Orlando Harmon
Medicaid is a health care program for low-income individuals of all ages, jointly funded by the state and federal government. In Ohio, Medicaid eligibility depends on income thresholds, which vary depending on age, marital status, and other factors. For 2025, a single nursing home applicant must have an income under $2,901 per month and assets under $2,000. For income-based Medicaid, the threshold is generally 138% of the Federal Poverty Guidelines (FPG), but this can vary depending on family size, pregnancy status, and age.
| Characteristics | Values |
|---|---|
| Administering agency | Ohio Department of Medicaid (ODM) |
| Funding | Jointly funded by the state and federal government |
| Eligibility | Low-income individuals of all ages |
| Household income up to 138% of the poverty level | |
| Income under $2,901/month for a single nursing home applicant in 2025 | |
| Assets under $2,000 for a single nursing home applicant in 2025 | |
| Income under $21,597 per year for an individual | |
| Income under $44,367 per year for a family of four | |
| Income under $67,837 per year for a family of four with members under 18 | |
| Income under $65,908 per year for a pregnant individual with a family of four | |
| Income under $43,358 per year for a single pregnant individual | |
| Application | Combined application form submitted to the County Department of Job and Family Services (CDJFS) office |
| Application checked via the Ohio Medicaid (Ohio Benefits) website | |
| Application checked via HealthCare.gov | |
| Application checked by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or 1-800-292-3572 (TTY) | |
| Application checked by calling 1-800-318-2596 (if under 65 and without Medicare) |
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What You'll Learn
Income-based thresholds for families
Medicaid is a health care program for low-income individuals of all ages. It is jointly funded by the state and federal government, with the Ohio Department of Medicaid (ODM) being the administering agency. The eligibility criteria for Medicaid in Ohio vary depending on age, marital status, and medical condition. Here is a detailed breakdown of the income-based thresholds for families:
Family of Four:
- Income limit: $44,367 per year to qualify for income-based Medicaid.
- If pregnant: Income up to $65,908 per year.
- If 18 or younger: Income up to $67,837 per year.
Single Individual:
- Income limit: $21,597 per year to qualify for income-based Medicaid.
- If pregnant: Income up to $43,358 per year.
It is important to note that Medicaid counts most types of earned and unearned income. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, some income is not counted, such as Supplemental Security Income (SSI) benefits and certain retirement account contributions. Additionally, there are no limits on resources or assets for income-based Medicaid eligibility.
Furthermore, if your income is higher than the threshold, you may still qualify for Medicaid through alternative pathways. For example, if you have a disability, you can apply for Medicaid Buy-In for Workers with Disabilities (MBIWD). Additionally, if you are a senior, you may be eligible for long-term care programs, such as Institutional/Nursing Home Medicaid or Medicaid Waivers/Home and Community-Based Services (HCBS). These programs have their own financial and medical eligibility criteria, which should be reviewed separately.
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Income-based thresholds for individuals
Medicaid is a health care program for low-income individuals of all ages. The program is jointly funded by the state and federal government, with the Ohio Department of Medicaid (ODM) being the administering agency. The income-based thresholds for individuals seeking Medicaid insurance in Ohio are as follows:
For an individual to qualify for income-based Medicaid in Ohio, their income must be at or under 138% of the Federal Poverty Guidelines (FPG), which equates to $21,597 per year for an individual. This is the general threshold for an individual seeking Medicaid coverage. However, it is important to note that Medicaid considers income from various sources, including employment wages, alimony payments, pension payments, Social Security Disability Income, and stock dividends.
Additionally, Ohio has specific programs and considerations for certain individuals:
- Pregnant women: If an individual is pregnant, their income threshold is slightly higher. They can have an income up to 205% of FPG, which is approximately $43,358 per year for a single pregnant woman with her first child. The unborn baby is considered a family member by Medicaid.
- Individuals with disabilities: Ohio offers the Medicaid Buy-In for Workers with Disabilities (MBIWD) program for individuals with disabilities who have higher incomes. This program allows individuals with disabilities to work and maintain Medicaid coverage, even if their income is higher than the standard threshold.
- Seniors: In Ohio, Medicaid provides long-term care programs for seniors aged 65 and older. The financial eligibility criteria for these programs can vary and may include income and asset limits. For example, a single applicant for Nursing Home Medicaid in 2025 must have an income under $2,901 per month and assets under $2,000.
- Children: While the focus is on income thresholds for individuals, it is worth noting that Ohio's Children's Health Insurance Program (CHIP) covers children up to age 19 from low-income families. The income threshold for CHIP is higher than that of Medicaid, with a threshold of 200% of poverty for a family of four.
It is important to remember that Medicaid eligibility in Ohio is determined by a combination of factors, including income, age, disability status, and family composition. Additionally, Medicaid considers both countable and non-countable assets when determining eligibility. Non-countable assets include personal belongings, household furnishings, an automobile, and certain retirement accounts.
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Countable vs. non-countable income
In Ohio, Medicaid is a health care program for low-income individuals of all ages. The state jointly funds the program with the federal government. The Ohio Department of Medicaid (ODM) is the administering agency.
To qualify for Medicaid, an applicant's income must be under a certain threshold. Nearly all income that a Medicaid applicant receives is counted towards this limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends.
However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. In Ohio, IRAs/401Ks in "payout status" are exempt from the income limit. This means that one's Required Minimum Distribution (RMD) is being withdrawn. Additionally, if only one spouse applies for Regular Medicaid, the income of the non-applicant spouse is also not counted towards the applicant's income eligibility.
When it comes to assets, countable assets are calculated towards Medicaid's asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. On the other hand, Medicaid considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, and irrevocable burial trusts.
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Countable vs. non-countable assets
In Ohio, Medicaid is jointly funded by the state and federal government, with the state administering the program within federally set parameters. The Ohio Department of Medicaid (ODM) is the administering agency. Medicaid is a health care program for low-income individuals of all ages.
When determining eligibility for Medicaid, the government considers an applicant's "countable" income and assets. Countable assets are calculated toward Medicaid's asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside.
Medicaid considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, and irrevocable burial trusts. In Ohio, IRAs/401Ks in "payout status" are exempt. This means that one's Required Minimum Distribution (RMD) is being withdrawn. One's primary home is also generally exempt.
Retirement accounts that are in payout status are no longer considered "countable" when calculating eligibility for Medicaid. Retirement accounts in payout status include, for example, Individual Retirement Accounts (IRAs) for which the owner must take required minimum distributions.
If one is over the asset limit after considering all non-countable assets, one can "spend down" assets in order to meet Medicaid's asset limit. For persons applying for Medicaid-funded nursing home care or Home and Community-Based Services via a Medicaid Waiver, there is a 60-month Look-Back Period. During the "look back", all past transfers are reviewed. If one has gifted assets or sold them under fair market value during this timeframe, a Penalty Period of Medicaid ineligibility will be established.
In 2025, a single Nursing Home Medicaid applicant in Ohio must meet the following criteria:
- Income under $2,901/month
- Assets under $2,000
- Require a Nursing Home Level of Care
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Medicaid expansion in Ohio
Medicaid is a health care program for low-income individuals of all ages. It is jointly funded by the state and federal government, with the state administering the program within federally set parameters. The income thresholds for Medicaid insurance in Ohio vary depending on the applicant's age, marital status, and number of dependents.
For a family of four, the income limit for Medicaid eligibility in Ohio is $21,597 per year or 138% of the Federal Poverty Guidelines (FPG). For a family of four with a pregnant woman, the income limit is $65,908 per year or 205% of FPG. The unborn baby is counted as a family member. For an individual, the income limit is $21,597 per year or 138% of FPG, while for a single pregnant woman, the income limit is $43,358 per year or 205% of FPG.
For those under 18 years old, the income limit is more flexible. A family of four with an annual income of up to $67,837 (211% of FPG) may qualify for Medicaid. This is because, for children under 19, the income limit is considered 206% of FPG, but Medicaid knocks 5% off the household income if it is above this threshold. Therefore, the effective income limit is 211% of FPG.
Ohio has expanded Medicaid under the Affordable Care Act (ACA), and low-income adults without dependent children have been eligible for coverage since 2014. The ACA's Medicaid expansion took effect in January 2014, and Ohio used a Section 1115 waiver to expand Medicaid in 2013 to cover 30,000 non-elderly adults in Cuyahoga County. The eligibility threshold was set at 138% of the poverty level, in line with ACA guidelines.
In addition to income criteria, Medicaid eligibility in Ohio also considers assets. Countable assets include cash, stocks, bonds, investments, bank accounts, and real estate that is not the primary residence. Exemptions include personal belongings, household furnishings, an automobile, and irrevocable burial trusts. IRAs/401Ks in "payout status" are also exempt.
Ohio offers alternative pathways to Medicaid eligibility, such as the Medicaid Buy-In for Workers with Disabilities (MBIWD) and Medicaid for people with severe and persistent mental illness (SPMI). Additionally, individuals who qualify for Supplemental Security Income (SSI) automatically receive Medicaid coverage without needing to apply separately.
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Frequently asked questions
Medicaid is a health care program for low-income individuals of all ages. It is jointly funded by the state and federal government, with the state administering the program within federally set parameters.
The income thresholds for Medicaid insurance in Ohio vary depending on the applicant's age, marital status, and number of dependents. For example, an individual with no dependents must have an income under $2,901 per month to qualify for Medicaid in Ohio as of 2025. A family of four with one child under 18 and a pregnant woman would fall under the threshold of $65,908 per year.
You can apply for Medicaid in Ohio by checking your eligibility on the Ohio Medicaid website and then enrolling if eligible. You can also call their hotline at 1-800-324-8680 or 1-800-292-3572 (TTY).
