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My spouse needs more care than I can give

Options that keep a couple together, and the spousal protections Ohio Medicaid provides.

Quick answer

Options that keep a couple together, and the spousal protections Ohio Medicaid provides.

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Home›By Situation›My spouse needs more care than I can give

Caring for a spouse is different from caring for a parent, financially and otherwise. Ohio Medicaid has specific protections for the spouse who stays at home.

Short answer

Options that keep a couple together, and the spousal protections Ohio Medicaid provides.

What to do, in order

  1. Understand the spousal protections. Ohio Medicaid has a Community Spouse Resource Allowance so the spouse at home is not impoverished, ranging from about $31,267 to $148,620 in 2025, plus a separate Minimum Monthly Maintenance Needs Allowance. Confirm current figures with Ohio Medicaid or an elder law attorney.
  2. Look at communities that keep couples together. Several Cleveland-area campuses offer more than one level of care on one site, so a couple can remain close even when needs diverge. Ask specifically how couples are handled and what a second-person fee covers.
  3. Be honest about your own health. Spousal caregivers routinely under-report their own decline. The plan needs to survive you being unwell for a fortnight.
  4. Get an objective assessment. The Area Agency on Aging serving your county can assess both of you at no cost, which is more useful than either of you assessing the other.

Questions Cleveland families ask

Are there minimum staffing rules for assisted living facilities in Ohio?

Staffing requirements are built into OAC 3701-16 and require facilities to maintain staff sufficient to meet residents' scheduled and unscheduled needs, though Ohio does not publish a single fixed resident-to-staff ratio for RCFs. Facilities must also ensure staff have training appropriate to residents' needs, including additional training obligations for staff working in a disclosed special care (memory care) unit.

Can a Cleveland assisted living resident get skilled nursing care without moving to a nursing home?

Yes, but only in a limited way. RCFs may provide skilled nursing services such as dressing changes, therapeutic diet supervision, and medication administration by licensed staff, capped at 120 days in any 12-month period under OAC 3701-16-02(D), unless the facility, resident, and physician agree in writing to extend it. Residents needing more than 8 hours a day of skilled nursing, ventilator support, or care for advanced pressure ulcers exceed what an RCF is licensed to provide.

Does Ohio's Medicaid expansion pay for a parent's assisted living or nursing home care?

No. Ohio's Medicaid expansion under the Affordable Care Act, effective January 1, 2014, covers adults age 19 to 64 up to 138 percent of the federal poverty level for acute and primary medical care. It's a completely separate pathway from the aged/blind/disabled Medicaid rules that govern nursing home and waiver eligibility for seniors. Long-term care coverage for seniors runs through Ohio's non-MAGI Medicaid rules, not the expansion population.

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