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Medicaid Overview

What is Medicaid?

Medicaid is a state and federally funded health care coverage plan providing assistance to certain 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.

Who is Covered by Medicaid?

Medicaid provides health care coverage to people who meet certain financial, age, disability and resource requirements.

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. Adults 19 and 20 years old may qualify for related Medicaid benefits. Low-income adults, 21 to 64 years of age, without dependent children do not qualify for Medicaid under existing eligibility categories.

Aged, Blind and Disabled (ABD) Adults 65 and older may be eligible for Medicaid.  Individuals of any age that receive SSI, SSD or with verifiable disabilities that will exceed 12 months may also qualify for Medicaid. To learn more about ABD Medicaid call the Ohio Department of Job and Family Services Medicaid Hotline at 1-800-324-8680 or 1-800-292-3572.

What is Medicaid Spenddown?  Medicaid spenddown is for individuals who meet the Medicaid eligibility guidelines except their income is too high. These individuals can pay cash or 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 or pays in the spenddown amount.

Medicare Premium Assistance Program

  Individuals with low incomes and resources 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. For more information about the Medicare Premium Assistance Program, you may visit the Office of Ohio Health Plan's web site at http://jfs.ohio.gov/ohp/

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. If you are in a managed care plan, be sure to check with the medical provider to see if your plan is accepted. Check with your managed care plan on specific coverage benefits. For Medicaid eligibility information, please refer to the following website http://jfs.ohio.gov/ohp/consumers/whoqualifies.stm

Gallia County Residents can fill out an application and be seen daily between the hours of 7:00 am and 2:00pm. An additional interview is generally scheduled for the following day with a caseworker. Not all Medicaid applicants require a face to face interview. To request an application be mailed to you, call 740-446-3222 or 1-800-371-5987.

Federally Mandated Services

Pregnancy related services (PRS)

Transportation to Medicaid services

Medical & surgical dental services

Medical & surgical vision services

Durable meal 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

Healthcheck (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

Podiatry

Prescription drugs

Independent psychological services for children

Vision care, including eyeglasses