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.
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
Who is Eligible? Any Medicaid beneficiary with a medical need.
How often? No limits.
How often? Up to 30 hours per week when combined with medical somatic.
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.
How often? Up to 30 hours per week when combined with counseling.
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.
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.
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)
How often? Dentures may be replaced based upon medical 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 retardation.
Copay: $3
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.
Who is eligible? All Medicaid beneficiaries
How often? Based upon medical necessity.
Info: No additional information
Copay:
Emergency Room Visits
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)
How often? As needed
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.
More Information
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.
How often? Medical review for more than 48 visits per year.
Info: Prior approval may be needed for some surgeries.
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
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.
Who is Eligible? Medicaid beneficiaries with serious mental illness and identified by the State as needing care coordination
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.
How often? 52 hours per year; applies to individuals age 21 and older only.
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.
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.
How often? 4 hours per year; applies to individuals age 21 and older only.
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.
How often? 2 hours per year; applies to adults only.
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.
Who is eligible? All female Medicaid beneficiaries
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.
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.
Who is Eligible? Long-term care facility residents
How often? Once every 12 month period.
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.
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.
Who is Eligible? Residents in residential facilities licensed by the Ohio Department of Developmental Disabilities
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.
Who is eligible? All Medicaid beneficiaries.
Who is eligible? All beneficiaries
How often? One conventional hearing aid every four years; one digital or programmable hearing aid every five years. Two hearing aids may be considered in special circumstances.
Info: Hearing aids with prior authorization.
How often? 30 visits every 12 months for children younger than age 21; 15 vists every 12 months for adults older than age 21.
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.
How often? 30 visits for occupational therapy every 12 months, prior authorization needed for additional visits.
How often? 30 visits for physical therapy every 12 months, prior authorization needed for additional visits.
How often? Up to 24 visits every 12 months with additional visits for specified conditions.
Info: Physician and family nurse practitioner services.
How often? One long-term care facility visit per month. One nail debridement per 60 days.
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.
How often? 30 visits for speech/language pathology and audiology services combined every 12 months, prior authorization needed for additional visits.
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.
Info: Non-emergency transportation to and from Medicaid-covered services through the County Department of Job and Family Services.
Non-Emergency Transportation Services
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.
