New Rules – Medicaid, Your House and Big Change

New Rules – Medicaid, Your House and Big Change

Ohio has made a significant change regarding homeowners who apply for Medicaid benefits for nursing home or assisted living care.

Until July 31, 2016, an unmarried homeowner who wanted Medicaid to pay for long-term care costs had 13 months to put his home up for sale. If the Medicaid applicant was married and the spouse still lived in the home, there was no obligation to sell.

That 13-month time period is gone. As part of the Aug. 1, 2016 change in rules, Ohio Medicaid rescinded the 13-month rule. Now, the unmarried applicant must decide to keep the house or to sell before applying for Medicaid.


If the person decides not to sell, he can choose to invoke Medicaid’s “intent to return home” condition. That means he is not required to sell the house before getting Medicaid coverage. The intent must be expressed in a written, signed statement. This exemption ends if he later establishes a “principal place of residence” elsewhere.

This new “principal place of residence” condition can jeopardize Medicaid coverage.

If someone has been in a nursing home or assisted living community for many months (not for rehabilitation purposes) it’s unlikely his home can still be called his principal place of residence.

If the person’s health isn’t likely to improve, the principal place of residence has probably become the nursing home or assisted liv- ing community. Even if the intent to return home is real, it may not be realistic. As a result, Ohio Medicaid may stop paying expenses for someone whose intent to return home is not realistic.

For now, it’s uncertain if Medicaid will challenge an applicant’s written statement of intent to return home. Upon renewal of Medicaid benefits, however, if he remains in the nursing home or assisted living community, Medicaid officials may rule the person’s house is no longer his “principal place of residence” because, by the time of the first renewal, he will have lived out of the house for at least a year. As a result, Medicaid coverage could be suspended until the house is sold and the proceeds spent.

If Medicaid accepts the person’s statement of intent to return home — even if it’s unlikely to happen — there won’t be enough money for property taxes, maintenance, insurance and other expenses. Medicaid allows recipients just $2,000 in savings and $50 in monthly income.

In addition, if the person keeps the house until he dies, Medicaid will place a lien on the house for the amount that Medicaid spent on his care.


A single homeowner applying for Medicaid for long-term care should decide about the house before applying for assistance. While the “intent to return” option is a way to delay making a decision, the inability to pay house expenses will not only be a financial hardship but could also cause the house to lose value.

In addition, the risk of Medicaid placing a lien or seeking recovery in other ways always looms. Selling a house can be traumatic, but it’s good to deal with it now rather than later.

About the author

Jim Koewler (last name rhymes with sailor) is an attorney who works with Miller Trust Services Company, LLC, which helps longterm care providers (such as nursing homes and assisted living facilities) and their residents meet their obligations with the Miller Trust rules. For additional information contact Jim at [email protected]

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