What Happens During a Medicaid "Spend-Down" in Ohio?

When someone applying for Ohio Medicaid long-term care has more countable assets than the program's limit — $2,000 for a single applicant in 2026, reported figures indicate — a spend-down means using the excess on the applicant's own behalf until countable assets fall under the limit, not giving assets away. Allowed spend-down purchases typically include paying off a mortgage or other debt, prepaying funeral and burial arrangements, home repairs or modifications, replacing an unreliable vehicle, and paying down medical bills. Converting a countable asset into an exempt one — for example, using cash to pay off the primary home's mortgage — can also reduce countable assets without being treated as a gift. This is different from the Medicaid look-back review, which specifically checks for assets given away or sold below fair market value in the prior five years; see our look-back period explainer for that distinction. Because spend-down mistakes (like an improperly documented gift) can trigger a penalty period, most elder law attorneys recommend planning a spend-down before, not during, a Medicaid application.