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.
Those who meet the age or disability criteria, but whose income is higher than the income limit can use the cost of medical care to “spend down” or offset their eligible income to qualify for Medicaid.
Disability Assistance and SSI-Case Management
DA is a program that offers case management and help with the costs of health care. (Some people who get DA only get help with the costs of health care.) The most cash one person can usually receive on DA is $115 a month.
You may be able to receive DA cash and medical help if you are disabled – this means you have a health problem that keeps you from working. This health problem could be physical or mental. It must last for at least nine months. If it lasts for less than nine months, it must be serious enough that it could lead to death. You must get information from a doctor or a clinic about your health problem. You will need to give this information to your county department of Job and Family Services (CDJFS). your CDJFS will give this information to the Ohio Department of Job and Family Services (ODJFS). ODJFS will decide if you are considered disabled based on your information.
Nursing Home/Long Term Care/Waivers
This program offers benefits to individuals who are elderly or disabled and meet additional criteria:
• 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.
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). The Ohio Department of Job and Family Services (ODJFS) and the ODH coordinated efforts to implement this new category of Medicaid eligibility effective July 1, 2002.
Getting help starts with a call to PASSPORT at 1-800-686-7367 or 740-8455 to determine what an individual’s long term care needs are, including eligibility for PASSPORT Home Care or other services.
To help determine the best way to meet long term care needs, a comprehensive, in-home assessment of an individual’s health and living conditions, conducted by a nurse/social worker team, is suggested. To receive an in-home assessment, the individual must be age 60 and over and considering community based care or nursing home placement.
If eligible for in-home services through PASSPORT, a six month plan of services is proposed.
Through the site, www.benefits.ohio.gov, Ohioans will be able to start their application for the state health care program and, in many cases, finish the application online. Online enrollment will be a first for Medicaid in Ohio. Currently, to enroll in the program, a person needs the approval of a caseworker at a county Jobs and Family Services office, …
Medicaid and Managed Care
Ohio Department of Job and Family Services (Medicaid Fact Sheet)