Step 1: Case Review
After you apply, you may get a letter asking for more information. If you need help getting the information, you should ask your case worker with the county department of job and family services. After the county office has all of the information needed to review your case, the eligibility determination process will begin.
Step 2: Approval
If your application for Medicaid is approved, you are automatically enrolled in either Fee-For-Service coverage; most people will be enrolled in managed care. You will get a letter with your Medicaid ID or your managed care ID card and can start using services right away.
Ohio Medicaid has a statewide network of providers including hospitals, family practice doctors, pharmacies and durable medical equipment companies. Always ask a provider if they accept Medicaid before you schedule an appointment. If you need help locating a provider who accepts your health coverage, please contact the Medicaid Consumer Hotline at 1-800-324-8680 or visit www.ohiomh.com or contact your managed care organization’s Member Services Hotline or plan website.
Individuals who remain on Fee-for-Service will receive a new card every month. Managed care members will receive one ID card, but can obtain a replacement by contacting the plan.
Step 3: Managed Care
In Ohio, most individuals who have Medicaid must join a managed care plan to receive their health care. Shortly after you are approved for Medicaid you will get a letter asking you to pick a plan. Below are the links to the five managed care plans for more information. You can also compare the plans by viewing the Managed Care Plans Report Card. Individuals who do not choose a managed care plan will be automatically enrolled in one to receive coverage.
The best way to enroll in managed care is online with the Consumer Hotline. A helpful way to enroll in managed care is online through the Consumer Hotline . With help from the Consumer Hotline, you can compare plans additional benefits and view plans’ provider networks. You may want to consider: what services you might need, which health plan is accepted by the doctors you use, which plan was found to meet the highest quality for your health care needs, and which extra benefits are most beneficial to you.
Managed Care works like regular private health insurance. Some services may require prior approval before you can receive them, or there may be limits for the number of services you can receive. Your MCO is available to answer your questions about coverage and help you find providers. You can file a grievance with your MCO, if you are dissatisfied with the MCOs services. You can also request an appeal from your MCO, in the event your pre-services request is denied. Contact your MCO Member Services Department for assistance.
Keep this card for as long as you are on the plan. Your plan will also send information about the doctors, providers, health services and benefits that are available to you.
Step 4: Keep Us Informed
Individuals covered by Medicaid should be aware that their eligibility will be reviewed every 12 months. Individuals that experience a change affecting their eligibility within that 12 month period must notify their case worker within 10 days of the change.