Ohio Medicaid Health Insurance is available to many Buckeye State residents. Medical plans are currently provided to more than three million individuals and families, with pre-existing conditions covered, and premiums either free or extremely inexpensive. Comprehensive benefits are provided after a short application is submitted and approved. Food and cash assistance, help with housing and utilities, and mental health and addiction services are also offered through other Agencies.
The two public assistance cards are “Direction” and “EPPIC.” If you currently utilize either of the cards, an additional application is not needed. Veterans or persons serving in the Military may have additional options. WIC (women, infants, and children) offers supplementary nutrition assistance to breastfeeding and pregnant women, and children less than five years old. Nutrition and breastfeeding education, and specific foods (eggs, vegetables, fruits, whole grains) are provided to eligible persons. Infant mortality has been greatly reduced, while birth weight and length of pregnancy have increased, due to WIC and other similar programs.
Applicants that can qualify for benefits include individuals with low income, persons with disabilities, older adults, infants, small children, and pregnant women. Additional requirements are US citizenship, legally reside in Ohio, and be able to meet specific income guidelines. Applications can be submitted online or through the mail. A personal visit is not required. Non US citizens that are ineligible for coverage can apply for alien emergency medical assistance or refugee medical assistance. Refugees who have been in the US less than eight months, and are ineligible for Medicaid, may be able to receive benefits if their household income is less than 100% of the poverty level.
CHIP and Medicaid eligibility is largely determined by the MAGI (Modified Adjusted Gross Income). Of course, the more money the household earns, the less federal or state funds are provided. You can view specific information regarding the calculation here. Expansion has taken place in many states (including Ohio), so more applicants are now eligible. “Healthy Start” and “Healthy Families” are available to state residents that have a social security number and meet certain financial requirements.
“Healthy Start” (also known as “SCHIP”) is available to uninsured children (19 and under) with household income up to 206% of the Federal Poverty Level (FPL). Applicants must be a US citizen, permanent resident, or legal alien. Any person that has illegally entered the United States will not be eligible for benefits.
Pregnant women in families with income up to 200% of the FPL and covered children (19 and under) with household income up to 156% of the FPL also qualify. There is no pre-existing condition clause, or waiting period for treatment, once enrolled in the program. After becoming eligible for Medicaid, each child will have access to Healthchek, Ohio’s early and periodic screening, diagnosis and treatment program.
Comprehensive coverage is provided (including preventative benefits) along with other coverage, including dental, ER, alcohol and drug addiction, family planning, hospitalization, Healthchek (see below), vision, transportation, mental health, pregnancy, transportation, prescriptions, and medical equipment.
“Healthy Families” is offered to families, with a child under age 19, that have income no higher than 90% of the Federal Poverty Level. Coverage is available to the adults, but not children. Applicants must be a US citizen and a legal resident of Ohio. There is no cost to enroll or secure coverage. Once approved for Medicaid, fee-for-service benefits begin, although you are required to re-apply every six months. Proof of US citizenship and income will be required.
Household income will be re-calculated every six months to ensure continued eligibility. Case workers should always be informed of changes that impact income or eligibility. Once approved, there is no waiting period before using services. A case worker will be assigned to provide assistance, and record changes that may impact eligibility.
Applying for coverage can be completed online by completing a CPA (Combined Programs Application). Phone assistance is also available. Covered benefits include Preventative healthcare, dental, vision, ER, outpatient and inpatient hospital expenses, prescription drugs, pregnancy and prenatal care, drug and alcohol addiction, and HealthChek. Typically, a “managed care” plan must be chosen. The four available options in Ohio are:
UnitedHealthcare Community Plan
Buckeye Health Plan
“Healthchek” provides newborns, children, and young adults (through age 20) preventative, diagnosis and treatment services. Ten checkups in the first two years along with follow-up annual checkups provide comprehensive healthcare. If additional treatment is required, Medicaid will pay for the expenses. NOTE: The program is also known as EPSDT (Early Periodic Screening, Diagnosis, and Treatment).
Each physical examination includes a medical history review, complete unclothed exam, vision and dental screening and other screenings and services, if recommended by the attending physician. Physical therapy benefits are actually more comprehensive than similar coverage offered to adults. Dental coverage is also more comprehensive than many plans offered to adults.
Other services include hearing and immunization assessments and additional diagnosis and treatment if a potential health problem is discovered. Any necessary lab tests and nutritional advice will also be provided. Additional information can be found here. Note: Newborns should utilize all 10 exams before their third birthday. By age three, only one exam is generally required each year. Physicians that accept Medicaid for insurance reimbursement, can also be used for Healthchek exams. If you move to a different county, a Healthchek Coordinator should be notified.
Medicaid Covered Benefits
The list is long and comprehensive, but we have highlighted the major coverage below:
Mental Health And Illness – Crisis intervention, partial hospitalization, psychological testing, group and individual counseling, psychiatric diagnostic interview, and pharmacological management.
Preventative Health – Immunization, mammogram, OBGYN visit, routine annual physical, annual flu and pneumonia shots, chest x-ray, and prostate and cancer screenings.
Drug And Alcohol Addiction – Case management, methadone administration, intensive outpatient, crisis intervention, drug/alcohol screening and lab urinalyses, and Naltrexone injection.
Pregnancy, Maternity, And Delivery – Covered females can receive benefits on all deliveries, including C-Sections. Generally, a $0 copay applies. Common benefit services include preconception and prenatal care, amniocentesis, physical examinations, blood tests and urinalyses, medical history assessment, counseling, high-risk monitoring, transportation of mother, ultrasound, pain medication, and of course, the delivery.
ER Visits – Benefits are included although a low $3 copay may apply if treatment is not considered an emergency.
Medical Equipment – Approved durable equipment includes (but is not limited to) walkers, wheelchairs, speech-generating devices, hospital beds, crutches, canes, prosthetic devices, breast pumps, diabetic supplies, and oxygen supplies.
Dental – Checkups and cleanings are provided every six months for persons under age 21 and annually for adults. A $3 copay applies to adult visits. Braces and orthodontia often require prior approval. Dentures and partial plates also must be approved. Fillings, extractions, root canals, and crowns are often covered. level of benefits are often determined based on medical necessity.
Vision – Medical and surgical benefits are provided along with annual vision checkup with one pair of glasses (every two years for adults). Screenings for Glaucoma are also covered.
Additional resources and initiatives include:
Balancing Incentive Program – Increased federal funding is utilized to improve long-term care services. Disabled persons and Seniors can live in non-conventional residences, and learn more about available services.
Electronic Visit Verification – Provides verification of services and the length of time they were performed. Private duty and home health nursing are included.
Payment Innovation – Quality of services rendered should be rewarded, as opposed to the volume of services provided.
MyCare Ohio – See below.
Disability Determination Changes – Several administrative procedures that determine eligibility were combined into one process. Persons impacted include the blind, aged, or disabled. “Spending down” is not required, and more lower-income individuals can qualify for benefits.
Budget Cost-Containment – Limiting per-member cost increases to less than 3% is the ultimate goal.
Transition Of Home And Community-Based Services – HCBS must meet specific guidelines and provide protections to persons receiving benefits.
Persons Receiving Both Medicaid And Medicare Benefits
Managed care benefits are available through MyCare Ohio, who provides long-term, medical, and behavioral coverage. Enrollment is required if you live in a “demonstration” county, are 18 or older, and currently are receiving Medicare and Medicaid benefits. A plan will be chosen for you, if you do not select a choice. Written confirmation will be sent, with the your deadline for enrollment. Behavioral support and long-term care is also provided. Note: You can compare Medicare Supplement plans in Ohio, and customize benefits and cost. Many levels of prescription drug coverage can also be chosen.
MyCare began in 2014 and provides benefits in 29 counties for more than 100,000 persons. Medicare-eligible applicants can retain their existing coverage. A “care team” helps coordinate your treatment. Members of the team include your primary-care physician, specialists, family members, case managers, and other medical personnel. Generally, reviews of your overall health are conducted regularly, and all treatment (if needed) is discussed. This system simplifies and organizes your benefits, since you have one main point of contact, instead of several persons in different cities.
Disabled and older adults often need assistance with routine daily activities, such as eating, getting mail, taking baths or showers, and preparing meals. LTC services help individuals and families enjoy a more routine and comfortable life, with Medicaid’s help. Specific services offered include private duty nursing (PDN), if the need is between 4 and 12 hours of continuous assistance. The personal-care physician (pcp) can help coordinate nurse’s care. Hospice services are also available for the terminally ill, and they can discontinue the benefits at any time. LTC plans are offered by several carriers, although the cost of coverage significantly increases as you get older.