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Ohio Medicaid Covered Services

Ohio Medicaid programs provides a comprehensive package of services that includes preventive care for consumers. Some services are limited by dollar amount, number of visits per year, or setting in which they can be provided. You can read more about how to get these services here.

We cover some of these services through our own programs and some are covered through your Managed Care plan.  The best thing to do is to talk with your county department of Job and Family Services or specific Managed Care plan to understand your coverage.

 

Alcohol and Drug Addiction

 

Alcohol/Drug Screening Analysis/Lab Urinalysis

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Ambulatory Detoxification

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Assessment

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Case Management

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? Up to 30 hours per week when combined with counseling and medical somatic

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Crisis Intervention

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Individual or Group Counseling (MHA certified providers)

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? Up to 30 hours per week when combined with case management and medical somatic

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Induction of Buprenorphine

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services and by hospitals, physician practices, and clinics. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Injection of Naltrexone (to treat addiction)

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services and by hospitals, physician practices, and clinics. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Intensive Outpatient (to treat addiction)

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Medical Somatic

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? Up to 30 hours per week when combined with counseling and case management

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Methadone Administration

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by a limited number of agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area that render this service.

Copay: $0

Dental

Braces

Who is Eligible? Individuals younger than age 21

How often? Braces are covered in extreme cases with prior authorization by the State.

Info: No additional information.

Copay: $0

Checkups and Cleanings

Who is Eligible? All Medicaid beneficiaries

How often? Every 180 days (6 months) for individuals younger than age 21; every 365 days (12 months) for individuals age 21 and older.

Info: There may be a copayment for dental services of $3 per visit for individuals age 21 and older.

Copay: $3 (individuals age 21 and older); $0 (individuals under age 21)

Dentures

Who is Eligible? All Medicaid beneficiaries

How often? Dentures may be replaced based upon meical necessity; dentures and partial plates must be prior authorized by the State.

Info: There may be a copayment for dental services of $3 per visit for non-pregnant individuals age 21 and older who are not residing in a nursing facility or intermediate care facility for people with mental retardardation.

Copay: $3

Fillings, Extractions, and Crowns

Who is Eligible? All Medicaid beneficiaries

How often? Based upon medical necessity; may require prior authorization by the State.

Info: There may be a copayment for dental services of $3 per visit for non-pregnant individuals age 21 and older who are not residing in a nursing facility or intermediate care facility.

Copay: $3

Medical & Surgical Dental Services

Who is eligible? All Medicaid beneficiaries

How often? Based upon medical necessity.

Info: No additional information

Copay:

Root Canals

Who is Eligible? All Medicaid beneficiaries

How often? Based upon medical necessity.

Info: There may be a copayment for dental services of $3 per visit for non-pregnant individuals age 21 and older who are not residing in a nursing facility or intermediate care facility.

Copay: $3

Emergency

Emergency Room Visits

Who is Eligible? All Medicaid beneficiaries

How often? Based upon medical necessity

Info: Non-emergency use of the emergency room may attract a $3 copayment.

Copay: $3 for non-emergency services ( applies to non-pregnant individuals age 21 and older who are not residing in a nursing facility or an intermediate care facility for persons with mental retardation)

Family Planning

Who is eligible? All Medicaid beneficiaries

How often? As needed

Info: No additional information.

Copay: $0

Healthchek

Who is eligible? Individuals younger than age 21

How often? 13 well-child visits by age 3 and then one every 12 months.

Info: Comprehensive health and developmental history; diagnosis and treatment identified as necessary during screening examinations.

Copay: $0

Hospital

Inpatient Hospital Services

Who is Eligible? All Medicaid beneficiaries

How often? Less than 30 covered days from the date of admission to 60 days after discharge with limited exceptions.

Info: Prior approval may be needed for some surgeries.  Chemical dependency detoxification is also covered.

Copay: $0

Outpatient Hospital Services

Who is Eligible? All Medicaid beneficiaries

How often? Medical review for more than 48 visits per year.

Info: Prior approval may be needed for some surgeries.

Copay: $0

Medical Equipment

Who is Eligible? All Medicaid beneficiaries

How often? Your health care provider must fill out a prior authorization form before you can get the equipment. Quantity limits and prior authorization requirements are specific.

Info: Medical equipment is also known as durable medical equipment; examples include bedside commodes, canes, crutches, diabetic supplies, hospital beds, incontinence garments, lactation pumps, lifts, and orthotics, ostomy or oxygen supplies, prosthetics, speech generating devices, walkers, and wheelchairs

Copay: $0

Medical Equipment

Who is Eligible? All Medicaid beneficiaries

How often? Your health care provider must fill out a prior authorization form before you can get the equipment. Quantity limits and prior authorization requirements are specific.

Info: Medical equipment is also known as durable medical equipment; examples include bedside commodes, canes, crutches, diabetic supplies, hospital beds, incontinence garments, lactation pumps, lifts, and orthotics, ostomy or oxygen supplies, prosthetics, speech generating devices, walkers, and wheelchairs

Copay: $0

Mental Health

Community Psychiatric Supportive Treatment

Who is Eligible? Any beneficiary with a medical need

How often? 104 hours per year; more service available with prior authorization documenting medical need.

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map to link you with eligible providers in your area and which services they provide.

Copay: $0

Crisis Intervention

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map that can link you with eligible providers in your area and which services they provide.

Copay: $0

Health Home Comprehensive Care Coordination

Who is Eligible? Medicaid beneficiaries with serious mental illness and identified by the State as needing care coordination

How often? No benefit limit

Info: This service can only be provided by agencies certified as Health Homes by the Ohio Department of Mental Health and Addiction Services. Click here for a list of health homes in Ohio.

Copay: $0

Individual or Group Counseling (MHA certified providers)

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? 52 hours per year; applies to individuals age 21 and older only.

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map to link you with eligible providers in your area and which services they provide.

Copay: $0

Individual or Group Counseling (non-MHA certified providers)

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? 25 visits per year.

Info: This service can be provided by a clinical psychologist, psychiatrist, physician, Advanced Practice Nurse, Licensed Counselor or Family Therapist, or a clinic. To locate an eligible provider, call the Medicaid consumer hotline at 1-800-324-8680.

Copay: $0

Injections (long-acting antipsychotic medications)

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services and other Medicaid providers including physician offices, clinics, and hospitals. Click here for a map to link you with eligible providers in your area and which services they provide. You may also locate eligible providers by calling the Medicaid consumer hotline at 1-800-324-8680.

Copay: $0

Mental Health Assessment

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? 4 hours per year; applies to individuals age 21 and older only.

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map to link you with eligible providers in your area and which services they provide.

Copay: $0

Partial Hospitalization

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? No benefit limit

Info: This service can only be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services. Click here for a map to link you with eligible providers in your area and which services they provide.

Copay: $0

Pharmacological Management

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? 24 hours per year; applies to adults only.

Info: This service can be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services and other Medicaid providers including psychologists, physician offices, clinics, and hospitals. Click here for a map to link you with providers certified by the Ohio Department of Mental Health and Addiction Services in your area and which services they provide. You may also call the Medicaid consumer hotline at 1-800-324-8680 for a list of Medicaid providers in your area.

Copay: $0

Psychiatric Diagnostic Interview

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? 2 hours per year; applies to adults only.

Info: This service can be provided by agencies certified by the Ohio Department of Mental Health and Addiction Services and other Medicaid providers including psychologists, physician offices, clinics, and hospitals. Click here for a map to link you with providers certified by the Ohio Department of Mental Health and Addiction Services in your area and which services they provide. You may also call the Medicaid consumer hotline at 1-800-324-8680 for a list of Medicaid providers in your area.

Copay: $0

Psychological Testing

Who is Eligible? Any Medicaid beneficiary with a medical need

How often? 8 hours per year.

Info: This service can be provided by a clinical psychologist, psychiatrist, physician, Advanced Practice Nurse, Licensed Counselor or Family Therapist, or a clinic. To locate an eligible provider call the Medicaid consumer hotline at 1-800-324-8680.

Copay: $0

Pregnancy

Who is eligible? All female Medicaid benficiaries

 

How Often? No limit.

 

Info: All pregnancy related services are covered. Services include: education, care coordination, counseling, high risk monitoring, nurse midwife services, preconception care, prenatal care, ultrasounds, prenatal risk assessment, delivery, and transportation.

 

Copay: $0

Prescriptions

Prescription Drugs

Who is Eligible? All Medicaid beneficiaries except those who are eligible to enroll in Medicare Part D; Part D-eligible beneficiaries can only receive Medicaid coverage for medications that are excluded from Medicare Part D coverage

How often? Less than a 34 day supply diespensed at a time for drugs to treat acute conditions.  Less than a 120 day supply dispensed at a time for drugs to treat chronic conditions.

Info: Prior authorization required for name-brand prescription drugs when generic ones are available.  Learn more about prescriptions here.

Copay: $3 for prescription drugs requiring prior authorization (non-pregnant and non-institutionalized individuals over age 21); $2 copay for most name-brand drugs (non-pregnant and non-institutionalized individuals over age 21); $0 copay for hospice consumers and medications for emergency services and family planning services.

Preventive Health

Chest X-Rays

Who is Eligible? Long-term care facility residents

How often? Once every 12 month period.

Info: No additional information.

Copay: $0

Immunizations

Who is Eligible? All Medicaid beneficiaries

How often? No limits

Info: Vaccines recommended by the Centers for Disease Control, the American Academy of Pediatrics, and the Advisory Committee on Immunization Practices are covered. Annual flu shots and pneumonia shots are also covered.

Copay: $0

Mammography

Who is Eligible? Women between the ages of 35-40

How often? One screening for women between the ages of 35-40, and then once every 12 month period thereafter.

Info: No additional information.

Copay: $0

Physical Exam

Who is Eligible? Residents in residential facilities licensed by the Ohio Department of Developmental Disabilities

How often? Once every 12 month period.

Info: No additional information.

Copay: $0

Preventive Exams and Screenings

Who is Eligible? All Medicaid beneficiaries

How often? No limits

Info: Services include cervical cancer screenings, colonoscopies for individuals age 50 and older or high risk individuals, employment physicals if not covered by another source, gynecologic exams, prostate cancer screenings, and required physician visits for long-term-care facility residents.

Copay: $0

Professional Medical Services

Ambulatory Surgery Centers

Who is eligible? All Medicaid beneficiaries.

How often? Based upon medical necessity.

Info: No additional information.

Copay:

Audiology Services

Who is eligible? All beneficiaries

How often? One conventional hearing aid every four years; one digital or programmable hearing aid every five years.

Info: Hearing aids with prior authorization.  Individuals younger than age 21 are eligible for conventional, digital, and programmable hearing aids.  Individuals age 21 and older are eligible for conventional hearing aids.

Copay: $0

Certified Family Nurse Practitioner Services

Who is eligible? All Medicaid beneficiaries

How often? Based upon medical necessity.

Info: No additional information

Copay:

Certified Pediatric Nurse Practitioner Services

Who is eligible? All Medicaid beneficiaries

How often? Based upon medical necessity.

Info: No additional information

Copay:

Chiropractor Services

Who is eligible? All Medicaid beneficiaries

How often? 30 visits every 12 months for children younger than age 21; 15 vists every 12 months for adults older than age 21.

Info: No additional information.

Copay: $0

Laboratory and X-Ray Services

Who is eligible? All Medicaid beneficiaries

How often? Annual chest X-rays for long-term care facility residents.

Info: Medically necessary services that are ordered by a physician are covered, as well as mammograms.

Copay: $0

Occupational Therapy

Who is eligible? All Medicaid beneficiaries

How often? 30 visits for physical and occupational therapy combined every 12 months, prior authorization needed for additional visits.

Info: No additional information.

Copay: $0

Physical Therapy

Who is eligible? All Medicaid beneficiaries

How often? 30 visits for physical and occupational therapy combined every 12 months, prior authorization needed for additional visits.

Info: No additional information.

Copay: $0

Physician Services

Who is eligible? All Medicaid beneficiaries

How often? Up to 24 visits every 12 months with additional visits for specified conditions.

Info: Physician and family nurse practitioner services.

Copay: $0

Podiatrist Services

Who is eligible? All Medicaid beneficiaries

How often? One long-term care facility visit per month.  One nail debridement per 60 days.

Info: No additional information.

Copay: $0

Private Duty Nursing Services

Who is eligible? All Medicaid beneficiaries

How often? Can be more than four hours per visit or up to 16 hours per day in limited circumstances.  Post-hospital stay benefit with less than 56 hours per week for less than 60 days.

Info: Nursing visits from 4 to 12 hours in length, prior authorization required.

Copay: $0

Speech/Language Pathology Services

Who is eligible? All Medicaid beneficiaries

How often? 30 visits for speech/language pathology and audiology services combined every 12 months, prior authorization needed for additional visits.

Info: No additional information.

Copay: $0

Transportation

Ambulance/Ambulette

Who is Eligible? All Medicaid beneficiaries

How often? When medically necessary and patient cannot be transported by any other type of transportation.

Info: Non-emergency transportation to and from Medicaid-covered services through the County Departments of Job and Family Services.  Prior authorization is not normally required for wheelchair vans, but certification of necessity is required.  Prior authorization is not normally required for ambulances, but certification of necessity is required for non-emergency use.

Copay: $0

Non-Emergency Transportation

Who is Eligible? All Medicaid beneficiaries

How often? When medically necessary and patient cannot be transported by any other type of transportation.

Info: Non-emergency transportation to and from Medicaid-covered services through the County Department of Job and Family Services.

Copay: $0

Vision

Medical and Surgical Vision Services

Who is eligible? All Medicaid beneficiaries

How often? Based upon medical necessity.

Info: No additional information

Copay:

Optometrist and Ophthalmologist Services

Who is eligible? All Medicaid beneficiaries

How often? One exam and eyeglasses every 12 months (individuals younger than age 21 and older than age 60).  One exam and eyeglasses every 24 months (individuals between the ages of 21 and 59).

Info: Contact lenses covered with prior authorization.  Glaucoma screenings also covered.

Copay: $2 for exam and $1 for eyeglasses (individuals older than age 21 not residing in a nursing facility or an intermediate care facility for people with mental retardation).

 

The information provided on this page is for informational purposes only, and ODM disclaims any obligation or liability based upon its use. The formally adopted state plan, statutes, and rules governing the Ohio Medicaid program prevail over any conflicting information provided here.

Consumer Hotline

Questions? Call the Ohio Medicaid Consumer Hotline at 800-324-8680

Find your County Office