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Changes to Medicaid Coverage FAQs: Extending Medicaid to more Low-Income Ohioans
Who is newly eligible for Medicaid coverage?  
  • Beginning January 1, 2014, a new group of Ohioans are eligible for Medicaid coverage in Ohio.
  • This group includes adults between the ages of 19 to 64, who are between 0 – 138%* of the Federal Poverty Level (FPL) and are not eligible under another category of Medicaid.
     
  • NEW: Parents who are between 91-138%  of the Federal Poverty Level are now eligible. (Prior to January 1, 2014, parents at or below 90% of the poverty level were eligible.)
How can I apply for Medicaid?
  • To see if you are eligible for Medicaid benefits, you should complete an application online at Benefits.Ohio.Gov
  • If you cannot complete an application online you can go to your local JFS office and complete an application with a case worker or call the Ohio Medicaid Consumer Hotline at (800) 324-8680.

I think I am in the newly covered Medicaid population, when do I sign up?
  • As of December 9, 2013, newly eligible adults are able to submit applications through Benefits.Ohio.Gov for coverage starting on January 1, 2014.  Please Note: If you are a part of an existing Medicaid category and need coverage now, click here to apply now.

What does 138%* FPL look like for an individual or household?

What does 138 percent of the federal poverty level look like for an individual or household?

What if I learn I do not qualify for Medicaid?

  • If you do not qualify for Medicaid, you may qualify for help paying for insurance on the federal Health Insurance Marketplace.
  • For more information on the federal Health Insurance Marketplace visit HealthCare.gov or call the federal hotline at (800) 318-2596. 

 For additional help please visit your local county JFS or call the Medicaid Consumer Hotline at (800) 324-8680.


 *138% includes individuals who are at 133% FPL with a 5% disregard during eligibility calculations.  


Details on Extending Medicaid to More Low-Income Ohioans
Will residents in the newly covered population be considered participants in the Medicaid program?  
  • Yes, residents who are part of the extension population will be full participants in the Medicaid program. 
  • Residents in the newly eligible population are included in the MAGI Medicaid group so the rules that apply to the MAGI program categories also apply to the new population (income and household calculation rules).

  • Click here to review the MAGI Medicaid FAQs
     
When will the newly eligible group begin enrolling for Medicaid benefits and if found eligible when will their Medicaid benefit coverage begin?  
  • Enrollment for the newly covered population started on December 9, 2013 and Medicaid benefit coverage started January 1, 2014.

Are residents who are currently eligible for Medicaid now going to be covered under the newly covered population? 
  • Most residents who are currently eligible for Medicaid are not going to be covered under the newly covered population.
     
  • Certain individuals who are currently eligible on the basis of blindness or disability will be eligible to be covered under a MAGI coverage group

If a resident currently has Medicaid coverage, do they have to change their Managed Care plan?  
  • No, residents who are currently covered by Medicaid will not have changes to their plans, unless they fall under the following categories:
     
  • Receive a Medicaid spenddown 
  • Are a part of the Medicaid buy in for workers with disabilities (MBIWD) 
  • If a resident is under age 65, currently pay a spenddown or MBIWD premium, and are NOT covered by Medicare, you may be eligible for coverage without a spenddown or premium.  Contact your case worker to find out. 

How will Medicaid benefits for the newly covered population be different from the benefits available to current Medicaid recipients?
 
  • The newly eligible group will have essentially the same Medicaid benefit coverage as individuals currently enrolled on Medicaid through the same Managed Care plans. Medicaid benefit coverage can be found here
  • The specific benefit package available to the newly eligible population will be available soon. Please check back here for more information. 

Will all residents who are part of the newly covered population be enrolled in Medicaid Managed Care Plans? 

  • Yes, all residents who are newly eligible for Medicaid will receive Medicaid benefits through a Managed Care provider.

Residents who are excluded from Medicaid Managed Care plans include:

  • Medicaid eligible Individuals on home and community based waivers 
  • Medicaid eligible Individuals who are institutionalized 
  • Individuals eligible for both Medicaid and Medicare 
  • Individuals eligible for Medicaid who have a spenddown 
  • BCMH (Bureau for Children with Medical Handicaps) children diagnosed with cancer, cystic fibrosis, or hemophilia

  • More information on Managed Care plans can be found here

Will residents who are part of the newly covered population be able to select and change Managed Care Plans like current Medicaid recipients?   

  • Yes, residents who are part of the newly eligible population will be able to choose, or change, their managed care plans just like current Medicaid recipients. 

Will residents in the newly covered population be subject to co-pays? 

  • Individuals on Medicaid may be subject to minimal co-pays for select services. More information on Medicaid services can be found here.

Does the newly covered population have any asset limits that can prevent someone from qualifying?

  • There are no asset tests or asset restrictions for the newly eligible population because the newly covered population falls within the MAGI eligibility rules. 

  • Click here to review the MAGI Medicaid FAQs