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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.

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Long-Term Care

Assisted Living Waiver Program

Who is Eligible? Medicaid eligible individuals age 21 and older who require at least an intermediate level of care, are in a nursing facility, and are enrolled in PASSPORT, Choices, Ohio Home Care Waiver, or Transition Carve-Out Waivers.

Description: Pays for the cost of care in an assisted living facility for certain Medicaid eligible individuals.

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Choices Program

Who is Eligible? Medicaid eligible individuals who are age 60 and older who require at least an intermediate level of care and live in an approved service area.

Description: Consists of adult day health programs, alternative meal services, environmental accessibility adaptations, home care attendants, home-delivered meals, personal emergency response systems, pest control, and specialized medical equipment and supplies.

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Home and Community-Based Services Waivers

Who is Eligible? Medicaid eligible individuals who would otherwise need to be in a nursing home, hospital, or facility for the mentally retarded and/or developmentally disabled.

Description: Helps Medicaid eligible individuals with long-term care needs remain at home instead of being in a nursing home.

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HOME Choice

Who is Eligible? Medicaid eligible individuals living in a facility based care setting for at least 90 days and moving into qualified housing.

Description: Assists older adults and people with disabilities with moving from long-term services and support systems to home and community based settings.

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Individual Options Waiver Program

Who is Eligible? Medicaid eligible individuals who meet an ICF-IID level of care.

Description: Consists of adult day supports, day habilitation, environmental accessibility and adaptations, homemaker/personal care, personal emergency response system, informal and institutional respite, specialized medical equipment and supplies, supported employment (community and enclave), adaptive equipment, transportation, and vocational rehabilitation.

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Level One Waiver Program

Who is Eligible? Medicaid eligible individuals who meet an ICF-IID level of care.

Description: Consists of homemaker/personal care, transportation, respite services, supported employment, environmental accessibility modifications, social work/counseling, nutrition services, interpreter services, home-delivered meals, adaptive and assistive equipment, day habilitation (adult day support), vocational habilitation, supported employment (community and enclave), supported employment, and adapted medical equipment.

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Ohio Home Care Waiver Program

Who is Eligible? Medicaid eligible individuals who are younger than age 59 who require an intermediate or skilled level of care.

Description: Allows Medicaid consumers to receive Long-Term care services at home instead of in a hospital or nursing home.

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Pre-Admission Screening System Providing Options and Resources Today (PASSPORT) Waiver Program

Who is Eligible? Medicaid eligible individuals who are age 60, or older, and require at least an intermediate level of care.

Description: Helps Medicaid-eligible Ohioans get the long-term care services and support they need to stay in their home instead of in a hospital or nursing home.

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Program for All-Inclusive Care for the Elderly (PACE)

Who is Eligible? Medicaid eligible individuals who are age 55 or older and living in Hamilton or Cuyahoga counties, or the surrounding areas.

Description: Provides holistic medical care to elderly Medicaid beneficiaries.

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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.

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Family Planning Services Program

Who is Eligible? Males or females of any age meeting specific financial requirements.

Description: Provides services for the prevention of or delay of pregnancy.

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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.

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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.

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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.

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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.

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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

Who is Eligible? Covered families who would otherwise lose coverage because of new employment or an increase in earned income.

Description: Enables those families who would otherwise lose Medicaid coverage because they no longer meet income requirements to keep it for twelve months.

Older Adults / Individuals with Disabilities

Assisted Living Waiver Program

Who is Eligible? Medicaid eligible individuals age 21 and older who require at least an intermediate level of care, are in a nursing facility, and are enrolled in PASSPORT, Choices, Ohio Home Care Waiver, or Transition Carve-Out Waivers.

Description: Pays for the cost of care in an assisted living facility for certain Medicaid eligible individuals.

More Information

Choices Program

Who is Eligible? Medicaid eligible individuals who are age 60 and older who require at least an intermediate level of care and live in an approved service area.

Description: Consists of adult day health programs, alternative meal services, environmental accessibility adaptations, home care attendants, home-delivered meals, personal emergency response systems, pest control, and specialized medical equipment and supplies.

More Information

Home and Community-Based Services Waivers

Who is Eligible? Medicaid eligible individuals who would otherwise need to be in a nursing home, hospital, or facility for the mentally retarded and/or developmentally disabled.

Description: Helps Medicaid eligible individuals with long-term care needs remain at home instead of being in a nursing home.

More Information

HOME Choice

Who is Eligible? Medicaid eligible individuals living in a facility based care setting for at least 90 days and moving into qualified housing.

Description: Assists older adults and people with disabilities with moving from long-term services and support systems to home and community based settings.

More Information

Individual Options Waiver Program

Who is Eligible? Medicaid eligible individuals who meet an ICF-IID level of care.

Description: Consists of adult day supports, day habilitation, environmental accessibility and adaptations, homemaker/personal care, personal emergency response system, informal and institutional respite, specialized medical equipment and supplies, supported employment (community and enclave), adaptive equipment, transportation, and vocational rehabilitation.

More Information

Level One Waiver Program

Who is Eligible? Medicaid eligible individuals who meet an ICF-IID level of care.

Description: Consists of homemaker/personal care, transportation, respite services, supported employment, environmental accessibility modifications, social work/counseling, nutrition services, interpreter services, home-delivered meals, adaptive and assistive equipment, day habilitation (adult day support), vocational habilitation, supported employment (community and enclave), supported employment, and adapted medical equipment.

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Medicaid Buy-In for Workers with Disabilities (MBIWD)

Who is Eligible? Individuals between the ages of 16 and 64 who are disabled and employed.

Description: Provides health care coverage for working Ohioans who have disabilities. MBIWD individuals may be required to pay a monthly premium.

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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.

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Medicare Part D

Who is Eligible? Individuals receiving Medicare.

Description: Provides Medicare recipients with prescription drug coverage.

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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.

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Ohio Home Care Waiver Program

Who is Eligible? Medicaid eligible individuals who are younger than age 59 who require an intermediate or skilled level of care.

Description: Allows Medicaid consumers to receive Long-Term care services at home instead of in a hospital or nursing home.

More Information

Pre-Admission Screening System Providing Options and Resources Today (PASSPORT) Waiver Program

Who is Eligible? Medicaid eligible individuals who are age 60, or older, and require at least an intermediate level of care.

Description: Helps Medicaid-eligible Ohioans get the long-term care services and support they need to stay in their home instead of in a hospital or nursing home.

More Information

Program for All-Inclusive Care for the Elderly (PACE)

Who is Eligible? Medicaid eligible individuals who are age 55 or older and living in Hamilton or Cuyahoga counties, or the surrounding areas.

Description: Provides holistic medical care to elderly Medicaid beneficiaries.

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Residential State Supplement (RSS)

Who is Eligible? Blind or disabled Medicaid eligible individual (or couples) whose condition is not serious enough to warrant placement in a nursing home.

Description: Provides monetary support to low-income, disabled adults, to assist with specific living arrangement costs.

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Spenddown

Who is Eligible? Individuals who are age 65 or older, blind, or disabled and have an income that is too high to receive Medicaid.

Description: Allows aged, blind, or disabled individuals who have income that exceeds the Medicaid income requirements to contribute a portion of their monthly income towards their medical expenses, thus enabling them to receive Medicaid coverage.

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.

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Medicaid for 19 and 20 Year Olds

Who is Eligible? Adults age 19 and 20 meeting specific financial requirements.

Description: Provides health care coverage for qualifying 19 and 20 years.

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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.

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Medicare

Medicare Part D

Who is Eligible? Individuals receiving Medicare.

Description: Provides Medicare recipients with prescription drug coverage.

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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.

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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.

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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.

Description: Offers health coverage for a limited period of time to refugees upon their arrival in the United States.

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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.

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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.

Consumer Hotline

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

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