Medicaid State Plan
Quality Strategy and Measures
Long Term Care
Children and Families
Older Adults / Individuals with Disabilities
Enrollment and Support
Provider Exclusion and Suspension List
Federal Requirement for Revalidation ReEnrollment
Automated Registry Check
Fee Schedule and Rates
HIPAA and EDI Information
How to Refund Overpayments
Answers for MITS Problems
HIPAA 5010 Implementation
Behavioral Health Integration Project
MITS Information Releases
Prior Authorization Requirements
Balancing Incentive Program
Disability Determination Redesign
Medicaid Health Homes
Frequently Asked Questions
Electronic Visit Verification
Reports and Research
Legal and Contracts
For Medicaid Vendors
Workgroups and Committees
Medical Care Advisory Committee
Ohio Medicaid Administrative Study Council
Testimony and Presentations
Acronyms & Glossary
CMP Grant Projects
Resources for Providers
Ohio Medicaid offers its consumers four different options for getting health care services. Access to these services depends mainly on a consumer's Medicaid eligibility category and/or care needs.
Traditional Medicaid (Fee-For-Service)
Ohio Medicaid has a network of providers statewide including (but not limited to): hospitals, family practice doctors, pharmacies and durable medical equipment companies. These providers bill Medicaid directly for health care services they provide to Medicaid consumers. Medicaid consumers eligible for getting care through Traditional Medicaid may go to any Ohio Medicaid provider who accepts Medicaid patients. Consumers should ask the provider if they accept Medicaid before scheduling an appointment. For a list of Ohio Medicaid providers, please contact the Consumer Hotline at (800) 324-8680.
Medicaid Managed Care
In Ohio, certain Medicaid consumers get their health care services through Managed Care plans (MCP). MCPs are private health insurance companies responsible for arranging health care services for covered members. MCPs provide all of the services offered through Traditional Medicaid but additional services may be provided by an MCP. Managed Care providers bill MCPs directly for health care services obtained by their members.
Home and Community-Based Services
Home and community-based services programs provide alternatives to living in facility-based care settings (such as a nursing home or intermediate care facility). These programs are called "waivers" and allow for consumers to have an active role in their health care and to remain in the community. Waivers serve people who are elderly, who have mental retardation and/or developmental disabilities, and who have physical disabilities.
Consumers who cannot care for themselves at home may need care in a facility-based care setting (such as a nursing home or other long-term care setting). Because this type of care can be costly, Ohio's Medicaid program can help Medicaid-eligible Ohioans pay for their long-term care.