Medicaid Spend-Down in Delaware County, Ohio (2026)

The Document You Have to Create: Ohio’s Qualified Income Trust

Start with this one because it has the longest critical path and because families do not know it exists.

Ohio applies an income limit to long-term-care eligibility tied to a multiple of the federal benefit rate. An applicant whose gross monthly income exceeds that limit is over-income — and unlike some states, Ohio does not simply let the excess be applied to the cost of care as a deductible. Ohio requires the excess to flow through a Qualified Income Trust, commonly called a Miller trust, which is a specific kind of irrevocable trust that receives the income and disburses it under rules Ohio Medicaid sets, with the state named in the required remainder position.

What that means practically:

• Somebody has to draft it. An Ohio elder law attorney, in language that satisfies Ohio Medicaid. Generic online trust forms fail.
• Somebody has to open a bank account for it — a separate account titled to the trust, with its own tax identification arrangements. Some banks handle these routinely; others will send you away.
• Somebody has to fund it every single month. This is where families fall down. The trust has to receive the required income each month, consistently. A missed month can mean a month of ineligibility, and the family often does not learn about it until a redetermination.
• It does not shelter money. A Miller trust is a mechanism for meeting an income test, not a way to keep income. Nearly all of what flows through it goes to the facility.

Ask the Delaware County Department of Job and Family Services on day one whether the applicant is over-income. If the answer is yes, call an attorney that week. Everything else in the packet can be gathered while the trust is being drafted; the trust cannot be gathered while everything else is being drafted.

Note also that income and assets are separate tests. A perfectly executed Miller trust does nothing about a countable life insurance policy, and clearing the asset test does nothing about an over-income problem.

What Only the Applicant’s Own Files Can Produce

These are the items that exist in a drawer, a safe deposit box, or nowhere. Nobody can reissue several of them quickly.

• Identity and citizenship documents. Birth certificate, Social Security card, photo identification. For an applicant born in the 1930s, a replacement birth certificate through Ohio’s vital records process can take weeks — start it immediately if it is missing.
• Marriage certificate, and a divorce decree or death certificate if applicable. These decide whether spousal rules apply, and spousal rules change every number in the case.
• Military discharge documents. A DD-214 opens the door to VA benefits that may run alongside Medicaid, including Aid and Attendance for a qualifying veteran or surviving spouse. Nobody at the county agency will ask about this; ask about it yourself.
• The durable power of attorney and health care power of attorney. Without financial authority, nobody can act on an account, a policy, or a trust. If these do not exist and the applicant no longer has capacity, guardianship through the Delaware County Probate Court takes weeks and costs money. This is the single most common cause of delay in the entire process.
• Any long-term care insurance policy. Find it. A long-term care policy can change the entire plan, and families forget policies bought in the 1990s and paid by automatic draft ever since.
• Prepaid funeral paperwork. Not just “the funeral is paid for” — the actual contract, including the paragraph stating whether it is revocable or irrevocable. An irrevocable prepaid funeral contract with an Ohio funeral home is generally non-countable; a revocable arrangement is generally countable beyond a small burial-fund exclusion. Same dollars, opposite treatment.

Do this inventory before the crisis if at all possible. In a crisis, do it on day one and assign it to whichever family member is not managing the hospital.

What Only the Carriers Can Produce: Four Facts Per Policy

Families bring the policy contract from 1987. The caseworker needs current numbers on carrier letterhead. For every policy the applicant owns, request in writing:

1. Current face amount — the death benefit today, not at issue. Face amounts change: a universal life policy may have been reduced to keep it in force, a group policy may have stepped down at retirement, a burial policy may have grown through paid-up additions.
2. Current cash surrender value, net of any policy loan. The asset test uses the net figure. Nine thousand dollars of gross cash value with a $5,000 loan outstanding is $4,000 net. If the statement does not show the net, ask specifically.
3. Current premium and payment mode. This matters more than families expect, because once the applicant’s income goes to the facility as patient liability, nobody is paying the premium. An unpaid permanent policy lapses, and the family receives nothing — no death benefit, no cash value, nothing.
4. The rider schedule. Specifically whether there is an accelerated death benefit or chronic illness rider. Read this before considering any other option, because a rider may pay a portion of the death benefit directly, sometimes on better terms than any outside offer, and reading it costs nothing.

How to get them: call the carrier’s policyholder service line with the policy number. If the carrier’s name has changed through merger — and for policies issued in the 1980s and 1990s it very often has — the current entity honors the old policy number. If the family cannot identify the carrier at all, search Ohio’s unclaimed funds program through the Ohio Department of Commerce and the industry policy-locator services.

The Delaware County wrinkle. This is the highest-income county in Ohio, sitting on the northern edge of the Columbus metropolitan area, and its retiree population skews toward corporate, professional and executive careers rather than industrial ones. That produces a particular kind of file: supplemental executive life insurance, split-dollar arrangements, universal life policies bought in the 1980s and early 1990s when illustrated interest assumptions were far more generous than what actually occurred, and group coverage through employers that have merged since. Those policies are often larger than the family realizes, more expensive to maintain than the family realizes, and more valuable than the surrender check suggests. All three facts are relevant, and all three come from the carrier statement.

What Only the Banks Can Produce, and Why to Ask Today

Ohio reviews the sixty months preceding the application for transfers of assets for less than fair market value. That review runs on bank records, and bank records have the longest lead time of anything in the packet.

Request in writing, on day one, from every institution: sixty months of statements for every checking, savings, money market, certificate of deposit and brokerage account — including accounts closed during the period. Closed-account records take longer to retrieve than open-account records. Institutions can generally produce them, sometimes for a per-statement fee, and it takes them weeks.

Then annotate as they arrive. Print them and write on them. The distinction that governs everything:

• Generally not a transfer: the applicant’s own medical, dental, hearing and vision bills; paying the applicant’s own debts; repairs and accessibility modifications to the applicant’s own home; a needed replacement vehicle; an irrevocable prepaid funeral; attorney and care-manager fees. Value came back to the applicant.
• A transfer: gifts to children or grandchildren of any size; paying a grandchild’s tuition; adding a name to a deed; forgiving a loan; a lump-sum payment to a family member for past caregiving without a written agreement made beforehand; transferring a life insurance policy’s ownership.

The federal gift tax annual exclusion is a tax rule with no application whatsoever to Medicaid eligibility. There is no small-gift safe harbor, and a recurring monthly gift aggregates into a single large transfer. A disqualifying transfer produces a penalty period computed by dividing the transferred amount by an average private-pay nursing facility figure the state publishes; ask the county agency for the current divisor rather than using an old one.

An unexplained withdrawal is, by default, treated as a transfer, because a caseworker has no other way to treat it. “$8,400 — roof, invoice attached” resolves in seconds. “I don’t remember” becomes a penalty period. Annotate now, while somebody still remembers. And never transfer a policy’s ownership as a planning step; it is valued at fair market value, which for a policy with real secondary-market value can substantially exceed cash surrender value. See how the look-back applies to a policy sale.

Document	Who holds it	Lead time
Qualified Income Trust (Miller trust) and its bank account	Does not exist yet — attorney drafts, family funds monthly	Longest critical path; start week one if over-income
Sixty months of statements, including closed accounts	Each bank, credit union and brokerage, in writing	Weeks; request on day one
Current face amount and net cash surrender value per policy	Each insurance carrier’s policyholder service line	Days to weeks; the 1987 contract is not a substitute
Rider schedule (accelerated death benefit, chronic illness)	The carrier	Read before considering any other option
Recorded deeds and mortgages	Delaware County Recorder	Days; recorded transfers will be found
Current market valuation of the home	Appraiser or broker	Days — needed because Ohio uses the lower federal equity cap
Durable and health care powers of attorney	Family records, or Delaware County Probate Court if guardianship is needed	Weeks if guardianship must be established
DD-214 military discharge	Family records or the National Archives	Weeks; opens VA benefits nobody will ask about
Prepaid funeral contract with irrevocability language	The funeral home	Days; read the paragraph that matters

What Only Delaware County Can Produce: Deeds, Values, and the Equity Cap

Three county records belong in the packet, and one of them raises an issue that is genuinely unusual for Ohio.

The Delaware County Recorder’s records hold every recorded deed and mortgage. Pull them for every parcel any family member has an interest in. If a parent added a child to a deed in 2022, it is recorded and public, and the caseworker will find it whether or not the family volunteers it. Better to know first.

The Delaware County Auditor’s records hold the current tax valuation, which the family will need and which is not the same as market value.

A current market valuation — an appraisal or a broker’s opinion — which is what raises the unusual issue.

A primary residence is generally excluded from countable resources while the applicant lives in it, and it remains excluded for a period during a facility stay where there is an intent to return home or where a spouse, minor child, or disabled adult child lives there. But the exclusion is capped by a federal home-equity limit, and Ohio has applied the lower end of the federal range — in the neighborhood of $730,000, with the 2026 figure to verify.

In most Ohio counties that cap is purely theoretical. In Delaware County it is not. This is the wealthiest county in the state, with median home values far above the Ohio median, and the higher-value stretches of Powell, the Delaware County side of Dublin and Westerville, and newer development around Sunbury and Lewis Center include properties whose owners hold equity approaching or exceeding that ceiling — particularly where a house has been owned outright for twenty years through a period of substantial appreciation.

So a Delaware County family should establish the equity figure before filing rather than assuming the house is protected. If the number is close to the cap, that is an elder law attorney conversation, not a self-help project.

The other Delaware County record worth pulling: whatever documentation exists for any interest in agricultural land. This county’s growth has converted a great deal of farmland into subdivisions, and older families frequently hold a remaining parcel, a fractional interest, or an option that is countable at equity value even where it cannot practically be sold.

What the Caseworker Does With the Insurance Numbers

The rule runs on face value and it aggregates, which is why the carrier statements matter more than the contracts.

Add the face amounts of every policy the applicant owns on their own life. If the combined total is $1,500 or less, the cash surrender value of those policies is generally excluded as a burial resource. If the combined total exceeds $1,500 by any amount, the entire cash surrender value of all of them becomes a countable resource.

A $1,400 burial policy is invisible. A $12,000 whole life policy with $4,300 of cash value puts $4,300 in the countable column, more than twice the limit. A $400,000 executive universal life policy with $95,000 of cash value puts $95,000 there — and in Delaware County, policies of that size are not unusual.

Term insurance carries no cash surrender value, so there is generally nothing to count as a resource, but its face amount still counts toward the $1,500 aggregation test and can therefore strip the exclusion from a small whole life burial policy sitting beside it. Verify the current threshold with the county agency. Our page on how life insurance is counted as a Medicaid asset covers the mechanics and the Ohio asset and income limits page holds the state figures.

Four exits exist when a policy lands in the countable column, and they are not interchangeable. Keep paying and stay ineligible. Surrender for cash value — the simplest, immediate, and by design the lowest-value exit. Elect reduced paid-up coverage, which stops the premium but leaves cash value countable and therefore fixes an affordability problem rather than an asset problem; see reduced paid-up versus a settlement. Or have the policy reviewed for the secondary market, where a licensed institutional buyer may pay more than surrender value if the policy meets its criteria.

Remember the sequencing: proceeds from any of these are generally treated as income in the month received and a countable resource afterward. Converting a policy to cash does not by itself create eligibility. It creates a countable balance that then has to be legitimately spent — on care, on the applicant’s own needs, on an irrevocable funeral arrangement — before the asset test is met.

When selling is the wrong answer. When the total face amount sits inside the burial exclusion, in which case leave it alone. When the face amount is above the exclusion but below the size institutional buyers evaluate, where the realistic options are surrender or an irrevocable funeral arrangement. When a surviving spouse will need the death benefit, particularly where a pension was elected without a survivor option. When the insured is in good health for their age, since secondary-market pricing runs on life expectancy underwriting and produces low offers or none. And always before the rider schedule has been read.

The Document That Comes Later: the Attorney General’s Estate Recovery File

Ohio does something most states do not, and every Delaware County family should know it before the application rather than after the funeral.

Ohio’s Medicaid Estate Recovery Program is administered through the Ohio Attorney General’s office, which pursues recovery against the estates of deceased Medicaid recipients who received long-term care services. That means the claim does not come from the county agency the family has been working with; it comes from the state’s collections operation, on its own timeline, after death.

Two practical consequences:

• An excluded house is not a protected house. The residence exclusion applies to eligibility during life. It does not immunize the property from an estate recovery claim afterward. In a county with Delaware County’s home values, that claim can be substantial.
• Ohio requires notice to the Attorney General in estate administration involving a Medicaid recipient. The executor of the estate has obligations here, and an executor who distributes assets without addressing a Medicaid claim can create personal problems. Whoever is going to serve as executor should know this now.

There are hardship provisions and exceptions in the estate recovery framework, and their application is fact-specific. This is another place to get an Ohio elder law attorney involved early rather than leaving it to an adult child with a probate form and good intentions.

Filing in Delaware, Ohio: Agencies, Costs, and the Local Reality

The Delaware County Department of Job and Family Services, in the city of Delaware, processes long-term-care Medicaid applications for county residents, with the state’s Ohio Benefits self-service portal available as well. Ask for the long-term-care document checklist before you begin, ask on day one whether the applicant is over-income, and expect sixty months of asset verification.

The Central Ohio Area Agency on Aging, in Columbus, is the designated Area Agency on Aging covering Delaware County and administers PASSPORT, Ohio’s home and community based program for older adults. It performs the assessment that establishes whether a nursing-facility level of care is met — a separate determination from financial eligibility — and provides free options counseling. This is the right first call if the family has not decided between home care and a facility.

OSHIIP, the Ohio Senior Health Insurance Information Program, is housed at the Ohio Department of Insurance and is the state’s federally funded free counseling program for Medicare and related insurance questions. It sells nothing, and it is the right place to bring policies nobody understands.

The Ohio Department of Insurance also regulates life insurance and life settlement activity in Ohio and can confirm whether a company contacting you about a policy holds an Ohio license.

An Ohio elder law attorney, for the Qualified Income Trust, for the home-equity question, for any transfer inside the look-back, for estate recovery planning, and for any married couple.

On cost: independent cost-of-care surveys and CMS Care Compare data place Ohio semi-private skilled nursing roughly in the $8,000 to $9,300 a month range as of 2026, with Delaware County and the northern Columbus suburbs generally at or above the state figure — local labor and real estate costs run higher — and assisted living in Powell, Lewis Center and the Dublin corridor commonly quoted between about $5,000 and $6,800 a month. Ranges, not quotes; get three written figures, and see our Delaware County nursing home cost page.

The local facts that change the packet strategy. First, Delaware County has the highest median household income and among the highest home values in Ohio, which makes the federal home-equity cap a live issue here in a way it is not in the rest of the state — so a current valuation belongs in the packet, not an assumption. Second, this county has been one of Ohio’s fastest-growing for two decades, and its skilled nursing capacity has not kept pace with a rapidly expanding 65-plus population, so families are frequently offered a bed in Franklin County rather than in Delaware, Sunbury or Powell. Start the placement search early, while it is still possible to choose rather than accept, and check CMS Care Compare ratings before geography.

If there is an in-force policy in the file, a free policy review will establish what it is genuinely worth before anyone signs a surrender form — including when the honest answer is that it has no market value and should be left alone. Pine Lake Life Solutions provides education and reviews only; eligibility belongs to Delaware County Job and Family Services and legal strategy to your own attorney.

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Frequently Asked Questions

What is a Qualified Income Trust and do we need one?

It is an irrevocable trust, often called a Miller trust, that Ohio requires when an applicant’s gross monthly income exceeds the long-term-care income limit. The excess income flows through the trust under rules Ohio Medicaid sets. It needs an attorney to draft, a dedicated bank account, and consistent monthly funding. Ask Delaware County Job and Family Services on day one whether the applicant is over-income.

Which document should we request first?

Three things simultaneously: ask the county agency whether the applicant is over-income so the trust drafting can start, request sixty months of statements from every financial institution including closed accounts, and request current written statements from every insurance carrier. Those three have the longest lead times, and everything else can be gathered while you wait.

Can a Delaware County house really exceed the home-equity limit?

It can. Ohio has applied the lower end of the federal home-equity range, in the neighborhood of $730,000 with the 2026 figure to verify, and Delaware County has the highest home values in Ohio. A property owned outright for twenty years in the higher-value parts of Powell, Dublin or Westerville can approach or exceed it. Get a current valuation before filing.

Why is the carrier statement so important?

Because the asset test uses today’s numbers, not the contract’s original ones. Face amounts change, cash value grows or is consumed by charges, and a policy loan reduces the net figure the caseworker uses. You need four facts in writing per policy: current face amount, net cash surrender value, current premium, and the rider schedule.

Why does a small burial policy stop being exempt?

Because the exclusion depends on the combined face value of every policy the applicant owns on their own life. If that total exceeds roughly $1,500, the entire cash surrender value of all of them becomes countable. One additional term certificate from a former employer is often enough to trip it. Add all the face amounts before assuming anything is protected.

Who pursues estate recovery in Ohio?

The Ohio Attorney General’s office administers Ohio’s Medicaid Estate Recovery Program, pursuing recovery against the estates of deceased recipients who received long-term care services. The claim comes from the state’s collections operation rather than the county agency, after death, and Ohio requires notice in estate administration involving a recipient. Whoever will serve as executor should know this now.

Why are we being offered a nursing home in Franklin County?

Because Delaware County has been one of Ohio’s fastest-growing counties for two decades and its skilled nursing capacity has not kept pace with its expanding 65-plus population. Placements frequently land in Franklin County. Start the search early while you can still choose rather than accept, and check CMS Care Compare ratings before deciding on geography.

Related Reading

• Nursing Home Costs Delaware County Oh
• Sell Life Insurance Policy Delaware County Oh
• Ohio Medicaid Asset Income Limits
• Life Settlement Taxes Ohio
• Life Insurance Counts Medicaid Asset
• Nursing Home Medicaid Spend Down
• Medicaid Lookback Selling Policy
• Reduced Paid Up Vs Settlement
• Sell Life Insurance Policy Butler County Oh

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Pine Lake Life Solutions does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.