When One Spouse Needs a Nursing Home: Ohio Medicaid's 2026 Figures for Couples

Why couples are treated differently

Federal spousal impoverishment rules exist so that one spouse's nursing home bill does not leave the other in poverty. Ohio applies them to nursing home Medicaid and to its home and community-based waivers, PASSPORT and the Assisted Living Waiver. The figures change every year, some in January and some in July, so a plan built on last year's numbers can be wrong.

The 2026 numbers

Sources: Ohio Medicaid MEPL No. 191 and No. 195, and OAC 5160:1-6-04 and 5160:1-6-07.

How the asset split works

Ohio takes a snapshot of the couple's combined countable assets when the spouse first enters continuous care. Generally the spouse at home keeps half, but never less than the minimum or more than the maximum. Everything above that, plus the applicant's $2,000, has to be spent down on allowable things before Medicaid pays: care itself, paying off a mortgage, home repairs, a car replacement, an irrevocable funeral contract.

Retirement accounts usually count. The house is exempt while the spouse lives there. A couple with $300,000 in countable assets, for example, would generally protect $150,000 for the spouse at home and need to spend down most of the rest.

Income: whose money is whose

The spouse at home keeps all income in their own name. If that income is below the maintenance allowance, part of the nursing home spouse's income can be shifted to make up the difference, up to the cap. The rest of the applicant's income, minus the $75 personal needs allowance and health insurance premiums, goes toward the cost of care.

If the applicant's own income exceeds $2,982 a month, a Qualified Income Trust is needed to qualify; many Dayton couples with pensions from manufacturing or federal service at Wright-Patterson fall into this group.

A simple example with round numbers

Imagine a Kettering couple with $240,000 in savings and IRAs, a paid-off house and two cars. The husband enters a nursing home after a stroke. Ohio takes the snapshot of their countable assets: $240,000 (one car and the house are exempt). Half is $120,000, which falls between the 2026 minimum and maximum, so the wife can keep about $120,000 as her resource allowance. The husband may keep $2,000. The remaining $118,000 must be spent on allowable things or on his care before Medicaid pays.

On income, the wife's own Social Security stays hers. If it is below her maintenance allowance, part of his pension can be redirected to her, up to the $4,066.50 cap, rather than going to the nursing home. Done carefully, with advice, the spend-down might include a new roof, paying off a car or prepaying both funerals, all of which help the wife who stays home.

Real cases are rarely this tidy, which is exactly why an elder law consultation before applying pays for itself. Bring statements for every account, the deed, insurance policies and five years of bank records.

Keeping the spouse at home financially secure

The point of the spousal rules is to protect the spouse who stays home, so plan around that person's next ten or twenty years, not just the next application. Make sure the home's repairs are done, the car is reliable and the funeral is prepaid while spending down. Review the at-home spouse's own will and powers of attorney so assets left to the ill spouse do not undo the plan. Revisit the budget each January and July when Ohio's figures change.

Mistakes that cost the most

Giving money to children during the five-year look-back without understanding the penalty. Retitling the house without advice. Assuming Medicare will pay for a long stay. Waiting to apply until the money is completely gone, which wastes spend-down choices that would have helped the spouse at home. An hour with an elder law attorney is cheap compared with any of these.