Enacted in 1965, the Medicaid program gives insurance coverage to people who meet the eligibility requirements. Each state has its own rules that are within the federal standards.

Under the Affordable Care Act of 2010, there will be a new national minimum eligibility level starting January 1, 2014. This will cover most people with incomes that are up to 133% of the Federal Poverty Level (FPL), meaning most adults who are below 65 years old with incomes of up to around $15,000 a year will be eligible for the Medicaid Insurance program in every state.

The Medicaid Insurance in Ohio offers various programs, depending on the condition of the applicants. Some of these programs include the following:

• Medicaid for Older Adults and People with Disabilities

• Medicaid for Pregnant Women, Children and Families

• Medicaid Buy-In for Workers with Disabilities

• Youth Aged Out of Foster Care

• Family Planning Services (FPS)

• Breast and Cervical Cancer Project (BCCP)

The Medicaid Insurance program in Ohio provides a wide array of services to consumers, including preventive care. Some of these services are restricted by the number of visits each year, the setting of how they are provided, or by dollar amount.

There are services that must be provided to consumers, as mandated by federal regulations including:

• Ambulatory Surgery Centers

• Certified pediatric nurse practitioner services

• Medical and surgical dental services

• Certified family nurse practitioner services

• Medical and surgical vision services

• Laboratory and x-ray

• Family planning services and supplies

• Home health services

• Healthchek (Early Periodic Screening, Diagnosis, and Treatment or EPSDT) program for children 21 years old and below

• Inpatient hospital

• Physician services

• Medicare Premium Assistance

• Nursing facility care

• Non-Emergency Transportation or NET to Medicaid health services

• Outpatient services (including those that are provided by federally qualified health centers and rural health clinics)

Since each state has the authority to provide optional benefits aside from the mandatory benefits, these are the medical services provided specifically to Medicaid consumers in Ohio (some of these services may need authorization first):

• Dental services

• Ambulance or Ambulette

• Community mental health services

• Chiropractic services for children who are below 21 years old

• Community alcohol and drug addiction treatment

• Hospice care

• Home and community-based services waivers

• Durable medical supplies and equipment

• Podiatry

• Occupational therapy

• Independent psychological services for children

• Physical therapy

• Intermediate care facility services for people who have mental retardation

• Private duty nursing

• Prescription drugs

• Vision care (including eyeglasses)

• Speech therapy

Eligibility Requirements

The Ohio Medicaid Insurance gives medical assistance to eligible people, including the following groups:

• People who have disabilities

• Old individuals (65 years of age and older)

• Pregnant women

• Children up to 19 years old

• Families with children who are below 19 years of age

• Certain women who are screened for Cervical and/or Breast Cancer

Here are the basic conditions to become eligible to receive Medicaid benefits:

• Must be a citizen of the United States or meet the citizenship requirements of Medicaid

• Must be a resident of the state of Ohio

• Must have a social security number or proof of application

• Must meet certain income requirements

There are certain income guidelines for each Medicaid programs. If you feel that you do not qualify, it is advisable to still submit an application because you might be eligible to have your income reduced through some deductions that will help you become qualified. You’ll never know if you do not apply since the actual verification of eligibility is carried out at the job and family services in each county department.

 

There are cases in which a copayment may be charged to you for certain medical services. Such payments must be given to your medical provider when you receive health care services.

 

Listed below are the services and the amount you need to pay as a copayment:

• Dental services: $3 per visit

• Non-emergency medical services acquired in an emergency room in a hospital: $3 per visit

• Eyeglasses: $1 per fitting

• Regular eye exams: $2 per check up

• Medicines that need prior approval: $3 per prescription or refill

• Non-generic medicines: $2 per prescription or refill

Your medical services provider cannot refuse to provide health care services if you’re unable to give copayment; however, this will be charged as a debt and you need to pay them in the future. Your providers may decline to give you medical services if you have not paid your copayments in the past.

 

Certain individuals may not be charged a copayment including those who are:

• Below 21 years old;

• Living in intermediate care facilities for the mentally retarded or in nursing homes;

• Pregnant or whose pregnancy ended 90 days ago at most (there are still copayments for eyeglass fittings and regular eye checkups);

• Given hospice care;

• Given services related to family planning; or

• In an MCP (Managed Care Plan) that doesn’t charge copayments to its members.

Medicaid Application Instructions




Here are the steps on how you can apply for the Ohio Medicaid Insurance:

1. Choose what Medicaid program you may be eligible and would want to apply for and then fill up the application. You may apply online by going to this link http://odjfsbenefits.ohio.gov/.

2. Carefully read and complete the application. You should attach copies of proof of your eligibility such as your income, resources, your citizenship or qualified alien status, other insurance (if you have any), pregnancy (if it applies to you), age (if you’re applying because you are already 65 years old or older), and disability (if applicable).

3. After completing the application, you should sign it and then send it to your local county department of job and family services, along with other additional materials. You may submit it through mail, fax, or drop it off personally. You also have a choice to have an authorized representative who will apply for you on your behalf. Here’s a list of the county agency directory of the Department of Job and Family services. http://jfs.ohio.gov/County/County_Directory.pdf

 

There are four different ways for consumers to get health care services through Ohio Medicaid Insurance. Admission to the various services depends on your eligibility category and/or your needs.

1. Fee-For-Service or the Traditional Medicaid – The providers of the health insurance program (including hospitals, pharmacies, doctors, and medical equipment companies) directly charge Medicaid for the services they give to the consumers. Those who are eligible for this service may go to any one of the Medicaid providers that receive Medicaid patients. Before scheduling for an appointment, it is best to first ask the medical service provider if they accept Medicaid. You may get a list of the Ohio Medicaid providers by calling the Hotline at 1-800-324-8680 or TTY/TDD 1-800-292-3572.

2. Medicaid Managed Care – Managed Care Plans or MCP are private insurance companies that arrange the needed health care services for covered members. All services offered through the Fee-For-Service, as well as other additional services, are provided by MCPs. The providers directly charge MCPs for the services acquired by the members.

3. Home and Community-Based Services – The programs under this type of service provide substitutes to living in facility-based settings (for example, an intermediate care facility or a nursing home). Home and community-based services programs, known as waivers, let consumers stay in their community and have an active part in their health care. Waivers are usually for people who have physical disabilities, who are elderly, and who have developmental disabilities and/or mental retardation.

4. Facility-Based Care – This type of setting (such as nursing homes) are for consumers who are unable to take care of themselves. This may be expensive that’s why the Ohio Medicaid program helps eligible people by providing financial support for their long-term care.

 

After you have been determined as qualified to receive Medicaid benefits, you will receive a medical card in your mail every month. If you are enrolled in an MCP, you will only get a monthly card for around two months; it will stop once you receive your permanent managed care I.D. from your MCP. It is important to always carry your card wherever you go.