid is means-tested public assistance. It is funded jointly by the federal and state governments, and you only qualify if your income and assets fall below set limits. Crucially, Medicaid is the primary payer for long-term custodial care in the United States.

So, what does this mean for you? If you or a loved one needs ongoing nursing home care, Medicare will not foot the bill. Medicaid often becomes the answer, but only after meeting strict requirements.

How Ohio Medicaid Decides Who Qualifies

Many people assume Medicaid eligibility is just about having low savings. In reality, Ohio applies two separate tests, and you must meet both.

The Financial Threshold

The first test looks at your income and assets.

• As of 2026, for a single applicant, countable assets must generally be at or below $2,000.
• Income rules also apply. Ohio is an income-cap state, which means applicants whose income exceeds the limit may need a Qualified Income Trust (sometimes called a Miller Trust) to qualify.
• For married couples, federal spousal protections create a more complex and more generous structure to keep the healthy spouse from becoming impoverished.

The Clinical Threshold

The second test is often overlooked. You must also meet Ohio’s level-of-care standard, which means a clinical assessment confirms you actually need nursing facility-level care.

Both thresholds matter. A person with significant assets cannot simply spend down and qualify if they do not also need that level of care. And a person with very limited assets may be financially eligible but not yet meet the clinical standard.

Countable vs. Exempt Assets

One of the biggest myths about Medicaid is that you must lose everything before it helps. That is only partly true. Ohio Medicaid separates your assets into two groups.

Countable Assets

These generally must be spent down to the eligibility limit. Examples include:

• Bank and savings accounts
• Stocks, bonds, and most investment accounts
• Second homes and vacation properties
• Additional vehicles

Exempt Assets

These do not count toward eligibility and do not have to be depleted. Examples often include:

• Your primary residence (under certain conditions, while you or your spouse live there)
• One vehicle
• Personal belongings and household goods
• Certain prepaid burial arrangements

The Home Exemption and Ohio Estate Recovery

Here is a distinction that catches many families off guard: “exempt during life” does not mean “protected forever.”

Your home is generally exempt while you or your spouse lives there. However, federal law requires states, including Ohio, to seek reimbursement for long-term care costs from the estates of Medicaid recipients age 55 and older. This is called estate recovery.

After the death of the recipient and any surviving spouse, the state may pursue a claim against the home or other estate assets. The scope of recovery can vary, and some non-probate assets may be reached depending on how things are structured.

The takeaway is simple but important. Protecting your home from the spend-down rules during life is not the same as protecting it from estate recovery after death. Both need attention in a complete plan.

Ohio HCBS Waivers: Care Beyond the Nursing Home

A common misconception is that Medicaid only pays for nursing homes. That is not accurate.

Ohio offers Home and Community Based Services (HCBS) waivers, which allow Medicaid funding to support care at home or in a community setting instead of a facility. These programs can help cover:

• Personal care aides
• Adult day services
• Home modifications
• Other supportive services that help you remain at home

A few things to keep in mind about waivers:

1. They are operated at the state level, so eligibility and covered services follow Ohio-specific rules.
2. They typically require meeting the same level-of-care criteria as nursing facility Medicaid.
3. Many waiver programs have wait lists, so availability is not guaranteed and may not match the moment care is needed.

For families who want to keep a loved one at home, these waivers can be a valuable option worth exploring early.

What Medicaid Does and Does Not Cover

Medicaid’s coverage is substantial, but it has limits. Knowing these gaps helps you plan realistically.

What Medicaid Generally Covers

• Nursing facility care at the Medicaid rate
• Semi-private room accommodations
• Care at the clinically approved level
• Certain home-based services through HCBS waivers

What Medicaid Often Does Not Cover

• Assisted living room and board. In most cases, Medicaid does not cover full room and board in assisted living, though some supportive services may be available through waivers.
• Private room upgrades. Medicaid pays for semi-private rooms. A private room usually requires a private supplement.
• Non-participating facilities. Medicaid only pays facilities that accept it. Many higher-end facilities limit their Medicaid beds.
• Care above the approved level. Services beyond your assessed need require private funding.

Understanding the Medicaid Spend-Down

A Medicaid spend-down is the process of reducing your countable assets to the eligibility limit before coverage begins. You generally must spend these assets on legitimate expenses, such as care costs, home repairs, or paying off debts.

Here is the catch many families miss: you cannot simply give your money away to qualify. Transfers made for less than fair market value during the 60-month look-back period can trigger a penalty period, during which Medicaid will not pay for care.

This is why thoughtful, early planning matters so much. The choices you make years before a care need can dramatically change the outcome.

Two Ways to Arrive at Medicaid

There is a meaningful difference between reaching Medicaid by accident and reaching it by design.

Medicaid as an Unplanned Safety Net

Some families spend down nearly everything paying for care until they finally qualify. For people with modest assets, this may be the expected and appropriate path. But for those who hoped to preserve a legacy, watching savings disappear feels like a painful loss.

Medicaid as a Deliberate Plan

Other families plan ahead. With proper legal tools and respect for the look-back rules, they may protect certain assets while still qualifying for benefits when needed. Both paths can lead to Medicaid eligibility, but they produce very different outcomes for the people you love.

The right approach depends on your age, health, assets, family situation, and values. The point is that you have a choice, and knowledge gives you the power to make it.

How DuPont Law Group Helps Ohio Families

Long-term care planning sits at the intersection of legal, financial, and tax decisions. That is exactly where our team focuses.

At DuPont Law Group in Dublin, Ohio, attorney Gregory S. DuPont brings a unique perspective as both a JD and a Certified Financial Planner (CFP®). This dual background allows us to look at the whole picture, not just one document.

Families across Central Ohio choose us because we offer:

• Flat-fee billing in most estate planning matters, so you know your costs upfront with no surprises
• The 4D Estate Plan™, our comprehensive framework built on four pillars: Document, Defend, Discover, and Deliver

That holistic, relationship-based approach helps you protect your assets, plan for care, and secure your legacy with confidence.

You do not have to face these decisions alone or wait for a crisis to act. With clear guidance and a thoughtful plan, you can preserve your legacy and gain real peace of mind.

To explore your options for long-term care and estate planning, contact DuPont Law Group at (614) 389-9711 to schedule your consultation. Let us help you secure your family’s future with confidence.

Frequently Asked Questions

What is the difference between Medicare and Medicaid?

Medicare is an earned federal benefit available at 65 regardless of income, covering hospital care, doctor visits, and short-term rehab. Medicaid is means-tested assistance for people with limited income and assets, and it is the primary payer for long-term custodial care.

Does Medicaid pay for nursing home care in Ohio?

Yes. Medicaid is the leading payer for nursing home care, but you must meet both the financial limits and the clinical level-of-care standard to qualify.

How much money can I keep and still qualify for Medicaid?

A single applicant generally must have countable assets at or below approximately $2,000. Married couples receive additional protections for the spouse who remains at home.

Does Medicaid cover assisted living in Ohio?

In most cases, Medicaid does not cover full room and board in assisted living. Some supportive services may be available through HCBS waivers, but coverage is limited.

Will Medicaid take my house?

Not while you or your spouse are living in it. However, after death, Ohio may seek repayment for care costs through estate recovery, which can affect the home.

Can I give money to my children to qualify for Medicaid?

Gifts made within the 60-month look-back period can trigger a penalty period. This is why planning well in advance, with professional guidance, is so important.

Contact DuPont Law Group to Understand Medicaid and Planning for Long-Term Care in Ohio

Reach out to the dedicated elder law attorneys at DuPont Law Group to schedule your initial consultation and learn more about Medicaid and paying for long-term care in Ohio.