Medicaid is a state and federally funded health care plan administered by ODJFS. Medicaid provides health care coverage to low-income and medically vulnerable people of all ages.
The Medicaid Consumer Hotline is available to answer general questions at 1-800-324-8680 and is available:
Monday through Friday from 7:00 a.m. to 8:00 p.m.; and
Saturdays from 8:00 a.m. to 5:00 p.m.
For people with hearing problems, the TDD number is 1-800-292-3572. More information about eligibility, covered services and programs can be found by visiting http://jfs.ohio.gov/ohp.
WHO IS COVERED BY MEDICAID?
Medicaid provides health coverage to a number of different groups of people who meet financial requirements. There are three major coverage groups:
- Families, Children and Pregnant Women
- People who are Aged, Blind, or have a Disability (ABD), and
- Extension Medicaid
Each major group has several programs.
1. Families, Children and Pregnant Women
provides family or individual coverage based on income and the presence of a child in the home.
provides coverage to the entire family and is available to families with very low income. When a family’s income exceeds the income standard, the family may be eligible for an additional 12 months of transitional coverage. Families receiving Ohio Works First cash assistance are in most instances also eligible for Healthy Families.
provides medical coverage to children and pregnant women. Healthy Start covers children from birth through age 18, in families with limited income. Children in families with slightly higher income must be uninsured in order to receive this coverage. Pregnant women with family income up to the designated federal poverty guideline are also covered by Healthy Start. Visit http://www.jfs.ohio.gov/ohp for details
To apply for Healthy Start of Healthy Families, you may call our agency or 1-844-640-6446 for an application. You may also apply online at http://benefits.ohio.gov. A face to face interview is not necessary.
2. Coverage for people who are Aged, Blind, or have a Disability (ABD)
is available to individuals who meet income and resource limits. Adults 65 or older may be eligible for Medicaid. Individuals of any age with a disability, including individuals who are legally blind, may also qualify for Medicaid.
3. Extension Medicaid
provides coverage to all individuals with household income below 138% of the Federal Poverty Level (FPL) unless they are covered by Medicare.
WHAT SERVICES ARE COVERED BY MEDICAID?
In general, Medicaid provides comprehensive coverage for necessary health services. There are two benefit packages: (1) Primary and Acute Care, and (2) Long-Term Care.
The Primary and Acute Care Benefit is available to all Medicaid enrollees. Services can be provided through a fee-for-service system or a managed care plan. The majority of Medicaid recipients are enrolled in managed care plans. In the fee-for-service system, each family receives a Medicaid card and finds a doctor who accepts the card as payment for services. In a managed care plan, each family receives a member card from the managed care plan and selects a primary care doctor from the plan’s list of doctors. Copayments may be charged to certain individuals for select services.
Ohio’s Medicaid program provides a rich package of services, including preventive care for consumers. Examples of services available through the Primary and Acute Care Benefit include:
- Doctor visits
- Prescription drugs*
- Hospital care
- Dental care
- Vision care
- Home health services
- Mental health and substance abuse treatment services
- Durable medical equipment
- Physical therapy
- Occupational therapy
- Outpatient clinic
- (*Consumers with both Medicare and Medicaid get their prescription benefit through Medicare.)
Healthchek is Ohio’s Early and Periodic Screening, Diagnosis and Treatment (ESPSDT) Program. It provides a group of services to children and teens (birth through age 20) that include prevention, diagnosis, and treatment. The purpose of Healthchek is to discover and treat health problems early. Healthchek services are marketed to parents as a set of preventive health screenings with follow-up diagnosis and treatment.
The Pregnancy Related Services (PRS) program, administered by the County Departments of Job and Family Services, helps expectant mothers receive care management services. The goal of this program is to maintain or improve the health of the pregnant woman, increase the chances for a healthier baby, and promote positive birth outcomes.
Long-term Care offers benefits to individuals who are elderly or disabled and who meet certain criteria related to their care needs. These benefits are offered in addition to basic Medicaid services. Long-term care services are offered through the following:
Home and Community Based Services Waivers
These allow certain people to receive care in their homes and communities instead of in institutions. To receive these services, a person must be eligible for Medicaid and require care in a hospital, nursing home, or facility for those with developmental disabilities. Ohio has multiple waivers. Consumers may ask to apply for Medicaid at our agency. For more information, go to http://www.jfs.ohio.gov/ohp.
Institutional Long-Term Care Services
These are provided to people who are elderly or disabled, and who are receiving care at either a nursing facility or an intermediate care facility for the developmentally disabled. An individual must spend at least 30 days in a long-term care setting to qualify for Medicaid payment of long-term care services.
HOME Choice is Ohio’s “Money Follows the Person” (MFP) project funded with a grant from the federal government. The goal of Home Choice is to help older adults and people with disabilities relocate from institutional settings into home and community based settings. Home Choice offers the services of a transition coordinator, along with supports such as assistance in locating appropriate housing, establishing a household, and establishing social support networks. It is estimated that Home Choice will relocate approximately 2,200 seniors and people with disabilities during the life of the project.
To be eligible for Home Choice, individuals must:
- Have lived in a facility-based care setting for at least 90 days;
- Have certain care needs; and
- Be eligible for Medicaid.
Medicaid Buy-IN for Workers with Disabilities (MBIWD) is an Ohio Medicaid program providing health care coverage to working Ohioans with disabilities. MBIWD was created to encourage Ohioans with disabilities to work and still keep their health care coverage. Individuals must be Medicaid eligible, be employed in paid work, pay a premium, and meet certain financial criteria.
Specialized Recovery Services (SRS) Program is a new Medicaid program that became effective August 1, 2016 for individuals with Severe and Persistent Mental Illness with income less than 300% of the federal benefit rate. Effective July 1, 2017, the SRS program was expanded to include individuals who have been diagnosed with chronic conditions or who are active on the solid organ or soft tissue waiting list. This includes individuals in need of transplants and former transplant recipients. It also includes certain malignancies, HIV/AIDS or Immune Deficiencies, End State Renal Disease, Sickle Cell Anemia, Cystic Fibrosis and Hemophilia.
The Breast and Cervical Cancer Project (BCCP) provides full Medicaid coverage to certain women diagnosed with breast or cervical cancer, including pre-cancerous conditions, through the Ohio Department of Health’s Breast and Cervical Cancer Project.