What is Medicaid?
Medicaid is a state and federally funded health care plan administered by the Ohio Department of Job and Family Services (ODJFS). Medicaid provides health care coverage to low-income and medically vulnerable people of all ages. More than $11.1 billion of the annual ODJFS budget goes to the Medicaid program to provide health care to lower-income, elderly and disabled Ohioans. The Medicaid Consumer Hotline can answer general questions and is open evenings and weekends at 1-800-324-8680 (TDD 1-800-292-3572).
Medicaid and Medicare – What is the Difference?
Medicare is a federal health plan administered by the Social Security Administration serving elderly, blind and disabled individuals. Most persons on Medicare pay a monthly premium. Medicare is the same nationwide.
Medicaid is funded by state and federal monies and administered by each state for its residents. Medicaid is health care coverage for certain Ohioans with low income.
It is possible to have both Medicare and Medicaid.
Who is Covered by Medicaid?
Medicaid provides health coverage to a number of different groups of people who meet financial requirements. There are two major coverage groups, MAGI (Modified Adjusted Gross Income) and people who are Aged, Blind or have a disability (ABD). Each major group is served by several programs.
MAGI (Modified Adjusted Gross Income)
The Ohio Medicaid program offers two programs for children, families and pregnant women with limited income to get health care.
Coverage for people who are aged, blind, or have a disability 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.
Most adults and children who receive Medicaid must join a managed care plan (MCP). This is a private health insurance company that provides all the services you get with the Medicaid card, with some important differences and extra benefits. For more information link is provided below.
Programs for Children, Families, and Pregnant Women
Healthy Start included Medicaid and CHIP programs.
The Medicaid program is available to:
- Insured or uninsured children (up to age 19) in families with income up to 156% of the federal poverty level.
- Pregnant women in families with income up to 200% of the federal poverty level.
- The CHIP program is available to:
- Uninsured children (up to age 19) in families with income up to 206% of the federal poverty level.
- Healthy Families is a Medicaid program available to:
- Families with income up to 90% of the federal poverty level and a child younger than age 19.
Healthchek services are for children younger than 21.
Healthchek is Ohio’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. It is a service package for babies, kids, and young adults younger than age 21 who are enrolled on Ohio Medicaid.
- The purpose of Healthchek is to discover and treat health problems early. If a potential health problem is found, further diagnosis and treatment are covered by Medicaid.
Healthchek covers ten check-ups in the first two years of life and annual check-ups thereafter and offers a comprehensive physical examination that includes:
- medical history
- complete unclothed exam (with parent approval)
- developmental screening (to assess if child’s physical and mental abilities are age appropriate)
- vision screening
- dental screening
- hearing assessment
- immunization assessment (making sure child receives them on time)
- lead screening; and
- other services or screenings as needed
If your children are enrolled on Ohio Medicaid, Healthchek services are available to them. If you are younger than age 21 and are also enrolled, you can receive Healthchek services, too.
Nursing Home/Long Term Care/Waivers
OHIO Benefits Long-Term Services and Supports (OBLTSS) 844-644-6582
This program provides assistance to individuals and families so they may make informed decisions about the care and services they receive. OBLTSS has a Support Navigator who will answer questions and connect them to community resources based on the individual’s responses to questions regarding their needs.
- Institutional long-term care services are provided through a Nursing Facility or Intermediate Care Facility for the Developmentally Disabled to persons who are elderly or disabled.
Home and Community Based Services Waivers allow certain people to live in the community rather than an institution. To receive these services, a person must be eligible for Medicaid and require care in hospital, nursing home or institution. There are multiple waivers in Ohio which are available on a limited basis. Consumers must ask for waiver services when they apply for Medicaid.
- Passport offers an alternative to nursing home placement through customized care plans that help older adults maintain a safe, happy life at home.
- Assisted living waiver provides 24/7 care and support while maintaining their privacy and independence in an approved assisted living facility.
Getting Help with waiver services
Ashtabula, Trumbull, Mahoning, Columbiana
Direction Home of Eastern Ohio
1030 N. Meridian Road
Youngstown, OH 44509
Getting help starts with a call to PASSPORT at 1-800-686-7367 or 1-330-505-2300 to determine what an individual’s long term care needs are, including eligibility for PASSPORT Home Care or other services.
Medicare Premium Assistance Programs
Medicaid may pay for some or all of a Medicare beneficiary’s expenses including premiums, deductible or coinsurance.
Medicaid Estate Recovery
Ohio has the right to recover the cost of services paid by Medicaid from the estates of Medicaid consumers age 55 and older. This recovery cannot take place as long as a dependent spouse, minor child, or disabled adult children are still alive.
Breast and Cervical Cancer Project (BCCP) Medicaid
Federal law allows states the option of providing full Medicaid coverage available to certain women diagnosed with breast or cervical cancer, including pre-cancerous conditions. This Medicaid option is available to certain women diagnosed through the Ohio Department of Health’s (ODH) Breast and Cervical Cancer Project (BCCP). This Medicaid option is available to certain women diagnosed through the Ohio Department of Health (ODH). The Ohio Department of Medicaid operates this program in tandem with ODH. Benefits are issued through the Ohio Medicaid program under Medicaid fee-for-service (FFS).
Specialized Recovery Services
Individuals diagnosed with a serious and persistent mental illness, a diagnosed chronic condition, or who are active on the solid organ or soft tissue transplant waiting list may be eligible for the Specialized Recovery Services (SRS) program. Services available through the SRS program include recovery management, individualized placement and support, and peer support. Individuals eligible for the SRS program also receive full Medicaid coverage.
You may be eligible for the SRS program if:
- You have income below $2,349 per month ($28,188 per year);
- You are 21 years of age or older;
- You have been diagnosed with a severe and persistent mental illness, are actively on the solid or soft transplant waiting list or have a diagnosed chronic condition, which includes certain malignancies, HIV/AIDS or immune deficiencies, end stage renal disease (ESRD), sickle cell anemia, cystic fibrosis, hemophilia or if you have had a previous organ transplant;
- You need help with medical appointments and/or activities of daily living;
- You have been determined to meet the definition of disability used by the Social Security Administration for purposes of SSI or SSDI (this does not apply if you are under 65 with ESRD, or over 65 with certain diagnosed chronic conditions or actively on the solid or soft transplant waiting list); and
- You do not live in a nursing facility, hospital or similar setting.
If you are eligible, you may get these Medicaid-covered services in addition to your current Medicaid health care coverage:
- Recovery Management – Assistance developing a plan of care specific to your needs
- Individual Placement and Support (IPS) – Supported Employment – Help finding and keeping a job
- Peer Support – Support from others with similar life experiences
Children, Families, Women
Community Based Services
Specialized Recovery Services