What is Medicaid?
Medicaid is a state and federally funded health care coverage plan providing assistance to low-income and medically vulnerable people. Ohioans eligible for Medicaid are entitled to medically necessary services at no or low cost. The state cannot limit the number of eligible persons enrolled in Medicaid or deny access to medically necessary services in order to control costs.
Please continue to read this General Medicaid Information page if you are unfamiliar with all of the categories of assistance, or select one of these programs:
Who is Covered by Medicaid?
Medicaid provides health care coverage to people who meet certain financial requirements including:
Families and Children Families, children up to age 19 and pregnant women with limited incomes, are covered through Medicaid under Healthy Start or Healthy Families. Additionally, families with children under age 18 who participate in the Ohio Works First cash assistance program (OWF), are automatically covered by Medicaid. Families who leave OWF for employment are eligible for 6-12 months of coverage during that transitional period. Low-income adults without dependent children do not qualify for Medicaid under existing eligibility categories. Click here to go to the Healthy Start & Healthy Families page.
Aged, Blind and Disabled (ABD) Adults 65 and older may be eligible for Medicaid. Individuals of any age with disabilities, including individuals who are legally blind, can also qualify for Medicaid. Also in some cases, individuals can "spenddown" their income to become Medicaid eligible. Click here to go to the Aged, Blind & Disabled page.
What is Medicaid Spenddown? Medicaid spenddown is for elderly and disabled individuals who meet the Medicaid eligibility guidelines except their income is too high. These individuals can use paid or incurred medical expenses to "spend down" their income to qualifying Medicaid income levels. Once the consumer reaches his or her designated "spenddown" limit each month, he or she becomes qualified for Medicaid. The date of eligibility each month depends on the date the consumer reaches the spenddown amount.
Medicare Premium Assistance Program Individuals with low incomes who are eligible for Medicare can receive help with all or part of their Medicare Part B premiums, co-payments and/or other deductibles. Different levels of assistance are available depending on income. Click here to go to the Medicare Premium Assistance Programs page.
Breast & Cervical Cancer Medicaid Medicaid is available to women who have been screened for breast or cervical cancer through the Ohio Department of Health's Breast & Cervical Cancer Prevention Program (BCCP), and are found to be in need of treatment for breast and/or cervical cancer, including precancerous conditions. In order to qualify, women also need to be uninsured and meet the basic Medicaid requirements (e.g., income, Ohio residency, etc.). Women who qualify will receive full Medicaid coverage benefits, not just cancer treatment benefits. Medicaid coverage ends when cancer treatment is completed. For further information, please contact BCCP at 1-800-324-8680, or view their website at www.odh.ohio.gov/odhPrograms/hprr/bc_canc/bcanc1.aspx
How Do Consumers receive Medicaid Services?
Medicaid provides primary and acute care services through a fee-for-service system or managed care plans. Both delivery systems provide all medically necessary primary care, specialty and emergency care, and preventive services.
Ohio Medicaid also provides both home health care and facility-based services for those consumers requiring a long-term care benefit package. Home care services allow consumers to remain in their homes and communities. Long-term care services are also available for consumers needing care in nursing homes and facilities for persons with mental retardation. Alternatives to institutional care are offered through Home and Community Based Services Waivers.
What Services Does Medicaid Cover?
Ohio's Medicaid program includes services mandated by the federal government, as well as optional services Ohio has elected to provide. Some services are limited by dollar amount, the number of visits per year, or the setting in which they can be provided. With some exceptions, all services are available as medically necessary to all Medicaid consumers.
Federally Mandated Services
- Transportation to Medicaid services
- Medical & surgical dental services
- Medical & surgical vision services
- Durable medical equipment & supplies
- Family planning services & supplies
- Home health services
- Inpatient hospital
- Lab & x-ray
- Medicare Premium Assistance
- Nursing Facility care
- Nurse midwife services
- Certified family nurse practitioner services
- Certified pediatric nurse practitioner services
- Outpatient services, including those provided by Rural Health Clinics & Federally Qualified Health Centers
- Physician services
- Healthchek (EPSDT) program services (screening & treatment services to children 21 and younger
Ohio's Optional Services
- Ambulance / ambulette
- Chiropractic services for children
- Community alcohol & drug addiction treatment
- Dental services
- Home and Community Based Services Waivers
- Hospice care
- Intermediate Care Facility services for people with Mental Retardation (ICF-MR)
- Physical therapy
- Occupational therapy
- Speech therapy
- Prescription drugs
- Independent psychological services for children
- Vision care, including eyeglasses
Eligibility at a glance*
|Who's Covered?||Income Guidelines|
|Pregnant Women & Children (up to 19)||200% FPL|
|Disabled Persons**||~ 64% FPL|
|Persons 65 & over**||~ 64% FPL|
|Disabled Person age 16-64 who are able to work**||~ 250% FPL|
|Medicare Premium Assistance Program||Varies|
|Institutional Level of Care||Income less than the cost of care|
|* Exceptions and calculations will affect final amount counted toward eligibility. Actual determination of eligibility is done at a county job & family services offices. Some eligibility categories consider resources other than income.|
|** Deductions and exceptions apply; this is an approximate guide. Persons with incomes higher than the FPL listed above may have medical expenses deducted from income calculations to "spenddown" to this level.|
Monthly FPL Guidelines (Effective 01/01/2012)
|Family Size||90% FPL||150% FPL||200% FPL||250% FPL|
For more information about the Medicaid program please contact the local county department of job and family services, call the Medicaid Consumer Hotline 1-800-324-8680 / TDD 1-800-292-3572, or view the Ohio Health Plans website at http://jfs.ohio.gov/ohp/