Ohio.gov  |   State Agencies   |   Online Services
FOR OHIOANS  >  Programs
Medicaid Programs

Managed Care

Who is eligible? Most Medicaid beneficiaries are eligible for membership in an Ohio Medicaid managed care plan. 

Exceptions

Description: In Ohio, most individuals who have Medicaid must join a managed care plan to receive their health care. Managed care plans are health insurance companies that are licensed by the Ohio Department of Insurance and have a provider agreement with the Ohio Department of Medicaid to provide coordinated health care to Medicaid beneficiaries. These managed care plans work with hospitals, doctors and other health care providers to coordinate care and to provide the health care services that are available with an Ohio Medicaid card. If you have Medicaid, and are in a managed care plan, you need to get most of your health care from health care providers that work with your managed care plan.

More Information

Long-Term Care

Long-term services and supports are programs or services that help older adults and people with disabilities accomplish everyday tasks. These tasks may include bathing, getting dressed, fixing meals, and managing a home. As our population ages, the number of individuals needing this kind of help will increase. Long-term services and supports allow individuals to live healthy, secure, and independent lives either in a long-term care facility or in a home and community-based setting.

The Ohio Department of Medicaid offers the following long-term services and supports:

Home and Community-Based Services: Home and community-based services offer individuals with long-term care needs the option of receiving their services at home or in a community setting. These programs serve a variety of populations including individuals with intellectual or developmental disabilities, physical disabilities or mental illness. More Information

Services in a Facility: Individuals who cannot care for themselves at home may require services through a facility-based care setting (such as a nursing home or other long-term care setting). Ohio's Medicaid program can help Medicaid-eligible Ohioans pay for their long-term care.  More Information

Additional Services: Additional resources, programs and services are available for individuals who have long-term care needs. These needs may include private duty nursing, hospice services, and targeted case management. More Information

Children, Families, and Women

Breast and Cervical Cancer Project (BCCP)

Who is Eligible? Medicaid eligible women between the ages of 40 and 65 diagnosed with breast or cervical cancer, including pre-cancerous conditions.

Description: Provides full Medicaid coverage for certain women diagnosed with breast or cervical cancer or pre-cancerous conditions.

More Information

Healthchek/Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)

Who is Eligible? Medicaid eligible individuals up to age 21.

Description: Comprehensive preventive health care and support services to Medicaid eligible individuals from birth to 21 years of age.

More Information

Healthy Families Program

Who is Eligible? Families with household income up to 90% of the federal poverty level and a child (or children) younger than age 18 in the home with the parent/caretaker.

Description: Provides health care coverage for entire families.

More Information

Healthy Start Program

Who is Eligible? Children younger than age 19 and pregnant women who meet specific financial requirements.

Description: Provides health care coverage for children younger than age 19 and pregnant women who qualify based on income.

More Information

Lead Poisoning Testing and Prevention

Who is Eligible? Medicaid eligible children under the age of six should be tested for high blood lead levels.

Description: Pays for lead investigations of the child’s environment to identify cause, and provides treatment for identified high blood lead levels.

More Information

Pregnancy Related Services

Presumptive Eligibility

Who is Eligible? Children (younger than age 19), Pregnant Women*, Parent/Caretakers, Adult extension population

Description: Allows children, pregnant women, parent/caretakers and adults in the extension population to be temporarily enrolled in Medicaid while their applications are being processed.

All Medicaid services are covered for children, parent/caretakers, and the adult extension population.

*Only ambulatory prenatal care (for example: doctor visits) and prescription drugs are covered for pregnant women. Hospitalization, and labor and delivery are not covered. 

Transitional Medical Assistance

Enables those families who would otherwise lose Medicaid coverage because they no longer meet income requirements to remain covered for an additional 6 - 12 months, based on timely completion of quarterly reporting requirements and income under the program income limit.

Older Adults / Individuals with Disabilities

Medicaid for Older Adults and People with Disabilities

Who is Eligible? Individuals who are age 65 and older, or are legally blind, or are determined disabled by the Social Security Administration.

Description: Provides health care coverage consisting of primary and acute-care benefit packages, along with long-term care, for older adults and people with disabilities.

More Information

Medicare Part D

Who is Eligible? Individuals receiving Medicare.

Description: Provides Medicare recipients with prescription drug coverage.

More Information

Medicare Premium Assistance Program

Who is Eligible? Individuals receiving Medicare and who meet specific income and resource requirements.

Description: Helps people who are eligible for Medicare and have limited income or assets get assistance with paying their Medicare premiums, deductibles, and coinsurance.

More Information

Individuals Age 18 and Younger than 21

Healthchek/Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Who is Eligible? Medicaid eligible individuals up to age 21.

Description: Comprehensive preventive health care and support services to Medicaid eligible individuals from birth to 21 years of age.

More Information

Youth Aged out of Foster Care

Who is Eligible? Youth between the ages of 18 and younger than 26 who aged out of foster care on their 18th birthday and received Title IV-E payments.

Description: Provides health care coverage for youth, who aged out of foster care on their 18th birthday, until age 26.

More Information

Medicare

Medicare Part D

Who is Eligible? Individuals receiving Medicare.

Description: Provides Medicare recipients with prescription drug coverage.

More Information

Medicare Premium Assistance Program

Who is Eligible? Individuals receiving Medicare and who meet specific income and resource requirements.

Description: Helps people who are eligible for Medicare and have limited income or assets get assistance with paying their Medicare premiums, deductibles, and coinsurance.

More Information

Non-U.S. Citizens

Alien Emergency Medical Assistance

Who is Eligible? Non-U.S. citizens who are not eligible for Medicaid.

Description: Provides coverage for the treatment of emergency medical conditions for certain individuals who do not meet Medicaid citizenship requirements

Refugee Medical Assistance

Who is Eligible? Refugees who have been in the country for less than 8 months, have an income up to 100% of the poverty level, and are ineligible for Medicaid. When applying for RMA, applicants must provide proof of income, pregnancy, citizenship and other health insurance (if applicable).

Description: Offers health coverage for a limited period of time to refugees upon their arrival in the United States. The purpose of RMA is to help refugees become self-sufficient as quickly as possible. Because this is a time-limited program, RMA is only available to qualifying refugees within the first eight months of entry to the U.S. Those who are found eligible will have access to the entire Medicaid benefit package.

 


Pregnant Women

Healthy Start Program

Who is Eligible? Children younger than age 19 and pregnant women who meet specific financial requirements.

Description: Provides health care coverage for children younger than age 19 and pregnant women who qualify based on income.

More Information

Pregnancy Related Services

Presumptive Eligibility for Pregnant Women

Who is Eligible? Pregnant women.

Description: Allows pregnant women to be temporarily enrolled in Medicaid while their applications are being processed.

Have questions: Consumer Hotline