Income Limits
Medicaid has income limits as part of its eligibility criteria. In 2025, the Ohio income-cap is $2,901 per month. However, due to the high costs of nursing home care, the state has enacted a “pathway” for applicants whose income is more than the income-cap to still qualify for benefits. This pathway is called a Qualified Income Trust.
Qualified Income Trusts
If the applicant has too much income, one mechanism for qualifying for Medicaid is the use of a Qualified Income Trust, also known as a Miller Trust. This is an irrevocable income-only trust that allows Medicaid recipients to place their “excess” income into the trust, and the trustee, in turn, uses those funds to pay the Medicaid co-pay and any other allowable monthly expenses.
Medicaid Co-Pay
Once eligible, the Medicaid recipient’s monthly income (less certain allowable deductions) must be paid to the nursing home each month toward the cost of care. This is known as “patient liability” and acts as a monthly co-pay. The allowable deductions include: (1) health insurance premiums; (2) a personal needs allowance of $50 for miscellaneous expenses; and (3) a monthly maintenance needs allowance for a spouse, if applicable.
Monthly Maintenance Needs Allowance
It’s a common myth that a spouse at home must use their income to support their spouse in the nursing home. In fact, the opposite is true. If the spouse at home, known as the Community Spouse, has monthly income below a certain threshold, some or all of the Institutionalized Spouse’s income can be allocated to the spouse at home. This is part of Medicaid’s spousal impoverishment rules which are designed to support the financial well-being of the spouse still residing at home in the community.
